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
Mom is 99 and has had persistent diarrhea and intermittent vomiting for the last month. All tests come back normal and all agree she is too frail for a colonoscopy, One nurse indicated this may be the beginning of her body shitting down. I can’t find any other resource that confirms that – in fact only the opposite, that constipation can be a sign. Her appetite is not what it once was but she is still eating and enjoying food, or as much as one can on a BRAT diet.
Can you tell me if this may be a possibility?
Hi Sherri, you asked how much longer your mom can go on not eating, agitated, falling; I don’t know. I really don’t have enough medical history information on your mom to make any predictions. Dementia just doesn’t play by the “rules” of dying from a disease. Not eating or drinking anything for 5 days would indicate she has entered the dying process. How long depends on her body size but probably weeks (since you said her vital signs are normal). Watch for her blood pressure to get lower and pulse faster. Look for bluish hands and feet.
Do you have my two booklets Gone From My Sight and How Do I Know You? They will be helpful during this time.
My blessings are with you and your mom. Barbara
My 90 yr old mother with Alzheimer’s and has had 3 strokes this yr is under Hospice care. Hasn’t eaten or drank anything fr 5 days. Yet her vital signs are all normal. She is very pale and not coherent. She fell 3 times in one week. Before hospice started the morphine for pain. Now adderall for agitation that was really bad. How much longer can she go on like this
Hi Lisa, I do not have enough medical information about your father in law to know why he hasn’t had a bowel movement in so long. Have you talked with his physician about this? What does he think is happening? This situation does not sound normal. I would hope the physician has some ideas. Blessings! Barbara
My father in law fell about 6 weeks ago. He was in a rehabilitation facility for a month and had one bowel movement due to an enema. He’s now home but has no physical activity. He’s in a hospital bed in his living room. Hospice comes in 3 times a week. They have been giving him suppositories and laxatives. He is eating small amounts of food, but has not had a bowel movement since he’s been home.(He has been home a week.) He says he is not in pain, and has no urge to go. The hospice nurses push on his stomach and check for pain, but he’s not hurting. He just doesn’t go. How is this possible?
Leave a comment