Causes and Treatment of End-of-Life Diarrhea in Hospice

Understanding End of Life Diarrhea in Hospice Care

Hospice nurses, caregivers, aides, and managers are crucial in managing symptoms like diarrhea for patients nearing the end of life. This article provides practical guidance on assessing, managing and treating diarrhea to ensure the best possible quality of life for patients under your care.

hospice nurse helping patient with end of life loose bowels

The Significance of Diarrhea in Hospice Patients

Diarrhea in hospice patients is more than a mere physical symptom; it holds significant implications for both the quality of life and the overall care approach in a hospice setting.

Understanding the Impact

The occurrence of diarrhea in hospice patients can be distressing and can significantly affect their comfort and dignity. It’s not just a physical issue; it has emotional and psychological dimensions as well:

  • Physical Discomfort: Frequent, uncontrolled bowel movements can lead to discomfort, pain, and complications like skin irritation and breakdown.
  • Emotional and Psychological Impact: Dealing with diarrhea can be emotionally taxing for patients, potentially leading to feelings of embarrassment and a decreased sense of dignity.
  • Caregiver Challenges: For caregivers, managing diarrhea in hospice patients requires extra time, effort, and resources, impacting the overall care experience.
Tailoring the Approach to Care

Tailoring the Approach to Care

Managing diarrhea in hospice care involves a personalized and empathetic approach:

  1. Assessment and Monitoring: Regularly monitoring the patient’s bowel movements is crucial for timely intervention.
  2. Diet and Nutrition: Adjusting the patient’s diet to include foods less likely to aggravate the digestive system can be helpful.
  3. Medication Management: Review and adjust medications to minimize diarrhea risk while ensuring well-managed pain and symptoms.
  4. Support and Reassurance: Providing emotional support and reassurance to patients and their families is essential. It’s crucial to address the emotional and psychological impacts of diarrhea in a hospice setting.

Causes of Loose Bowels in End-of-Life Hospice Care

Diarrhea can result from various factors, including:

  • Laxative use
  • Chemotherapy or radiation therapy-induced inflammation of the mucosa
  • Infections (including C-Diff)
  • Certain types of cancer (colon, pancreatic, biliary, lymphoma)
  • Short bowel syndrome
  • Post-surgical complications (colon resection, cholecystectomy)
  • Inflammatory bowel disease
  • Viral infections
  • Fecal impaction
  • Food intolerance
  • Medication side effects
  • Psychological factors
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Assessing End-of-Life Diarrhea in Hospice Patients

To effectively manage diarrhea, it is essential to conduct a thorough assessment. Consider the following during your evaluation:

  • Onset, duration, and frequency of diarrhea
  • Factors that worsen or alleviate the symptoms
  • Timing of diarrhea episodes
  • Underlying diseases or illnesses
  • Medications, radiation therapy, and diet
  • Previous bowel movements and routines
  • Associated symptoms (nausea, cramping, fever, gas)
  • Anxiety and social/spiritual concerns
  • Medical equipment needed (BSC, bedpan, etc)
  • Impact on functionality and quality of life

Conduct a physical examination to evaluate the patient’s appearance, bowel sounds, abdominal tenderness, signs of dehydration or infection, stool characteristics, and perianal skin integrity.

hospice nurse helping patient with end of life diarrhea

Non-Pharmacological Interventions for Loose Bowels

Managing diarrhea involves a combination of non-pharmacological and pharmacological interventions. Non-pharmacological interventions include:

  • Stopping the offending agent (if possible)
  • Implementing a clear liquid or BRAT diet (bananas, rice, apples, tea, toast)
  • Avoiding stimulating agents (caffeine, lactose products, spicy food, high fiber or high-fat foods)
  • Eating small, frequent meals instead of large ones
  • Avoiding fresh fruits and vegetables
  • Ensuring hydration and electrolyte replacement (Gatorade®, Pedialyte®, broth, caffeine-free soft drinks)
  • Advancing the diet slowly as diarrhea subsides
  • Maintaining perianal skincare

Pharmacological Interventions for Diarrhea in Hospice Patients

Pharmacological treatment should focus on addressing the underlying cause of diarrhea whenever possible. Some commonly used medications include:

  • Lomotil (Diphenoxylate/Atropine) or Imodium (Loperamide) for non-infectious diarrhea
  • Flagyl (Metronidazole) or Vancomycin for C-Diff-induced diarrhea
  • Levsin (Hyoscyamine) for cramping symptoms related to diarrhea
  • Cholestyramine or psyllium (Metamucil) for radiation-induced enteritis
  • Mesalamine for ulcerative colitis flares
  • Pancrelipase for pancreatic insufficiency-induced diarrhea
How to Manage Diarrhea in Bedridden Patients?

Terminal Cancer and Diarrhea: Understanding the Link

In the journey of terminal cancer, one symptom that often arises yet is less frequently discussed is diarrhea. This condition can significantly affect a patient’s quality of life, making its management a crucial aspect of hospice care.

Why Diarrhea Occurs in Terminal Cancer

Diarrhea in terminal cancer patients can be attributed to a variety of factors:

  • Treatment Side Effects: Chemotherapy and radiation, standard cancer treatments, can damage the lining of the digestive system, leading to diarrhea. Certain medications used for pain management may also disrupt normal bowel function.
  • Metabolic Changes: As cancer progresses, the body’s ability to absorb nutrients efficiently can diminish. This malabsorption can lead to loose, frequent bowel movements.
  • Direct Impact of Cancer: Some cancers, particularly those affecting the digestive system, can directly cause diarrhea by disrupting normal gastrointestinal function.

