Bowel management is the process of keeping the bowel healthy and functioning well. It is vital for the quality of life of terminally ill patients because it can affect their comfort, dignity, and infection risk. Bowel problems are common in terminally ill patients, and they can have different causes and consequences. Some of the bowel problems are constipation, diarrhea, obstruction, and ascites. Constipation is when the stool is hard and difficult to pass. Diarrhea is when the stool is loose and watery. Obstruction is when a tumor or scar tissue blocks the bowel. Ascites are when fluid builds up in the abdomen. These bowel problems can cause pain, nausea, vomiting, bloating, gas, bleeding, and infection.
This article provides information and guidance on preventing and treating bowel problems. It is for caregivers and hospice nurses caring for terminally ill patients at home or in a facility. We hope this article will help you understand and manage the bowel problems of your loved ones or patients.
Constipation
Constipation is a common bowel problem in terminally ill patients. It means that the stool is hard and difficult to pass. It can cause discomfort, pain, bleeding, and infection. Constipation can have many causes, but one of the most common is opioid therapy. Opioids are strong painkillers that can slow down the movement of the bowel. Other causes of constipation include dehydration, lack of fiber, inactivity, and some medications.
Constipation can be prevented and treated by using different measures. Some of these measures are:
Laxatives: These are medicines that help the stool move through the bowel. There are different types of laxatives, such as stimulants, osmotic, and bulk-forming. The doctor will prescribe the best type and dose for the patient.
Stool softeners are medicines that make stool softer and easier to pass. They are often used together with laxatives.
Hydration: Drinking enough fluids can help prevent dehydration and keep the stool moist. Water, juice, soup, and ice chips are good sources of fluids.
Dietary modifications: Eating foods high in fiber can help the stool move through the bowel. Fiber is found in fruits, vegetables, whole grains, and nuts. However, some patients may have trouble digesting fiber, so they should follow the doctor’s advice on what to eat and avoid.
Caregivers and hospice nurses play a significant role in monitoring and managing constipation. They should:
Keep track of the patient’s bowel movements, such as the frequency, consistency, and amount of stool.
Report any changes or problems to the doctor, such as no bowel movement for over three days, severe pain, blood in the stool, or signs of infection.
Administer the prescribed laxatives and stool softeners as directed by the doctor.
Encourage the patient to drink fluids and eat fiber-rich foods unless contraindicated by the doctor.
Help the patient with toileting, such as providing privacy, comfort, and assistance.
Provide gentle massage or abdominal exercises if the doctor or nurse recommends.
Constipation can be a distressing and debilitating condition for terminally ill patients. By following these measures, caregivers and hospice nurses can help patients achieve regular bowel movements and improve their quality of life.
Diarrhea
Diarrhea is another common bowel problem in terminally ill patients. It means that the stool is loose and watery. It can cause discomfort, pain, dehydration, and skin irritation. Diarrhea can have many causes, but some of the most common are infections or bowel disorders. Infections can be caused by bacteria, viruses, or parasites that enter the body through food, water, or contact with other people or animals. Bowel disorders can be caused by inflammation, ulceration, or cancer of the bowel. Other causes of diarrhea include medications, chemotherapy, radiation, and surgery.
Diarrhea can be prevented and treated by using different measures. Some of these measures are:
Antidiarrheal agents: These medicines help reduce the frequency and severity of diarrhea. They work by slowing down the movement of the bowel or by killing the germs that cause the infection. The doctor will prescribe the best type and dose for the patient.
Fluid replacement: Drinking enough fluids can help prevent dehydration and electrolyte imbalance. Electrolytes are minerals that help the body function properly. Water, juice, broth, and oral rehydration solutions are good sources of fluids.
Skin care: Keeping the skin around the anus clean and dry can help prevent irritation and infection. Caregivers and hospice nurses can use gentle wipes, creams, or ointments to protect the skin. They can also frequently change the patient’s underwear, pads, or diapers.
Dietary modifications: Eating foods that are easy to digest and absorb can help reduce the amount and frequency of stool. These foods include rice, bananas, applesauce, toast, crackers, and yogurt. However, some patients may have trouble tolerating certain foods, so they should follow the doctor’s advice on what to eat and avoid.
Caregivers and hospice nurses play a significant role in monitoring and managing diarrhea. They should:
Keep track of the patient’s bowel movements, such as the frequency, consistency, and amount of stool.
Report any changes or problems to the doctor, such as severe pain, blood in the stool, fever, or signs of dehydration.
Administer the prescribed antidiarrheal agents as directed by the doctor.
Encourage the patient to drink fluids and eat bland foods unless contraindicated by the doctor.
Help the patient with toileting, such as providing privacy, comfort, and assistance.
Provide gentle massage or abdominal exercises if recommended by the doctor or nurse.
Diarrhea can be a distressing and debilitating condition for terminally ill patients. By following these measures, caregivers and hospice nurses can help the patient control and cope with diarrhea and improve their quality of life.
Bowel obstruction is a serious bowel problem in terminally ill patients. It means that the bowel is blocked by something that prevents the stool from passing through. It can cause severe pain, nausea, vomiting, bloating, gas, and infection. Bowel obstruction can have many causes, but one of the most common is advanced malignancies. Malignancies are cancers that spread to other parts of the body. They can grow in or around the bowel and press on it or narrow it. Other causes of bowel obstruction include scar tissue, hernia, volvulus, or intussusception.
