Caring for a terminally ill loved one during the last three months of their life can be emotionally challenging and comes with many questions, including those related to bodily functions. Bowel movements are a natural bodily function, and it’s essential to understand what to expect and when to become concerned if a terminally ill patient is not having regular bowel movements.
Normal Bowel Movements
Bowel movements, often called “going to the bathroom” or “having a bowel movement,” are a normal part of daily life. However, in terminally ill patients, especially during the final months, bowel movements may change due to numerous factors, such as reduced food and liquid intake, medication side effects, and overall physical decline. It’s important to remember that everyone’s experience is unique, and there is no strict “normal” frequency for bowel movements in this context.
Frequency of Bowel Movements
1. Reduced Frequency: As the illness progresses, it’s common for bowel movements to become less frequent. Some patients may have a bowel movement every few days or less frequently. This reduction is often due to decreased food intake and decreased physical activity.
2. Individual Variation: It’s crucial to understand that there is no set time limit for bowel movements during the end-of-life journey. What’s most important is to monitor your loved one’s comfort. If they are not in discomfort and there are no signs of distress related to bowel movements, there may not be a cause for concern.
Other Changes to Expect
Incontinence: Incontinence means losing control of urine or stool. This can happen in terminally ill patients as the body’s systems shut down. This can lead to decreased muscle control, resulting in incontinence or constipation. Additionally, food and fluid intake may decrease, causing stool to become hard and dry. Incontinence can be embarrassing and uncomfortable for patients and caregivers. It can also increase the risk of skin irritation, infection, and odor. You can help your loved one cope with incontinence using pads, diapers, or bed protectors. You can also keep their skin clean and dry by applying moisturizers or barrier creams. You can also change their position frequently and provide privacy and dignity.
Terminal Bowel Incontinence: Terminal bowel incontinence means passing stool involuntarily near the end of life. This can happen due to muscle relaxation or a loss of consciousness. This is a natural and common occurrence in the dying process, and it does not mean the patient is suffering. You can prepare for this possibility by placing absorbent pads or sheets under your loved one. You can also gently clean their skin and clothing after each episode. You can also use air fresheners or candles to mask any odor. You can also reassure your loved one and yourself that this is normal and not their fault.
When to Be Concerned
While reduced frequency is expected, there are instances when you should be concerned and seek medical advice:
1. Signs of Discomfort: When someone is very sick, they may be unable to tell you how they feel. You can look for discomfort in their face, body, and behavior. For example, they may frown, grimace, groan, or cry. They may also move around, hold their stomachs, or refuse to eat or drink. Constipation is a common cause of discomfort in terminally ill patients, especially if they take pain medicines. Constipation means having hard, dry stools that are difficult to pass. Other gastrointestinal issues, such as nausea, vomiting, or bowel obstruction, can cause discomfort. If your loved one is visibly uncomfortable due to constipation or any other gastrointestinal issue, it’s essential to address this discomfort promptly. You can try to make them more comfortable by giving them fluids, fiber, and gentle massage. You can also ask their doctor for medicines to help with constipation or other problems.
2. Sudden Changes: Sometimes, terminally ill patients’ bowel habits can change suddenly. This can be a sign of a severe problem that needs medical attention. For example, if your loved one has not had a bowel movement for several days, they may have a bowel obstruction. This means that something is blocking the passage of stool through the intestines. This can cause severe pain, bloating, nausea, and vomiting. Bowel obstruction is more common in patients with certain types of cancer, such as ovarian or colon cancer. Another example of a sudden change is severe diarrhea. This means having frequent, loose, or watery stools. Diarrhea can cause dehydration, weakness, and electrolyte imbalance. Infections, medications, or food intolerances can cause diarrhea. If there is a sudden and notable change in bowel habits, such as a prolonged absence of bowel movements or the presence of severe diarrhea, consult a healthcare professional. They can diagnose the cause of the change and provide appropriate treatment.
3. Pain is one of the most common symptoms experienced near the end of life. Pain can affect the quality of life and well-being of terminally ill patients and their families. Pain can have many causes, such as cancer, infections, or injuries. Pain can also be related to bowel problems, such as constipation, obstruction, or inflammation. If your loved one experiences abdominal pain or cramping, it’s a cause for concern and should be discussed with a healthcare provider. They can assess the source and severity of the pain and prescribe pain medicines or other treatments to relieve it. Pain medicines can be given in different ways, such as pills, liquids, patches, or injections. Some pain medicines, such as opioids, can cause constipation, so they should be used along with laxatives and stool softeners.
Conclusion
Understanding bowel movements in terminally ill patients requires patience, compassion, and a focus on their comfort. While there is no fixed schedule for bowel movements during this period, monitoring your loved one’s well-being is crucial. If there are signs of discomfort or sudden changes in bowel habits, seek guidance from a healthcare professional. Remember, the goal is to ensure the best possible quality of life for your loved one during this challenging time.
