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
Sarah
My mom has dementria
Occasionally on a given day
She has this uncontrollable bowel movement that flow like chocolate milk and smell
Awful always occurring late in the day…any thoughts on what could be the problem.?
My mom has dementria
Occasionally on a given day
She has this uncontrollable bowel movement that flow like chocolate milk and smell
Awful always occurring late in the day…any thoughts on what could be the problem.?
Barbara Karnes
Hi Karen, the color of your father’s stools , odor and the jaundice are indications of liver malfunctions. They are not signs of immediate approaching death but it appears the cancer is catching up with him. Blessings! Barbara
Hi Karen, the color of your father’s stools , odor and the jaundice are indications of liver malfunctions. They are not signs of immediate approaching death but it appears the cancer is catching up with him. Blessings! Barbara
karen
Afternoon -
Help me understand a few things. My 84 year father was diagnosed with liver cancer as a secondary location. (primary is not clear – no additional testing done because of age and health) December 2017.
During this time, he has not really followed the rules of what is considered normal symptoms of liver cancer. He is a strong spirited man. He has been doing really well until this past weekend – he is becoming weaker and I noticed this since Thursday evening. Even his current bowel movements have now changed in color; from a brownish/mustard color to a pale grayish color with a an odor change. Is this a normal thing? He is also showing some jaundice.
Thanks
Afternoon -
Help me understand a few things. My 84 year father was diagnosed with liver cancer as a secondary location. (primary is not clear – no additional testing done because of age and health) December 2017.
During this time, he has not really followed the rules of what is considered normal symptoms of liver cancer. He is a strong spirited man. He has been doing really well until this past weekend – he is becoming weaker and I noticed this since Thursday evening. Even his current bowel movements have now changed in color; from a brownish/mustard color to a pale grayish color with a an odor change. Is this a normal thing? He is also showing some jaundice.
Thanks
Barbara Karnes
Hi Earlier, regarding your question about not pooping yet being alert enough to talk on the phone and chew but not swallow I don’t have enough medical information to make any suggestions. It does sound unusual which leads me to think there is a medical reason for the advice you are receiving. Talk with your physician , ask your questions and don’t stop until you understand the reason for the advice you are being given.
Blessings! Barbara
Hi Earlier, regarding your question about not pooping yet being alert enough to talk on the phone and chew but not swallow I don’t have enough medical information to make any suggestions. It does sound unusual which leads me to think there is a medical reason for the advice you are receiving. Talk with your physician , ask your questions and don’t stop until you understand the reason for the advice you are being given.
Blessings! Barbara
Earlier tillman
Can a person whom on hospice and no bowl sound but is talking on phone but can eat food he can chew it but no swallow it cause they told him not to.and he can’t poop they say an it nothing they can do about that.can we give him a suppository
Can a person whom on hospice and no bowl sound but is talking on phone but can eat food he can chew it but no swallow it cause they told him not to.and he can’t poop they say an it nothing they can do about that.can we give him a suppository
Barbara Karnes
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
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
Samantha Romaine
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 .
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 .
Barbara Karnes
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
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
RM
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?
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?
Donna
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.
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.
Barbara Karnes
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
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
carol redelheim
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
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
Barbara Karnes
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, 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.
Barbara Karnes
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
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
Lisa Moore
At the end of life care. When bowel sounds are absent. Do we still need to suppositories?
At the end of life care. When bowel sounds are absent. Do we still need to suppositories?