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 Dad has poor circulation to his left leg, dementia, stenosis of the aortic valve (congestive heart failure). The vascular doctor will not agree to do the bypass surgery on Dad’s left leg. Daddy was willing to take his chances on whether he ran the risk of dying. But Doctor will not do surgery.
They told us to go home or a nursing home on Hospice. We went to a nursing home. Now Daddy’s biggest problem has been not his leg pain—but Constipation! Hospice has given Colace, now they give Senna. Added Miralax—he pooped once on May 26th and once again on May 28th but not enough to clear out the Days and Days of Food—He was eating double sized portions. Still hospice was not concerned about no BM. May 31st Dad went into a weird wacky state of confusion. We were thinking maybe it was a UTI infection from Foley Catheter. Someone mentioned that it looked like he was suffering from High Ammonia. I googled and he had all the symptoms. But his is from CONSTIPATION not liver disease. Very concerned I contacted his Hospice caseworker nurse. The weekend nurse came. Dad woke up Saturday June 1st with an injured left arm from apparently hitting it on the bed during a confusion episode. Hospice ordered Lactulose for the constipation—will not do any test to see if it is high ammonia—says the remedy is the same: Lactulose. Today is June 2, 2019, after 2 doses of Lactulose, Senna, Miralax and prune juice—still no Bowel Movement. Hospice tells us to wait. AT what point do we say the heck with Hospice and take Daddy to the ER??? Also note: Nothing has been done to address his injured left arm/wrist. It is painful to Daddy when he moves it. Hospice finally told me 30 minutes ago that it will be up to the nursing home and not Hospice to exam the injury and or get exrays. Again, I am left wondering, do we leaving Hospice and go to the ER?
Hi Patty, with your mom having colorectal cancer her bowel activity is not functioning as a normal intestine would. That is probably why you are seeing all the “brown, odorous liquid”. Did you ask your hospice nurse what she thought? Just know your mom’s body is shutting down and nothing works the way it normally would.
My blessings are with you and your family. Barbara
Hi. Mom is in her final hours or days before her passing; we are receiving Hospice care; mom was diagnosed with stage 4 colorectal cancer with lung matastisis, last June. She had radiation and chemotherapy for a combined 7 months. Her bowels have been distressed the entire time. Re: bowels at this time: mom’s bowel movements have been brown, odorous, and liquid for some time; she has not eaten in two weeks; how can she still be having bowel movements? Is her body getting rid of itself? Thanks for your consideration and expertise in responding to our question.
Hi Alma, I do not have enough knowledge of your mother’s condition to make any comment about her bowels. I suggest you talk with her hospice nurse about what you see and your concern. That is what hospice is there for, to support and guide you through this challenging time. Don’t be afraid to call them and ask questions. Blessings to you and your mom. Barbara
My mother is 97 years old , she has dementia and also has cervical cancer. She eats well , sleeps a lot, but is more or less aware. She went through radiation treatments to stop the bleeding and it worked, the tumor shrunk but it didn’t go away. She is in hospice but she seems to be doing well. Her bowel movements are a lot, we are wondering if this is normal, it is sometimes very watery and a dark brown color and it’s a lot for what she eats, lately it’s been very watery, but also sometimes it comes a little more dense. She drinks ensure , one to two cartons, and some yogurt. Is that normal?
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