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 Carol, I think you are right about not being able to push all that stuff out being part of the problem. I have seen this inability many times with the same challenge of how do we get it all out. I think Hospice is doing a good job with laxatives, stool softeners, etc. Enemas are really the only way of getting it out when laxatives don’t force it out. You want to make sure the stool is soft enough that he does not become impacted
About your question: does this mean he is dying soon. Not necessarily. Your key factor is less food intake. Because he has dementia the sleeping and withdrawal signs of approaching death don’t count. Based on the information you have given me it does not appear that he has started “labor” (one to three weeks before death).
Have you read my booklets Gone From My Sight, The Eleventh Hour and How Do I Know You? I think they will be helpful during this time.
Blessings! Barbara
My husband is in end stages of Parkinson’s Disease with dementia. He is bed ridden and completely dependent for all ADLs. He has not had an unassisted bowel movement in 35 days. He has had three partial bowel movements w/enemas and the kind assistance of our caregiver. In spite of still having some appetite, a good diet,and a hospice approved regimen of laxatives, suppositories, stool softeners, including enemas, he is not producing any waste. He is still urinating. I believe the PD factors in as he is no longer able to push. His vital signs are still normal. Is there anything more we should be doing? I am very concerned about this, and worry that this is a sign that he may be nearing his end.
Thank you
Hi Lisa, I first thought you were referring to laxative suppositories but as I read this I am thinking about other suppositories—for pain, fever, agitation. Yes, you can use suppositories because we are not talking about the bowel but about absorption through the mucus membrane. Circulation as well as all bodily functions are diminishing so the response to the suppository will not be as timely as it would be a healthy body. My choice for administering drugs when the person is non responsive is suppositories.
Hi Lisa, your question about the absence of bowel sounds and using suppositories is a good one. I am not sure I have a definitive answer. I’m thinking there are variables—how far along are they in the dying process? If months it would be different than days. What is the diagnosis? To be safe I would ask the attending or hospice physician. Thanks for asking. Barbara
At the end of life care. When bowel sounds are absent. Do we still need to suppositories?
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