Bowel obstruction can be very difficult to treat, especially in terminally ill patients. Sometimes, surgery can be done to remove the blockage or bypass it. However, surgery may not be possible or desirable for some patients due to the risks, complications, or preferences. In these cases, palliative and supportive measures can relieve the symptoms and improve the quality of life. Some of these measures are:
Analgesics: These medicines help reduce the pain caused by bowel obstruction. They can be given by mouth, injection, or patch. The doctor will prescribe the best type and dose for the patient.
Antiemetics are medicines that help prevent or stop nausea and vomiting caused by bowel obstruction. They can be given by mouth, injection, or patch. The doctor will prescribe the best type and dose for the patient.
Corticosteroids: These medicines help reduce inflammation and swelling of the bowel. They can also help shrink some types of tumors that cause obstruction. They can be given by mouth or injection. The doctor will prescribe the best type and dose for the patient.
Octreotide: This medicine helps reduce the secretion of fluids and gases in the bowel. It can also help slow down bowel movement and reduce pressure and pain. It can be given by injection or infusion. The doctor will prescribe the best type and dose for the patient.
Decompression is a procedure that helps remove excessfluids and gases from the bowel. It can be done by inserting a tube through the nose or mouth into the stomach or intestine or by inserting a needle through the abdomen into the bowel. The tube or needle is connected to a suction device, draining fluids and gases. This can help relieve bloating, vomiting, and pain.
Caregivers and hospice nurses play a significant role in assessing and alleviating the symptoms of bowel obstruction. They should:
Keep track of the patient’s bowel movements, such as the frequency, consistency, and amount of stool.
Report any changes or problems to the doctor, such as severe pain, persistent vomiting, fever, or signs of infection.
Administer the prescribed analgesics, antiemetics, corticosteroids, and octreotide as directed by the doctor.
Assist the patient with decompression, such as inserting, removing, or flushing the tube or needle.
Help the patient with toileting, such as providing privacy, comfort, and assistance.
Provide emotional support and comfort to the patient and their family.
Bowel obstruction can be a distressing and debilitating condition for terminally ill patients. By following these measures, caregivers and hospice nurses can help patients cope and improve their quality of life.
Ascites
Ascites (uh-SIGH-tees) is a condition where fluid builds up in the abdomen. It can cause discomfort, pain, swelling, and difficulty breathing. Ascites can have many causes, but some of the most common are liver failure or peritoneal carcinomatosis. Liver failure is when the liver stops working properly and cannot filter the blood. Peritoneal carcinomatosis is when cancer spreads to the lining of the abdomen and makes it leaky. Other causes of ascites include heart failure, kidney disease, or tuberculosis.
Ascites can be very hard to treat, especially in terminally ill patients. Sometimes, the underlying cause can be treated with medicines or surgery. However, this may not be possible or effective for some patients due to the risks, complications, or preferences. In these cases, palliative and supportive measures can ease the symptoms and improve the quality of life. Some of these measures are:
Diuretics: These medicines help the body eliminate excess fluid by making more urine. They can be given by mouth or injection. The doctor will prescribe the best type and dose for the patient.
Paracentesis is a procedure for draining fluid from the abdomen. It involves inserting a needle through the skin into the fluid and connecting it to a bottle or a bag. This can help relieve pressure, pain, and breathing problems.
Shunts: These devices help divert the fluid from the abdomen to another body part, such as the bladder or the heart. They can be inserted by surgery or by a catheter. They can help reduce the amount of fluid and the need for paracentesis.
Caregivers and hospice nurses play a significant role in assessing and alleviating the symptoms of ascites. They should:
Keep track of the patient’s weight, urine output, and fluid intake.
Report any changes or problems to the doctor, such as severe pain, fever, or signs of infection.
Administer the prescribed diuretics as directed by the doctor.
Assist the patient with paracentesis or shunt care, such as preparing, cleaning, or dressing the site.
Help the patient with toileting, such as providing privacy, comfort, and assistance.
Provide emotional support and comfort to the patient and their family.
Ascites can be a distressing and debilitating condition for terminally ill patients. By following these measures, caregivers and hospice nurses can help patients cope and improve their quality of life.
Conclusion
Bowel management is the process of keeping the bowel healthy and functioning well. It is crucial for the quality of life of terminally ill patients because it can affect their comfort, dignity, and infection risk. Bowel problems are common in terminally ill patients, and they can have different causes and consequences. Some of the bowel problems are constipation, diarrhea, obstruction, and ascites. These bowel problems can be prevented and treated using different measures, such as medicines, procedures, and dietary modifications. Caregivers and hospice nurses are significant in monitoring and managing these bowel problems. They should keep track of the patient’s bowel movements, report any changes or issues to the doctor, administer the prescribed medicines or procedures, help the patient with toileting, and provide emotional support and comfort. By following these measures, caregivers and hospice nurses can help patients achieve regular bowel movements and improve their quality of life.
Bowel management is a vital part of palliative care for terminally ill patients. It can help them cope with their condition and maintain their dignity and comfort. We hope this article has provided useful information and guidance on preventing and treating bowel problems. If you need more assistance, don’t hesitate to contact your doctor or hospice nurse. You can also find more resources and references on the following websites:
