Constipation is common in dying patients because of inactivity, opioid and anticholinergic drugs, and decreased fluid and dietary fiber intake.
Laxatives help prevent fecal impaction, especially for those receiving opioids, and all patients should be asked about their bowel habits.
Most patients do well on a twice-daily regimen of stool softener (docusate) combined with a mild stimulant laxative like casanthranol or senna.
Patients who experience cramping discomfort on stimulant laxatives may respond to increased doses of docusate alone or to an osmotic laxative like lactulose or sorbitol (which is much cheaper and equally effective), started at 15 to 30 mL bid and titrated to effect.
Patients with soft fecal impaction may be given a bisacodyl suppository or saline enema.
For hard fecal impaction, before digital disimpaction a mineral oil enema may be given, possibly with a short-acting benzodiazepine (eg, lorazepam) or with an analgesic.
After disimpaction, patients should be placed on a vigorous bowel regimen to avoid recurrence.
Regular bowel movements are vital to the comfort of a dying patient.