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 (95) under hospice care quit eating for several days. Now she has started eating again and is having major bowel blow outs. She is on heavy duty pain meds accompanied by a laxative and natural fiber capsules.
Wondering if something should be cut back on due to blow outs. She has awakened and needed a shower due to feces on her.
Hi Jodi, what a mess. It is hard to believe this is happening. Get a different doctor to see her ASAP or take her to the emergency room and get someone to really listen to what you are telling them. Be fierce and get the CT Scan NOW. Obviously something is seriously wrong and needs immediate attention. She may just be impacted and need to have it removed but I’m thinking something more serious than that is happening here. Be forceful, don’t take no or later for an answer. Demand that she get immediate attention. Barbara
Hi Debbie, I just don’t have enough information about our mother’s health condition to know why she doesn’t know if she has had a BM or not. You might ask her doctor to see what he/she thinks.
Blessings! Barbara
I’m so overwhelmed and don’t know what to do. My mother is 87 and takes absolutely no medication – hard to believe but true. However, since about May 2018 she has had potty problems. It started out a little red blood in her feces that we initially thought was hemorrhoids, even though she’s never been diagnosed with them. She went to her sister for the summer and when she came back in September she was very emotional because she has not had a bowel movement since she left and has to wear pads because slime will leak out when she stands up without her knowing. Her excrement is a bloody mucus. Took her to doctor who thought she may have drank well water and have an infection but we live on city water and so does my Aunt. Then they sent her home with a stool sample kit- I explained to them once again that she doesn’t have ANY STOOL to put in the vials. They said do your best. She did – she put some slime in the 3 tubes but not enough to fill them like directed. So today I called in expecting them to say the test were inconclusive due to lack of specimen but lo and behold they said EVERYTHING was NORMAL. How on Earth can that be possible? Now she is weaker and getting dizzy, food is not desirable and still no poop. They want to schedule her for a CT scan to see what’s going on in her stomach but they failed to get authorization from her insurance so I’m still waiting to hear back on scheduling. I am a mess – I need help, answers or just someone to act like they care. Any ideas? Mom thinks it’s cancer and I’m just so besides myself with what to do next. It’s so sad to see her suffer and I feel helpless.
My mother is 92 is in stage 5 kidney failure, heart disease. When she has a bm she can’t tell if she has gone or not, she will ask me have I passed anything yet! Why can’t she feel her bowel movements?
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