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 Chris, I do not have enough medical history to know why your husband is pooping so much. Since hospice doesn’t seem to know call your husband’s doctor and ask him/her why and what you can do (if anything) about it. My blessings are with your and your husband during this challenging time. Barbara
I see nothing here and can find nothing to explain why my husband is pooping every few hours. He has stopped eating, taking only a little Ensure each week. He takes a very low dose of morphine three times a week when hospice workers come in to bathe him. But, meantime, every time I change his diaper (every 12 to 3 hours), there is a significant amount of poop. I have asked the hospice workers but nobody can tell me why this is happening and if it is ever going to taper off?
Hi Joanne, it does sound like your mum has entered the dying process (weeks to days) The fact that she asked about her bowels tells me she is not as close as I originally thought reading your comments. Do you have a mild laxative you can give her? Is she complaining of discomfort, pressure in the area of her rectum? That could suggest stool is just sitting inside the opening. Do you have hospice services or nurses coming to your home? If so ask them to check her for an impaction and what laxative to give her. Sounds like you are not in the US so it is challenging to get my booklets to you but you can get Gone From My Sight and The Eleventh Hour in Ebook form, both would be helpful for you now. Email me at Barbara@bkbooks.com if I can be of further help. Blessings to you and your mum during this time. Barbara
my mum is 91 weighs under 4 stone and is near end of life , were just keeping her comfortable at home. last few days shes slept nearly all day. today shes a little brighter. shes ate 8 teaspoonful of puree pear over 3 days im lucky to get half a cup of drink in her. and urine now very low. today shes asked why shes not had bowels open for days. is it because of the stage shes at in life ?. please email me your reply if you have one thank you
Hi Tamela,
I am disappointed your mother’s doctor didn’t offer you more help. Not controlling your bowels is not necessarily a part of aging, although having 9 children could mean that the muscles in that area are not as strong as they once were. You might ask her doctor if anti-diarrhea medication would help as I’m thinking the increase in fiber did not help. I’m sorry to say that adult diapers might be in your future. My blessings to you and your mom. Barbara
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