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
- uses of morphine
- sedation as it relates to dying
- supplemental therapies
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?
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.
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?
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.
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
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