Constipation

When we're healthy, constipation is at the least annoying and at the worst, uncomfortable and painful. For people who are dying, constipation can be extremely uncomfortable and painful. 

Causes 

There are several causes for constipation and people who are at the end-of-life may have a combination of them, increasing their risk of becoming constipated and having a difficult time to relieve the constipation. Some causes of constipation are: 

• Being immobile, remaining in bed 
• Medications that have constipation as a side effect 
• Lack of appetite or not eating foods with fiber 
• Poor fluid intake 
• Overall weakness, making pushing difficult 
• Tumours or masses blocking the intestines 
• Hemorrhoids that cause pain when having a bowel movement 
• Difficulty reaching a toilet or commode 

Issues Associated with Constipation in Palliative Care 

When someone who is terminally ill is also constipated, the constipation can cause nausea, vomiting, pain, and a general feeling of not being well. Since the goal of palliative care is to make terminally ill people feel as comfortable as possible during the end-of-life stage, it's important to prevent constipation and relieve it effectively if it does occur. 

Preventing Constipation 

Prevention is the best medicine, the saying goes. So, part of the role of the palliative care team is to prevent constipation from happening in the first place. This can be done with use of: 

• Laxatives 
• Increased fiber in the diet 
• Increased fluid intake 
• Making toileting easily accessible, either by the patient or by quick response by the caregiver 
• Encouraging the patient to be as active as is possible 

Treating Constipation 

If a patient hasn't had a bowel movement within the set number of days according to the palliative care team's protocol, the patient may be given suppositories or enemas to try to stimulate the bowels. Sometimes, the stool (bowel movement) is in the lower part of the bowel but is too hard or firm to be pushed out. In that case, the nurse has to do a disimpaction, removing the stool with a gloved finger. 

When Constipation is Caused by a Blockage 

How constipation caused by a blockage is treated depends on the prognosis for the individual patient. Surgery to remove the blockage may be an option for patients who have a few months or more to live. Otherwise, comfort care is what is called for at this point. Trying to relieve the nausea and pain caused by the constipation is the most important issue. 

If the constipation is severe, a total blockage, it can happen that the patient may vomit fecal material (stool). This is very disturbing to both the patient and the family and friends. If this happens, mouth washes and quick clean ups are vital to help reduce the psychological effect of this problem.