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
65 comments
Hi Samantha, about your husband’s diarrhea issues: have you talked with his doctor about this. Even though your husband’s COPD is end stage his physician can still assist with comfort care.
Something as simple as an anti-diarrhea medicine may be all he needs. However—with his history of alcoholism his liver could be saying enough is enough. Blessings! Barbara
My husband has end stage COPD for the last couple of weeks he hasn’t been able to keep anything in him as soon as he eats he’s in the bathroom Even when he drinks he is 55 year’s old and has been a alcoholic most of his life I no the end is near doctor’s can’t do anything for him because his lungs are so bad is there anything I could give him so maybe he would be going to the bathroom so much .
RM, In response to your question of why the Hospice policy requires a laxative to be administered when the conditions you described are present—I don’t know. Doesn’t make sense to me either. In end of life situations one plan fits all just doesn’t work. There has to be leeway for individual circumstances — an example of too many regs and policies and not enough common sense.
Thanks for reaching out to me. Blessings! Barbara
This person is in hospice care, imminent, has not been eating or drinking since last bowel movement, no BM in 4 days, non-responsive, no agitation, face relaxed, abd soft and non-tender. Any form of laxative would cause more discomfort than anything else. Why does the hospice company’s policy require administration of a laxative?
Dear Lisa,
If a person with pancreatic cancer is eating very little, (a few spoons off yogurt, pudding, ice cream, etc) a day, how is it possible to produce large Bowel movements? Where is the waste coming from? I’m concerned.
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