Let's Talk Poop--Bowel Movements and End of Life Care

Hello, I am a caregiver for a family friend that is in hospice care. She is 80 years old, had a very bad stroke around this time last year, was on the ground for about 12 hours. She is home now and it’s been a challenge with family members. She was on a feeding tube, but had lots of issues with it, one being bloating and diarrhea and tube clogging and leaking. They had the tube replaced, stopped the feedings and only use the tube for med passing and water
Flushes. She has been doing well eating and drinking, not a lot but she does eat and drink. She use to have a catheter as well and that was removed. Lately her daughter has been wanting her to have more water pushed in to her because she doesn’t think she is getting enough water. Her belly is bloated and having a lot of bowel movements. Could forcing extra water in her tube be the source of discomfort?
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BK Books replied:
Hi Christina, to answer your question, yes, forcing fluids could be causing discomfort. Sounds like a lot is causing her discomfort. Has anyone talked with the family about hospice or end of life doula services? The support and guidance could be helpful during this challenging time. Blessings! Barbara

Hello, my husband has bladder cancer. They stopped continuing chemotherapy because he has gotten so frail and thin (down to 115 from 180), it is felt that the chemo will now do more harm than good. They told me that he needs to strengthen before they can continue. Home health care P/T is to start, but I don’t think it will help. He has started continually pooping, which he had not been doing. Does this mean the cancer is moving faster? He only sleeps, and has absolutely no strength in his legs.
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BK Books replied:
Toni, I don’t know enough about your husband’s history to say anything definitive but I will say from what you have described, loss of weight, withdrawing, sleeping more, it appears to me your husband has entered the dying process. You might read *Gone From My Sight https://bkbooks.com/collections/booklets/products/gone-from-my-sight-the-dying-experience?variant=36961181171868 <https://bkbooks.com/collections/booklets/products/gone-from-my-sight-the-dying-experience?variant=36961181171868>. *for more insight. I suggest you call your physician for a hospice referral. Tell him you recognize that there will be no more chemotherapy and you need the support and guidance Hospice can give you. Blessings to you and your husband. Barbara

Hello. My brother has been hospitalized for almost 3 weeks now. Up until Monday he was talking and responsive. Monday morning he became unresponsive, he isn’t moving or talking. We were told that he has end stage liver disease. He hasn’t eaten since Sunday yet here we are Saturday and he still has a bowel movement daily. Is that normal?! His ammonia level was at 123 last time checked which it came down from 155 from when he became unresponsive. The doctors have said that they weren’t sure what was going on with him, and basically just said, it was end stage liver disease and nothing can be done. I’d like to know, can he has bowel movements without food intake and still be in the dying process?! How long could he last like this?
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BK Books replied:
Hi Ann Marie, yes, even though a person isn’t eating their body will still make poop. It does not surprise me that even though he isn’t eating he is pooping. How long does he have not eating or drinking? I don’t know. It depends upon how heavy or thin he is and how advanced his disease is. It could be days or a few weeks, just depends. The gift here is time. It is an opportunity to sit with him, talk to him even though he is not responding. Tell him what he has meant to you, tell him when you are leaving and when you will return. He has limited control over the time that he dies. If you are there it is because he wants you there. If he dies when you are not there, that is his gift of protection. My blessings to you and your family. Barbara

My wife’s cancer has progressed rapidly and she hasn’t had a bm in 3 weeks. That’s right.
She’s in hospice care here at home, doing well!
She snacks a little each day now, and is still sharp, gets around a little. The meds are so wonderful as she suffered so badly at the start of this stage.
What is the time expectation for her now?
Will she eventually be forced into full time care facilities?
As I write this, it seems so obvious that no one knows.
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BK Books replied:
Hi Chuck, my first response to your email is “no bm in three weeks?” Is that right? If correct that is WAY too long and tell hospice to address it. To answer your questions: I do not have enough medical history information to know where your wife is in the dying process. Your hospice team is the one to ask these questions. They know her history and can evaluate her progress and condition now. As to will she have to go into a nursing facility? I suppose that depends upon how capable you are of taking care of her. Many people can die in their homes. It helps if they have guidance and support. Again ask your hospice team what their thoughts are. Blessings to you and your wife. Barbara

