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 Shalinda, Oh my goodness! Not having a bowel movement for two weeks is not okay, no matter how close to death a person is. Well, that is not exactly correct. If she is days from death (non responsive, has start and stop breathing, no eating, no drinking) then don’t put her body through the ordeal BUT if she weeks (1 to 3), is eating a little, drinking, a little, even picking at her bedclothes, rambling verbally she should be helped to have a bowel movement. Contact your hospice nurse, now (don’t wait until Monday) if your mom is in the weeks category. Have you read my booklet Gone From My Sight? It gives some guidelines and where your mom is in the dying process. I am sorry your mother has this problem. Her body must be very uncomfortable. Even when we don’t eat very much our body still makes waste and it has to come out. If you have further questions please use my personal email barbara@bkbooks.com
Blessings! Barbara
My mom is on hospice she has anaplastic thyroid cancer and she hasnt had a bowel movement in 2wks !!! Is that close signs to death?
Hi Karen, about your mom’s declining condition and should she be on Hospice care: it would seem to me if she continues as she is doing her body will not be able to sustain itself. You have nothing to lose and a lot to gain by getting a hospice consult. Ask your doctor for a referral. If he says no, your mom is not appropriate, you can call a hospice yourself and ask for an assessment visit. Taking care of anyone in a life threatening situation is difficult and you need all the guidance and support you can get. If I can be of further help email me at barbara@bkbooks.com. My blessings to you and your mom. Barbara
My mom has stage 4 lung cancer. She has been on a cancer medication that has cause severe diarrhea. She refuses to shower and get up to go to the bathroom but will get up to get food when needed. She has psoriatic arthritis and lives on pain meds. Her feet swell and are black and blue some days. She was just diagnosed with colitis and is on steroid but still has diarrhea issues. She has made numerous trips to the hospital but they cant seem to get it under control. She is getting very weak and still no resolution as they sent her home from rehab and said its up to her to keep up treatment. Some days she just refuses care. Should she be on hospice? Is this a sign her cancer has moved to another area and they are not seeing it? How much longer can mom go on like this.
Hi Susan, because your mom is receiving hospice care I would ask her hospice nurse if the laxative dose needs to be decreased. Being on high quantities of narcotics makes it very important to regulate the laxative dosage. You want to keep the bowels moving. Maybe this was a one time occurrence and she will be back to her bowels being managed on the laxatives she was on before this happened. Thank you for reaching out to me. Know that your hospice nurses are there to answer all of your questions. Don’t hesitate to contact them.
Blessings to you and your mom. Barbara
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