question about BM's

[sclpn]

I have a stupid question that's really been bugging me.

Well as any hospice nurse knows....we are obsessed with patients having BM's.

So here's my question. If a patient has been eating little to nothing.(mostly nothing)

then for how long should they continue to have a bowel movement?? until death or does it

depend on how long they haven't been eating?

[tewdles, RN]

Hhhhmmmm. Let me ask you a question in response...lets assume that a patient is transitioning to the active dying phase of their journey. They haven't eaten very much in the past several days. Your assessment of the situation would lead you to believe that the person will not be eating again. Do you worry about when they did or will have a BM or do you worry about their comfort secondary to BMs? I make this distinction because I believe that our interest in bowel hygiene "shifts" a bit when the person is in their final decline. I will not, for instance, give enemas etc at end of life because they have been more than 3 days without stool. I will if they are more than 3 days AND they are uncomfortable. As you pointed out, the lack of PO intake pretty much insures that the volume of stool will be much smaller and therefore, the patient is less likely to be uncomfortable. A more direct answer to your question...even when we don't eat much we may continue to have small stools, our bowel makes mucous afterall. I know people who pass "stool" even though their lower intestine is completely disconnected from the upper! It is not common for hospice patients to continue to have BMs right up until death for several reasons...they are dehydrated, they are receiving opioids, they are receiving anticholinergics...all of which make it less likely to see any stool in the last several days.

[leslie :-D]

I have a stupid question that's really been bugging me.

Well as any hospice nurse knows....we are obsessed with patients having BM's.

So here's my question. If a patient has been eating little to nothing.(mostly nothing)

then for how long should they continue to have a bowel movement?? until death or does it

depend on how long they haven't been eating?

every pt is different.

the only time i intervene is when the pt is symptomatic, i.e., distention, vomiting, etc.

if the belly is nice and soft and pt seems comfortable, then i do not worry.

don't fix it if it's not broken.

leslie

[Ginapixi, BSN, RN]

I agree totally with Leslie:-D

some pts will move stool or need to move to the end, some do not; checking the rectal vault if they have not moved their bowels and it is empty and an enema does not have the desired effect AFTER we have tried po things, and there is no discomfort, wait it out; once pts can no longer swallow po meds, are not distended, bowel sounds are present - even if hypo active- "poopin" is no longer on top of the worry list

then there are some patients, i had one, NOTHING had worked for weeks and he had still been eating in the beginning, he would not stop loosing liquid BM for days before he passed;

we are all different.....