Hi Karen, I do not have enough of your mom’s medical history to know why she is having diarrhea. I can say that taking morphine every 4 hours I would think constipation rather than loose stools would be an issue. Call her physician and explain the diarrhea and see what is suggested. If you are not working with a hospice agency you might also as your doctor for a referral. They can help you during this time. My blessings to you and your mom. Barbara

Hi! My mom is actively dying and she on Morphine and Lorazepam every 4 hours. A couple of weeks ago she stood up and her leg broke. It was a major break and at her age surgery could not be done. The issue I’m dealing with now is that she has diarrhea frequently. Is this normal? Cleaning her up repeatedly is hard on everyone involved. Suggestions?

Hi Tamra, about your question of when do you stop worrying about bowel movements as end of life approaches; each person’s situation is different so no one statement can apply to all. Making a generalized statement I would say when you are thinking days. BP dropping, mottling beginning, basically non responsive. Before that time, when labor begins and you are looking at weeks the body, even though there is almost no food intake, is still making waste, slowly but still making. I would forgo the enemas but still use suppositories. Blessings to you in the work you are doing. Barbara

Hi Barbara. I am a hospice nurse and we have been debating about bowel movements in the imminent patient. At what point do you recommend to stop worrying about bowel movements? When people’s organs are shutting down, does it at some point cause increased discomfort/pain to keep giving bowel meds such as suppositories and enemas?

Hi Diane, what has your doctor said about your mother continually pooping? Maybe at 101 her rectal muscles have just weakened. Blessings to you both. Barbara

My mother is going to be 101 in April
She just poops all the time. She is in pretty good shape. She does have conjestive heart failure and also in the kidneys. She is pretty active just anything she eats just poops alot. It’s pretty much pretty soft. Goes all the time

Hi Chris, I do not have enough medical history to know why your husband is pooping so much. Since hospice doesn’t seem to know call your husband’s doctor and ask him/her why and what you can do (if anything) about it. My blessings are with your and your husband during this challenging time. Barbara

I see nothing here and can find nothing to explain why my husband is pooping every few hours. He has stopped eating, taking only a little Ensure each week. He takes a very low dose of morphine three times a week when hospice workers come in to bathe him. But, meantime, every time I change his diaper (every 12 to 3 hours), there is a significant amount of poop. I have asked the hospice workers but nobody can tell me why this is happening and if it is ever going to taper off?

Hi Joanne, it does sound like your mum has entered the dying process (weeks to days) The fact that she asked about her bowels tells me she is not as close as I originally thought reading your comments. Do you have a mild laxative you can give her? Is she complaining of discomfort, pressure in the area of her rectum? That could suggest stool is just sitting inside the opening. Do you have hospice services or nurses coming to your home? If so ask them to check her for an impaction and what laxative to give her. Sounds like you are not in the US so it is challenging to get my booklets to you but you can get Gone From My Sight and The Eleventh Hour in Ebook form, both would be helpful for you now. Email me at Barbara@bkbooks.com if I can be of further help. Blessings to you and your mum during this time. Barbara

my mum is 91 weighs under 4 stone and is near end of life , were just keeping her comfortable at home. last few days shes slept nearly all day. today shes a little brighter. shes ate 8 teaspoonful of puree pear over 3 days im lucky to get half a cup of drink in her. and urine now very low. today shes asked why shes not had bowels open for days. is it because of the stage shes at in life ?. please email me your reply if you have one thank you

Hi Tamela,
I am disappointed your mother’s doctor didn’t offer you more help. Not controlling your bowels is not necessarily a part of aging, although having 9 children could mean that the muscles in that area are not as strong as they once were. You might ask her doctor if anti-diarrhea medication would help as I’m thinking the increase in fiber did not help. I’m sorry to say that adult diapers might be in your future. My blessings to you and your mom. Barbara

My mom is 88, and other than arthritis, and Afib, she is relatively healthy. However, the past few months she has started getting diarrhea, and many times she doesn’t make it to the bathroom in time. Is this just part of aging? Her doctor doesn’t seem too concerned about it, and has told her to up her fiber. She is depressed and keeps talking about wanting to die. Side note: Not sure if this is important, but she has given birth to 9 kids.

