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
My mom is 88, and other than arthritis, and Afib, she is relatively healthy. However, the past few months she has started getting diarrhea, and many times she doesn’t make it to the bathroom in time. Is this just part of aging? Her doctor doesn’t seem too concerned about it, and has told her to up her fiber. She is depressed and keeps talking about wanting to die. Side note: Not sure if this is important, but she has given birth to 9 kids.
Hi Kim, I do not have enough medical history or information on your mom to say why she is not aware of pooping. Is dementia involved? If the stool is very loose then maybe too much fiber and poop inducing foods but most likely it is just her mental state declining. If she hasn’t had a doctors appointment in a while it might be time for a physical or just call her doctor and ask what could be happening. It might just be time to get the adult diapers out. What about urine. Does she know when she is peeing? If she knows when she has to pee then not knowing when she poops is something for the doctor to know about. Also any medication changes that could be affecting this? So many questions, so few answers. . Blessings! Barbara
Hi Kim, I do not have enough medical history or information on your mom to say why she is not aware of pooping. Is dementia involved? If the stool is very loose then maybe too much fiber and poop inducing foods but most likely it is just her mental state declining. If she hasn’t had a doctors appointment in a while it might be time for a physical or just call her doctor and ask what could be happening. It might just be time to get the adult diapers out. What about urine. Does she know when she is peeing? If she knows when she has to pee then not knowing when she poops is something for the doctor to know about. Also any medication changes that could be affecting this? So many questions, so few answers. . Blessings! Barbara
Hello:
I happened upon your website today, searching for answers. My mother just turned 89. She has recently had quite a few poop issues. Most recently not feeling when she is going. Having several accidents due to not knowing when she is going. She is frail, has loss of sight, we have a daytime caregiver for her. She is doing all I feel that is necessary for being able to poop. Forcing fluids, tons of fiber, walking with her walker around the house. Is this common for end of life ? We have not had this issue before. Thank you for your time,
Hi Mary Ellen, about your mom’s persistent diarrhea and could it be a sign she is beginning the dying process. At 99 years old anything is possible. Obviously something is going on inside her body that is not normal or healthy BUT if she is comfortable (not in pain) and reasonably happy I’d say just love her, enjoy her and let her body do what it is doing. At her age anything out of the ordinary can be an indication her body is beginning to activly shut down. Old age is a way of dying gradually without a specific disease process to speed it along so from that stand point she has entered the dying process. It will just take her longer than if she had a detectable disease.
My blessings are with you both during this gift of time that you to have. Barbara
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