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An uncomfortable subject: constipation in hospice patients

By Lorraine Thayer

Throughout our lives we have learned what is considered polite conversation. We try to avoid topics that are indelicate or may be offensive to others. Generally, discussions around body functions, especially elimination are difficult even between a patient and their health care provider.  This conversation becomes especially important as a patient nears the end of their life when comfort is the central goal for our loved one. Constipation is a frequent problem for patients nearing end of life.

What exactly is constipation? Some people believe if they do not have a daily BM they are constipated.  This is not the case. A medical definition of constipation includes 2 of the following.

  • Straining during a bowel movement more than 25% of the time
  • Hard stools more than 25% of the time
  • Incomplete evacuation more than 25% of the time
  • Two or fewer bowel movements in a week

Some of the causes of constipation in Hospice patients are:

  • Inadequate water intake
  • Inadequate fiber in the diet
  • Inadequate activity or exercise or immobility
  • Stress
  • Resisting the urge to have a bowel movement, this is sometimes the result of pain or lack of privacy
  • Overuse of laxatives prior to the illness, which, over time, weaken the bowel muscles
  • Some medical conditions
  • Some Medications

Constipation can be very uncomfortable, and should be treated as aggressively as other symptoms that cause discomfort near end of life. Constipation can lead to abdominal pain and cramping, nausea, or loss of control of bowel movements.

How to prevent or treat constipation

Although often helpful for healthy people, extra fiber can actually be quite detrimental in patients near end of life. Fiber supplements depend on high water intake and many people can not tolerate the extra fluid required with additional fiber.

When possible begin by increasing fluids. As foods pass through the digestive track fluids are removed. When too much fluid is removed the stool becomes hard and difficult to pass.

Ask your health care provider to review all the medications. Perhaps medications can be adjusted or substituted for less constipating alternatives.

Medications may need to be added.

  • Laxatives are often used on a regular daily basis when patients are prescribed narcotics for pain. They come in pill and liquid making it easier for the patient to swallow. This is a proactive approach to prevent constipation.
  • Stool softeners may help make stool pass easier with less straining.
  • Suppositories can stimulate the lower bowels to help bring on a bowel movement
  • Enemas are liquids injected into the rectum and can help to bring liquid into the lower bowels, and therefore soften stools and bring on bowel movements.

Each laxative has properties that are unique to that product. Your health care provider will know which product would be best and have the least adverse consequences. So resist the temptation to consider constipation an indelicate. A frank open discussion will save you or your loved one the unpleasant side effects of constipation. The discomfort of the conversation will pass quickly and the benefits will be long lasting.

Lorraine Thayer is an advance practice nurse with Holy Redeemer Hospice- NJ Shore. In her role, Lorraine assesses hospice eligibility in addition to providing consultation and management of complex pain and other symptoms. Lorraine’s wealth of knowledge and experience is a great resource for our hospice patients and their families, and our interdisciplinary team.

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