Hi Kim, I do not have enough medical history or information on your mom to say why she is not aware of pooping. Is dementia involved? If the stool is very loose then maybe too much fiber and poop inducing foods but most likely it is just her mental state declining. If she hasn’t had a doctors appointment in a while it might be time for a physical or just call her doctor and ask what could be happening. It might just be time to get the adult diapers out. What about urine. Does she know when she is peeing? If she knows when she has to pee then not knowing when she poops is something for the doctor to know about. Also any medication changes that could be affecting this? So many questions, so few answers. . Blessings! Barbara

Hi Kim, I do not have enough medical history or information on your mom to say why she is not aware of pooping. Is dementia involved? If the stool is very loose then maybe too much fiber and poop inducing foods but most likely it is just her mental state declining. If she hasn’t had a doctors appointment in a while it might be time for a physical or just call her doctor and ask what could be happening. It might just be time to get the adult diapers out. What about urine. Does she know when she is peeing? If she knows when she has to pee then not knowing when she poops is something for the doctor to know about. Also any medication changes that could be affecting this? So many questions, so few answers. . Blessings! Barbara

Hello:

I happened upon your website today, searching for answers. My mother just turned 89. She has recently had quite a few poop issues. Most recently not feeling when she is going. Having several accidents due to not knowing when she is going. She is frail, has loss of sight, we have a daytime caregiver for her. She is doing all I feel that is necessary for being able to poop. Forcing fluids, tons of fiber, walking with her walker around the house. Is this common for end of life ? We have not had this issue before. Thank you for your time,

Hi Mary Ellen, about your mom’s persistent diarrhea and could it be a sign she is beginning the dying process. At 99 years old anything is possible. Obviously something is going on inside her body that is not normal or healthy BUT if she is comfortable (not in pain) and reasonably happy I’d say just love her, enjoy her and let her body do what it is doing. At her age anything out of the ordinary can be an indication her body is beginning to activly shut down. Old age is a way of dying gradually without a specific disease process to speed it along so from that stand point she has entered the dying process. It will just take her longer than if she had a detectable disease.
My blessings are with you both during this gift of time that you to have. Barbara

Mom is 99 and has had persistent diarrhea and intermittent vomiting for the last month. All tests come back normal and all agree she is too frail for a colonoscopy, One nurse indicated this may be the beginning of her body shitting down. I can’t find any other resource that confirms that – in fact only the opposite, that constipation can be a sign. Her appetite is not what it once was but she is still eating and enjoying food, or as much as one can on a BRAT diet.

Can you tell me if this may be a possibility?

Hi Sherri, you asked how much longer your mom can go on not eating, agitated, falling; I don’t know. I really don’t have enough medical history information on your mom to make any predictions. Dementia just doesn’t play by the “rules” of dying from a disease. Not eating or drinking anything for 5 days would indicate she has entered the dying process. How long depends on her body size but probably weeks (since you said her vital signs are normal). Watch for her blood pressure to get lower and pulse faster. Look for bluish hands and feet.
Do you have my two booklets Gone From My Sight and How Do I Know You? They will be helpful during this time.
My blessings are with you and your mom. Barbara

My 90 yr old mother with Alzheimer’s and has had 3 strokes this yr is under Hospice care. Hasn’t eaten or drank anything fr 5 days. Yet her vital signs are all normal. She is very pale and not coherent. She fell 3 times in one week. Before hospice started the morphine for pain. Now adderall for agitation that was really bad. How much longer can she go on like this

Hi Lisa, I do not have enough medical information about your father in law to know why he hasn’t had a bowel movement in so long. Have you talked with his physician about this? What does he think is happening? This situation does not sound normal. I would hope the physician has some ideas. Blessings! Barbara

My father in law fell about 6 weeks ago. He was in a rehabilitation facility for a month and had one bowel movement due to an enema. He’s now home but has no physical activity. He’s in a hospital bed in his living room. Hospice comes in 3 times a week. They have been giving him suppositories and laxatives. He is eating small amounts of food, but has not had a bowel movement since he’s been home.(He has been home a week.) He says he is not in pain, and has no urge to go. The hospice nurses push on his stomach and check for pain, but he’s not hurting. He just doesn’t go. How is this possible?

