As individuals approach the end of life, changes in bodily functions, including bowel movements, are a common and natural part of the process. Understanding these changes helps caregivers to provide comfort and maintain dignity. This information offers a sensitive overview of what to expect regarding stool changes during this delicate time.
Understanding Stool Changes
Stool appearance, consistency, and frequency can vary significantly as a person nears the end of life. One possible change is the presence of dark, tarry stools, known as melena. This type of stool is typically black, sticky, and has a strong odor, indicating bleeding in the upper gastrointestinal tract. The blood turns black as it travels through the digestive system, interacting with digestive chemicals.
Conversely, very loose or liquid stools, referred to as diarrhea, may occur. This can manifest as frequent, watery bowel movements. Diarrhea can also sometimes be “overflow diarrhea,” where watery stool leaks around a blockage caused by severe constipation.
Another common alteration is constipation, characterized by infrequent or difficult-to-pass bowel movements. Stools may be hard, dry, and smaller than usual, or there might be an absence of bowel movements for several days. Patients in hospice care should ideally have a bowel movement at least every two to three days.
Contributing Factors
Several factors contribute to altered bowel patterns observed at the end of life. Decreased food and fluid intake plays a substantial role, as less material passes through the digestive system, leading to reduced stool bulk. Reduced mobility also slows down intestinal movement, making constipation more likely.
Medications frequently contribute to bowel changes, especially opioids, which cause constipation by slowing gut motility. Other medications, including antidepressants, diuretics, and some anti-nausea drugs, can also induce constipation. Conversely, some medications, such as antibiotics or certain cancer treatments, may lead to diarrhea. Underlying diseases can also impact bowel function, such as tumors obstructing the bowel or neurological conditions affecting muscle control.
Providing Comfort and Care
Managing bowel changes at the end of life focuses on enhancing comfort and preserving dignity. For constipation, a regular bowel regimen, including prescribed stool softeners and laxatives, is often implemented. Gentle abdominal massage can sometimes provide relief, and ensuring adequate hydration, if appropriate and tolerated, helps soften stools. Privacy and a comfortable toileting position, such as using a footstool, can also facilitate bowel movements.
When diarrhea occurs, meticulous skin care is important to prevent irritation and breakdown around the anal area due to frequent bowel movements. Gentle cleansing with soft materials and the application of barrier creams can protect the skin. Absorbent products, like pads or briefs, help manage incontinence and maintain cleanliness, changing them promptly when soiled. Dietary adjustments, such as avoiding irritating foods and encouraging bland options, may help manage diarrhea.
When to Contact a Professional
Caregivers should contact a healthcare professional, such as a hospice nurse or doctor, if concerns arise regarding bowel changes. This is important if the individual experiences severe abdominal pain, bloating, or vomiting, as these could indicate a serious issue like a bowel obstruction. A lack of bowel movement for more than three days, despite interventions, warrants professional consultation.
Any signs of severe distress or discomfort related to bowel issues that cannot be managed with routine care should prompt a call to the care team. The presence of blood in the stool, particularly dark, tarry melena, should be reported immediately. Healthcare professionals can assess the situation, adjust medications, or suggest further interventions to ensure comfort and well-being.