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 Debby, about your dad’s foul smelling and continuous poop— I don’t have any of your dad’s medical information to know why he is having this bowel problem. Have you talked to your hospice nurse about this and what are her explanations and recommendations? I can say that when a person is in the dying process nothing in their body works right, nothing functions are it normally would. Diarrhea can be from the actual disease and how it is affecting the body. It can be caused by medication your father is on. This is why I encourage you to ask your hospice team not only for why this is happening but to address it and try to stop it. My blessings are with you and your father. Barbara
My dad is 92. He won’t eat. All he wants is ice water. He is so weak and confined to a hospital bed. He soils himself multiple times a day with the must foul smelling BMs. The entire house smells I have candles lit, door open, spraying disinfectants! How can he go this much with no food in his body? He’s on hospice
Is this an end of life smell?
Hi Judy, when we are sick and more so when we have dementia we don’t necessarily know what we need or what is “best” for us. Our body needs to poop. It is that simple. 7 days is too long to go without a bowel movement. The longer she goes the harder it will be to get the stool out and the more painful it will be on her to remove it. You must insist that she take the senna (although I am not sure at this point that will be strong enough). An enema may be in order. Good luck. Barbara
My mom is 90 years old. Hasn’t been eating much this past 2 weeks…just picking at her food. She does like milkshakes and will drink them. That’s about all she will eat. She has diabetes, 20% kidney function, and moderate stage dementia. She hasn’t had a bowel movement in 7 days. She refuses enema’s and laxative (senna). What to do? I respect her opinions and decisions, but I worry she will get sick without bowel movements. Thank you.
Hi Patricia, what a mess. Your dad has to be so uncomfortable. At this point I wonder about impaction, even obstruction. Has anyone checked his rectum to remove stool that way? I would really have to be there to see his entire chart to have a more reliable opinion. Before you just take him to the ER call his doctor directly, by pass hospice and the nursing home, and tell the doctor your concerns. See if you get results that way. Yes, you can always sign yourself off of the hospice benefit. You can also talk with other hospices in your area to compare notes and see if you will be happier with a different one. My thoughts and blessings are with you. Barbara
Leave a comment