HI Debby, about your dad’s foul smelling and continuous poop— I don’t have any of your dad’s medical information to know why he is having this bowel problem. Have you talked to your hospice nurse about this and what are her explanations and recommendations? I can say that when a person is in the dying process nothing in their body works right, nothing functions are it normally would. Diarrhea can be from the actual disease and how it is affecting the body. It can be caused by medication your father is on. This is why I encourage you to ask your hospice team not only for why this is happening but to address it and try to stop it. My blessings are with you and your father. Barbara

My dad is 92. He won’t eat. All he wants is ice water. He is so weak and confined to a hospital bed. He soils himself multiple times a day with the must foul smelling BMs. The entire house smells I have candles lit, door open, spraying disinfectants! How can he go this much with no food in his body? He’s on hospice
Is this an end of life smell?

Hi Judy, when we are sick and more so when we have dementia we don’t necessarily know what we need or what is “best” for us. Our body needs to poop. It is that simple. 7 days is too long to go without a bowel movement. The longer she goes the harder it will be to get the stool out and the more painful it will be on her to remove it. You must insist that she take the senna (although I am not sure at this point that will be strong enough). An enema may be in order. Good luck. Barbara

My mom is 90 years old. Hasn’t been eating much this past 2 weeks…just picking at her food. She does like milkshakes and will drink them. That’s about all she will eat. She has diabetes, 20% kidney function, and moderate stage dementia. She hasn’t had a bowel movement in 7 days. She refuses enema’s and laxative (senna). What to do? I respect her opinions and decisions, but I worry she will get sick without bowel movements. Thank you.

Hi Patricia, what a mess. Your dad has to be so uncomfortable. At this point I wonder about impaction, even obstruction. Has anyone checked his rectum to remove stool that way? I would really have to be there to see his entire chart to have a more reliable opinion. Before you just take him to the ER call his doctor directly, by pass hospice and the nursing home, and tell the doctor your concerns. See if you get results that way. Yes, you can always sign yourself off of the hospice benefit. You can also talk with other hospices in your area to compare notes and see if you will be happier with a different one. My thoughts and blessings are with you. Barbara

My Dad has poor circulation to his left leg, dementia, stenosis of the aortic valve (congestive heart failure). The vascular doctor will not agree to do the bypass surgery on Dad’s left leg. Daddy was willing to take his chances on whether he ran the risk of dying. But Doctor will not do surgery.
They told us to go home or a nursing home on Hospice. We went to a nursing home. Now Daddy’s biggest problem has been not his leg pain—but Constipation! Hospice has given Colace, now they give Senna. Added Miralax—he pooped once on May 26th and once again on May 28th but not enough to clear out the Days and Days of Food—He was eating double sized portions. Still hospice was not concerned about no BM. May 31st Dad went into a weird wacky state of confusion. We were thinking maybe it was a UTI infection from Foley Catheter. Someone mentioned that it looked like he was suffering from High Ammonia. I googled and he had all the symptoms. But his is from CONSTIPATION not liver disease. Very concerned I contacted his Hospice caseworker nurse. The weekend nurse came. Dad woke up Saturday June 1st with an injured left arm from apparently hitting it on the bed during a confusion episode. Hospice ordered Lactulose for the constipation—will not do any test to see if it is high ammonia—says the remedy is the same: Lactulose. Today is June 2, 2019, after 2 doses of Lactulose, Senna, Miralax and prune juice—still no Bowel Movement. Hospice tells us to wait. AT what point do we say the heck with Hospice and take Daddy to the ER??? Also note: Nothing has been done to address his injured left arm/wrist. It is painful to Daddy when he moves it. Hospice finally told me 30 minutes ago that it will be up to the nursing home and not Hospice to exam the injury and or get exrays. Again, I am left wondering, do we leaving Hospice and go to the ER?

