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

Let’s talk about a topic that is often overlooked in our medical end of life care: bowel movements. Why bring up a subject that is difficult to discuss? Because there are major misconceptions about bowel movements in people who can’t be fixed and people who are taking medicines for pain, narcotics and/or non-narcotics. Everybody has bowel movements, everyone needs to have them, yet in our prudishness we tend to not talk about them. I think we are embarrassed to bring up the subject but we need to. So, here I go.

We often think that when a person is not eating very much they will then not have much to eliminate. Wrong. Whether we eat or not our body still produces waste and we will still need to eliminate that waste.

Being active helps us poop therefore the less active we are, and people approaching the end of their life through disease or old age gradually have less and less energy hence do less and sleep more, the more prone to constipation we will be. Constipation becomes a problem as activity decreases. Laxatives become necessary.

Narcotic and non-narcotic pain medicines slow bodily functions and constipation becomes a big issue. Anyone taking medication for pain needs to be taking a laxative. Pain medicine and laxatives go together, always. Don’t wait until the person is impacted with three or four days of backed up stool and in great discomfort before considering a laxative.

So, most people with a life threatening illness need to be assessed for a laxative regime. Of course there are exceptions, the particular disease and the person’s bowel history can affect and determine bowel activity, but everyone needs to be assessed. Ninety nine percent of people on pain medicine will need to also be on a laxative.

What kind of laxative? Ask the doctor who prescribed the pain medicine what is recommended. Generally, the stronger the pain medicine the stronger the laxative.

Something More... about Let's Talk Poop...

Caring for someone at end of life is challenging and when pain is part of the dying process, the challenge intensifies. That's why I wrote Pain At End of Life: What You Need To Know About End of Life Comfort and Pain Management. It addresses, in fifth grade, non-medical terminology:

  • pain as it relates to the dying process
  • fear of overdosing and addiction
  • standardized dosages
  • around the clock administration
  • laxatives
  • uses of morphine
  • sedation as it relates to dying
  • supplemental therapies

 

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61 comments

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

Karen

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?

barbara karnes

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

Tamra

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?

barbara

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

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