Changes in Elimination During the Dying Process

As hospice caregivers, nurses, and managers, you provide comfort and dignity to patients nearing the end of life. One common challenge in hospice is managing changing in elimination, such as constipation, incontinence, and loose bowels in end-of-life care.

This article aims to provide practical hospice education on managing these concerns, considering care’s physical and emotional aspects. We’ll discuss maintaining patients’ comfort and dignity while addressing their bowel care needs and supporting their families.

hospice training for changes in elimination

Managing Constipation and Diarrhea in Hospice Care

As patients approach the end of life, changes in bowel patterns are common due to the slowing down of the body’s natural functions. Addressing these changes promptly and effectively is essential to maintain the patient’s comfort and prevent complications.

Constipation can be a significant source of discomfort for hospice patients. While they may not eat as much, waste materials must be eliminated. To address constipation, consider the following steps:

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  1. Continue administering laxatives and other treatments as part of the care plan.
  2. Monitor bowel movements and adjust treatment as needed.
  3. Encourage gentle physical activity if the patient is able.
  4. Ensure the patient stays well-hydrated.


Diarrhea can lead to skin irritation and ulceration, making meticulous perineal care vital for maintaining the hospice patient’s comfort. To manage diarrhea, consider the following:

  1. Monitor bowel movements and adjust medications accordingly.
  2. Provide appropriate skin care, including gentle cleansing and barrier creams.
  3. Encourage fluid intake to prevent dehydration.
  4. Offer emotional support and reassurance to the patient and family.
hospice training for changes in elimination holding hands

Addressing Bowel Incontinence End-of-Life Care

Incontinence can result from the relaxation of sphincter muscles as the body begins to shut down. It’s essential to address incontinence with sensitivity and understanding, as it can cause psychological distress for the patient and their family.

Maintaining Dignity and Comfort

Incontinence care should prioritize the hospice patient’s dignity and comfort. Here are some tips to help:

  1. Provide gentle and thorough perineal care to prevent skin breakdown.
  2. Use appropriate incontinence products like pads or briefs to manage leakage.
  3. Change soiled clothing and bedding promptly to maintain cleanliness.
  4. Offer emotional support and reassurance to the patient and family.

Supporting Family Members

Family members may find incontinence care challenging and emotionally demanding. As a hospice professional, supporting them during this time is crucial. Consider the following approaches:

  1. Educate family members about incontinence care, address their concerns, and answer questions about end-of-life bowel movements.
  2. Assess the family’s ability and willingness to provide incontinence care and adjust the care plan accordingly.
  3. Increase hospice aide or certified nurse aide visits to assist with incontinence care if necessary.
  4. Explore alternative caregiving options, such as professional caregivers or volunteers, if family members cannot provide care.

Considering Indwelling Catheters

Indwelling catheters should be used as a last resort. Still, they can provide comfort and relief for patients and families struggling with incontinence care. Weigh the risks and benefits carefully, and consult with the patient, family, and hospice team before deciding.

Managing bowel issues and incontinence in hospice care requires a compassionate and knowledgeable approach. You can help patients maintain their dignity and comfort during their final days by addressing these concerns with sensitivity and expertise. 


Understanding how to assess, treat, and manage hospice patients during end-of-life care is essential in providing compassionate care. Consider hospice training online for you and your hospice team to learn these skills. Online training offers flexible and self-paced courses covering symptom management, end-of-life care, and communication with patients and families.


What happens to bowels at end of life?

At the end of life, bowel function often declines as the body’s systems shut down. This can lead to decreased muscle control, resulting in incontinence or constipation. Additionally, food and fluid intake may decrease, causing stool to become hard and dry. Hospice caregivers can manage these issues with appropriate interventions, such as medication, gentle exercise, or increased fluid intake. Ultimately, bowels become less active, and bowel movements cease as the body approaches the final stages of life.

What is uncontrolled bowel movement before death?

Uncontrolled bowel movement in end-of-life care, also known as terminal bowel incontinence, is caused by losing control of rectum muscles. Terminal bowel incontinence can happen due to muscle relaxation or a loss of consciousness near the end of life. Patients may involuntarily release feces during the dying process, making it common.

How often should hospice patients have bowel movements?

The frequency of bowel movements for hospice patients varies based on individual needs, medical conditions, and medications. Patients should have a bowel movement at least every 2-3 days. However, please consult the hospice care team to determine the appropriate frequency for each patient. They can offer personalized recommendations and help manage any constipation or bowel-related concerns.

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