Hi Patty, with your mom having colorectal cancer her bowel activity is not functioning as a normal intestine would. That is probably why you are seeing all the “brown, odorous liquid”. Did you ask your hospice nurse what she thought? Just know your mom’s body is shutting down and nothing works the way it normally would.
My blessings are with you and your family. Barbara

Hi. Mom is in her final hours or days before her passing; we are receiving Hospice care; mom was diagnosed with stage 4 colorectal cancer with lung matastisis, last June. She had radiation and chemotherapy for a combined 7 months. Her bowels have been distressed the entire time. Re: bowels at this time: mom’s bowel movements have been brown, odorous, and liquid for some time; she has not eaten in two weeks; how can she still be having bowel movements? Is her body getting rid of itself? Thanks for your consideration and expertise in responding to our question.

Hi Alma, I do not have enough knowledge of your mother’s condition to make any comment about her bowels. I suggest you talk with her hospice nurse about what you see and your concern. That is what hospice is there for, to support and guide you through this challenging time. Don’t be afraid to call them and ask questions. Blessings to you and your mom. Barbara

My mother is 97 years old , she has dementia and also has cervical cancer. She eats well , sleeps a lot, but is more or less aware. She went through radiation treatments to stop the bleeding and it worked, the tumor shrunk but it didn’t go away. She is in hospice but she seems to be doing well. Her bowel movements are a lot, we are wondering if this is normal, it is sometimes very watery and a dark brown color and it’s a lot for what she eats, lately it’s been very watery, but also sometimes it comes a little more dense. She drinks ensure , one to two cartons, and some yogurt. Is that normal?

Hi Shalinda, Oh my goodness! Not having a bowel movement for two weeks is not okay, no matter how close to death a person is. Well, that is not exactly correct. If she is days from death (non responsive, has start and stop breathing, no eating, no drinking) then don’t put her body through the ordeal BUT if she weeks (1 to 3), is eating a little, drinking, a little, even picking at her bedclothes, rambling verbally she should be helped to have a bowel movement. Contact your hospice nurse, now (don’t wait until Monday) if your mom is in the weeks category. Have you read my booklet Gone From My Sight? It gives some guidelines and where your mom is in the dying process. I am sorry your mother has this problem. Her body must be very uncomfortable. Even when we don’t eat very much our body still makes waste and it has to come out. If you have further questions please use my personal email barbara@bkbooks.com
Blessings! Barbara

My mom is on hospice she has anaplastic thyroid cancer and she hasnt had a bowel movement in 2wks !!! Is that close signs to death?

Hi Karen, about your mom’s declining condition and should she be on Hospice care: it would seem to me if she continues as she is doing her body will not be able to sustain itself. You have nothing to lose and a lot to gain by getting a hospice consult. Ask your doctor for a referral. If he says no, your mom is not appropriate, you can call a hospice yourself and ask for an assessment visit. Taking care of anyone in a life threatening situation is difficult and you need all the guidance and support you can get. If I can be of further help email me at barbara@bkbooks.com. My blessings to you and your mom. Barbara

My mom has stage 4 lung cancer. She has been on a cancer medication that has cause severe diarrhea. She refuses to shower and get up to go to the bathroom but will get up to get food when needed. She has psoriatic arthritis and lives on pain meds. Her feet swell and are black and blue some days. She was just diagnosed with colitis and is on steroid but still has diarrhea issues. She has made numerous trips to the hospital but they cant seem to get it under control. She is getting very weak and still no resolution as they sent her home from rehab and said its up to her to keep up treatment. Some days she just refuses care. Should she be on hospice? Is this a sign her cancer has moved to another area and they are not seeing it? How much longer can mom go on like this.

Hi Susan, because your mom is receiving hospice care I would ask her hospice nurse if the laxative dose needs to be decreased. Being on high quantities of narcotics makes it very important to regulate the laxative dosage. You want to keep the bowels moving. Maybe this was a one time occurrence and she will be back to her bowels being managed on the laxatives she was on before this happened. Thank you for reaching out to me. Know that your hospice nurses are there to answer all of your questions. Don’t hesitate to contact them.
Blessings to you and your mom. Barbara

My mom (95) under hospice care quit eating for several days. Now she has started eating again and is having major bowel blow outs. She is on heavy duty pain meds accompanied by a laxative and natural fiber capsules.
Wondering if something should be cut back on due to blow outs. She has awakened and needed a shower due to feces on her.