Managing Diarrhea in Terminal Cancer Patients

Effective management of diarrhea in hospice care requires a multifaceted approach:

  1. Medication Adjustment: Oncologists and hospice care providers may need to modify the patient’s medication regimen to reduce the incidence of diarrhea.
  2. Dietary Management: Simple dietary changes, like incorporating more soluble fiber and avoiding foods that irritate the digestive system, can help.
  3. Hydration and Electrolyte Balance: Maintaining fluid and electrolyte balance is vital, as diarrhea can quickly lead to dehydration.
  4. Comfort Measures: Beyond physical interventions, ensuring patient comfort through gentle, compassionate care is vital.

Team Collaboration and Ongoing Evaluation

Collaborate with your hospice team to assess, intervene, and educate the patient and their family about managing diarrhea. Evaluate and document the patient’s symptoms at each visit until resolved, and consider discontinuing medications as symptoms improve.

Boost Your Hospice Team’s Skills with Training

Learning to assess, treat, and manage end-of-life diarrhea is crucial for delivering empathetic hospice care. Consider online hospice training for you and your team to acquire these skills. Online courses provide flexible, self-paced learning on symptom management, end-of-life care, and effective communication with patients and families.

FAQ

Why Is Diarrhea Common in Terminal Cancer Patients?

Terminal cancer patients often experience diarrhea due to treatments like chemotherapy or side effects from pain medications. Managing this involves adjusting medications and dietary changes to ensure patient comfort.

What Happens to Bowel Movements at the End of Life?

At the end of life, bowel movements can change, becoming less frequent or looser due to reduced food intake and slower metabolic processes. Caregivers need to adapt care for these changes to maintain patient comfort.

How to Manage Diarrhea in Bedridden Patients?

Diarrhea in bedridden patients requires careful management to prevent dehydration and skin issues. Monitoring hydration, adjusting diet, and using skin protective measures are important.

What’s Unique About Managing Diarrhea in Elderly Hospice Patients?

In elderly hospice patients, managing diarrhea involves balancing medications and diet to avoid dehydration and maintain comfort. Tailored care plans are essential due to their increased sensitivity to these symptoms.

Can Someone Die from Diarrhea, Especially in Cases of Terminal Cancer or at the End of Life?

While diarrhea itself is rarely a direct cause of death, in hospice patients, particularly those with terminal cancer, it can contribute to a significant decline in health. Prolonged diarrhea can lead to severe dehydration, electrolyte imbalances, and malnutrition, all of which can exacerbate the already fragile health of a patient in hospice care. Moreover, diarrhea can be a symptom of a more serious underlying condition, such as an infection or organ failure, which can be life-threatening in advanced stages of illness. Therefore, careful management and monitoring of diarrhea in terminally ill patients are essential for maintaining their comfort and quality of life.

What Are the Signs of Impending Death Related to Bowel Movements?

As life nears its end, changes in bowel movements, including diarrhea, can be observed. These changes can be indicators of the body’s gradual shutting down. Decreased food intake and slowing digestive processes often lead to less frequent bowel movements or constipation. Conversely, diarrhea may occur due to medication side effects or as a natural response to the body’s declining ability to absorb nutrients and regulate bowel function. Caregivers and hospice professionals must be aware of these signs, as they can provide critical insights into the patient’s comfort and care needs during their final days.

Why Does a Dying Person Experience Changes in Bowel Movements, Such as Diarrhea?

In the final stages of life, the body’s systems, including the digestive system, undergo several changes. This can result in various symptoms, including increased or loose bowel movements. Factors such as medication side effects, reduced physical activity, and changes in metabolism can all contribute to these symptoms. Additionally, as the body’s overall function declines, organs like the bowel can become less effective at processing waste, leading to diarrhea or constipation. Understanding and managing these symptoms is crucial to providing compassionate end-of-life care, ensuring that the patient’s dignity and comfort are maintained.

Is diarrhea normal at end of life?

Yes, diarrhea is a normal symptom at the end of life. Medication side effects, infections, or organ failure typically cause diarrhea. Monitoring and managing the condition ensures the individual’s comfort and dignity. Consult a healthcare professional for appropriate treatment and care.

What are bowel movements like at end of life?

At the end of life, bowel movements may become irregular due to decreased food intake, reduced mobility, and medication side effects. They may become infrequent, smaller, or harder, leading to constipation. In some patients, loss of control over bowel movements can result in incontinence.

References

Clinical Practice Guidelines: The Hospice of the Florida Suncoast (2008).

Economou DC. Bowel management: constipation, diarrhea, obstruction and ascites.

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Grauer P, Shuster J & McCrate-Protus B. (2008). Palliative Care Consultant: A reference guide for palliative care 3RD ed.

Kendall/Hunt publishing, 2007.

Kuebler KK, Davis MP & Moore CD. (2005). Palliative Practices: An Interdisciplinary Approach. Elsevier/Mosby: Missouri.

McEvoy, GK, Editor, AHFS Drug Information-2003. American Society of Health-System Pharmacists, Bethesda, MD, pp.2740-41

Mercadante, S in Principles and Practice of Palliative Care and Supportive Oncology. 2nd Edition, Lippincott, pp 233-237

Saunders DC. Principles of symptom control in terminal care. Med Clin North Amer 66: 1175, 1982.

Sykes, N, Diarrhoea. In: Doyle D, Hanks G, Cherny N, Calman K eds Oxford 

Textbook Palliative Medicine. 3rd ed. pp. 490 -496, Oxford University, 2005.

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