Observing a loved one experience bodily changes during the final stages of life can be deeply distressing, and the appearance of a colored fluid from the mouth is a particularly concerning symptom. This phenomenon, which is a rare but documented occurrence, often raises questions about what is happening internally and whether the person is in discomfort. Understanding the physiological processes behind these secretions is helpful for caregivers seeking clarity and peace of mind during this difficult time, allowing for a more informed approach to providing comfort and managing symptoms.
Identifying the Source of the Green Color
The green or yellowish-green fluid expelled from the mouth is typically bile, a digestive liquid produced by the liver. Bile is stored and concentrated in the gallbladder before being released into the small intestine. It is composed of water, cholesterol, bile salts, and the pigment bilirubin, which gives it its characteristic greenish-yellow hue.
When this fluid is seen outside the body, it is usually a mixture of bile and other gastric contents regurgitated from the stomach. The presence of bile indicates the fluid originated in the digestive system, not the lungs or respiratory tract. This distinction confirms the fluid is unrelated to the noisy breathing sometimes heard at the end of life, which involves respiratory secretions pooling in the throat.
The color can range from bright yellow to a darker, almost brownish-green, depending on its concentration and time in the digestive tract. While it may be confused with blood, partially digested blood appears dark brown or black, not green. Identifying the fluid as bile helps focus concern on digestive system changes rather than respiratory distress.
Physiological Reasons for Fluid Accumulation
The appearance of bile-tinged fluid is a consequence of the body’s declining systems, specifically the loss of coordinated function in the digestive tract. As the dying process advances, the entire gastrointestinal system begins to slow down significantly. This reduction in activity, known as decreased gastrointestinal motility, means the muscular contractions moving food and fluids become weak and ineffective.
When the contents of the stomach and small intestine are not moved along efficiently, they begin to back up. Simultaneously, the muscle rings that act as one-way valves, called sphincters, begin to relax and lose their tone. The lower esophageal sphincter, which normally seals the stomach from the esophagus, may open passively, allowing the mixture of gastric juices and bile to travel backward and exit through the mouth.
A person nearing the end of life often loses the ability to swallow effectively (dysphagia) and loses the gag reflex, which normally prevents aspiration. This combination of decreased forward movement, relaxation of muscular barriers, and inability to clear secretions leads to the passive expulsion of fluids. This is a passive process that indicates the body is shutting down, rather than an active, painful event like vomiting.
Providing Comfort and Symptom Management
The primary focus of care is to maintain comfort and dignity for the patient and provide reassurance to the family. Healthcare professionals, particularly those in palliative and hospice care, employ non-invasive techniques to manage this symptom. A simple measure is to position the patient correctly, typically by turning them onto their side or elevating the head of the bed slightly, which allows gravity to facilitate natural drainage and reduce aspiration.
Gentle oral suctioning may be used to clear secretions visible in the mouth, but deep suctioning is typically avoided as it can be agitating for the patient. Frequent, meticulous mouth care is also paramount to prevent dryness and keep the oral cavity clean.
Medical interventions often involve anticholinergic medications, sometimes called drying agents, such as glycopyrrolate or hyoscyamine. These medications block the nerve signals that stimulate the production of secretions, helping to reduce the overall volume of fluid in the digestive and respiratory tracts. While the sight of these secretions is unsettling for observers, the patient is often unconscious or has a diminished level of awareness, meaning the symptom is not typically a source of pain or distress for them.