Hi Jodi, what a mess. It is hard to believe this is happening. Get a different doctor to see her ASAP or take her to the emergency room and get someone to really listen to what you are telling them. Be fierce and get the CT Scan NOW. Obviously something is seriously wrong and needs immediate attention. She may just be impacted and need to have it removed but I’m thinking something more serious than that is happening here. Be forceful, don’t take no or later for an answer. Demand that she get immediate attention. Barbara

Hi Debbie, I just don’t have enough information about our mother’s health condition to know why she doesn’t know if she has had a BM or not. You might ask her doctor to see what he/she thinks.
Blessings! Barbara

I’m so overwhelmed and don’t know what to do. My mother is 87 and takes absolutely no medication – hard to believe but true. However, since about May 2018 she has had potty problems. It started out a little red blood in her feces that we initially thought was hemorrhoids, even though she’s never been diagnosed with them. She went to her sister for the summer and when she came back in September she was very emotional because she has not had a bowel movement since she left and has to wear pads because slime will leak out when she stands up without her knowing. Her excrement is a bloody mucus. Took her to doctor who thought she may have drank well water and have an infection but we live on city water and so does my Aunt. Then they sent her home with a stool sample kit- I explained to them once again that she doesn’t have ANY STOOL to put in the vials. They said do your best. She did – she put some slime in the 3 tubes but not enough to fill them like directed. So today I called in expecting them to say the test were inconclusive due to lack of specimen but lo and behold they said EVERYTHING was NORMAL. How on Earth can that be possible? Now she is weaker and getting dizzy, food is not desirable and still no poop. They want to schedule her for a CT scan to see what’s going on in her stomach but they failed to get authorization from her insurance so I’m still waiting to hear back on scheduling. I am a mess – I need help, answers or just someone to act like they care. Any ideas? Mom thinks it’s cancer and I’m just so besides myself with what to do next. It’s so sad to see her suffer and I feel helpless.

My mother is 92 is in stage 5 kidney failure, heart disease. When she has a bm she can’t tell if she has gone or not, she will ask me have I passed anything yet! Why can’t she feel her bowel movements?

Hi Sonia, About your question “Could these be the signs of her last days?" I don’t know your lady’s medical history so I can’t say whether she has entered the dying process but from what you have written it does not appear that she has begun “labor" (weeks to days) although the changes you mentioned could signal the beginning of “she may not be here next year at this time”. I just don’t have enough information to be more specific. I do suggest you talk with her family physician to get her bowels more regulated and tell him/her of the changes you are seeing. Thanks for reaching out to me. Blessings to you in the work you are doing. Barbara

Hi Barbara, I care for someone who has COPD & kidney disease both are stage 4. She has been withdrawing herself from going out and shopping. She doesn’t want to shower , she is extremely moody and she is either constipated or has diarrhea. We never have a good day where she goes regularly. Could these be signs of her last days? She also has been trying to reach out to her daughter whom she hasn’t spoken to in 15 years.

Hi Priscilla, it does sound like your father has entered the dying process. Withdrawing, sleeping a lot, not eating very much, losing weight, wetting or stooling himself, his age, all tell me death is approaching. When becomes the question. Since I don’t know all the medical particulars I can’t give a length of time. Actually no one can. We die in our own way and our own time but we can get an idea of how long based on the progression of the above signs I mentioned. The restlessness could be an indication of weeks but again I don’t know all the details of your father’s disease. You said your father was on Hospice. Ask your nurse your questions. Hospice is there to guide and support you, to answer your questions, to make this experience easier for you. If I can be of any help use my personal email barbara@bkbooks.com. My blessings are with you and your family during this challenging time. Barbara
I just had a thought—if you haven’t read my booklet Gone From My Sight it will be helpful in guiding you during this time. Ask your hospice if they have it or get it from my website.

Hi. My father is 85 and he is very ill. I know for sure he is diabetic, and has copd. He is in hospice, and keeps losing weight. He is down to 83 pounds. Is having bowel movement on himself a sign that the end of life is near? He barely eats, sleeps alot, and is very restless. He also has a fatty liver, and smokes alot.

Hi Sarah, I do not know what is happening with your mother’s bowel movements. Have you checked with her physician? Could be drug side effects (check the list of side effects on all the drugs she is taking), food issues or something more serious. Blessings! Barbara