Bowel and bladder problems when you’re living with a terminal illness

If you're living with a terminal illness, you may have problems with your bowel and bladder. These could be caused by your condition, or might be a side effect of some treatments.

On this page:

Words we use on this page

We use the words poo and pee throughout this page. Some people might use other words or phrases instead. For example, going for a wee, or passing urine, instead of pee. And faeces, opening your bowels, or having a bowel movement, instead of poo or going for a poo.

Constipation when you have a terminal illness

Constipation is a known symptom in people living with a terminal illness. Constipation can include:

• straining or experiencing pain when having a poo
• being unable to completely empty your bowel (having some poo left inside)
• going for a poo less often than normal.

How often people go for a poo is different for everyone. What is usual for you might be different to what is usual for someone else.

You might also have poo that is dry, hard or lumpy, and unusually big or small. It is also possible to be constipated and have normal or soft poo.

If you feel you are constipated but have liquid leaking from your bottom, you could have something called overflow diarrhoea. Read our information about overflow diarrhoea.

What causes constipation when you have a terminal illness?

There are many possible causes of constipation. Sometimes it can be caused by more than one thing, and sometimes there is no clear cause.

Causes of constipation when you're living with a terminal illness include:

• Medications. Constipation is a side effect of several medications, including opioid painkillers such as codeine, morphine, and oxycodone.
• Changes in diet.
• Dehydration. This is when your body loses more fluids than you take in. For example, if you are unable to drink enough fluids, being sick, or sweating a lot.
• Moving less. You may be spending less time standing up and moving about, and spending more time sitting down or in bed.
• Feeling weak or breathless. This can make it hard to get to the toilet, and to have enough energy to go for a poo.
• Not having privacy. For example, if you live or are being cared for outside of your home, or if someone helps you when going to the toilet.
• Having to adapt to changes in going to the toilet. For example, if you need assistance, use a commode, or cannot sit comfortably on a toilet.
• Ignoring the feeling that you need a poo.
• Your illness. Constipation can be a direct effect of your terminal illness.
• Other health conditions. For example, irritable bowel syndrome (IBS), diabetes, and conditions that affect the brain, spinal cord and nerves (neurological conditions).

It's a good idea to speak to your health and social care professionals if you have another condition that affects your digestive system. It's important they understand how you manage your condition, and what does and does not work for you.

Managing constipation when you have a terminal illness

Here are things you can do to try to avoid or help with constipation:

Food and drink

• Drink more fluids, such as water, diluted squash, and fruit juice (unless a healthcare professional has advised you not to drink fruit juice).
• Eat foods containing fibre, such as high fibre breakfast cereals, wholemeal bread, fruit and vegetables, and beans and pulses.

It may not always be right or possible for you to increase the amount of fibre in your diet. This may apply if you are already following a special diet, or if you are not able to eat or drink enough. Check with your nurse, doctor or a dietitian before changing your diet.

Activity and routines

• Keep as active as possible. Even gentle movement can help you poo regularly.
• Try to keep a regular routine for going to the toilet and avoid rushing.
• Go to the toilet when you feel the urge. Ignoring the urge to go could make your constipation worse.

Adaptations and support

• Rest your feet on a low stool while sitting on the toilet. This may make it easier to poo. Raise your knees above your hips if you can.
• If you need help to go to the toilet, talk to the person helping about what kind of support you would like.

Medicines

If you've been prescribed laxatives, take them as your doctor or specialist nurse has told you to. And let them know if there are any problems stopping you from taking them. Read our information about laxatives. 

When to see a healthcare professional about constipation

You should talk to your doctor or nurse if you have not gone for a poo for longer than is usual for you – this is different for everyone. If you have tried the suggestions above and your constipation has not improved, it's important to tell them this.

You should also tell your healthcare professional if you:

• have pain in your tummy or bottom
• feel sick or have been sick
• have bleeding from your bottom
• pass a watery poo after having constipation.

They can assess whether there's a particular cause, discuss if you need any treatment (such as laxatives) and give you advice.

Taking laxatives when you have a terminal illness

Laxatives are a type of medication that can treat and prevent constipation. Your doctor or specialist nurse might recommend laxatives if your constipation does not improve after trying to manage it yourself. Read our information about managing constipation.

Your healthcare professional should prescribe laxatives when prescribing medications that are likely to cause constipation, such as opioids. Opioids are a group of painkillers, which include codeine, morphine, and oxycodone.

Laxatives are not suitable for everyone. Visit NHS.UK for general information about laxatives.   However, please be aware the information on the NHS.UK page about laxatives is general advice, and might not be right for you. It's important to check with your healthcare professional before trying new medicines.

Diarrhoea when you have a terminal illness

Having diarrhoea means your poo is loose or watery, and you poo more often than is usual for you.

You may also feel the need to go to the toilet urgently or struggle to get to the toilet in time.

Diarrhoea can make you lose fluids, which might make you feel thirsty and tired. You may also get headaches and pee less often.

What causes diarrhoea when you have a terminal illness?

Causes of diarrhoea in people living with a terminal illness include:

• some medications, including having too much laxative
• long term constipation, which can cause overflow diarrhoea
• side effects of some treatments, including radiotherapy to the abdomen (tummy)
• your illness
• infection
• diet, including eating too much fibre – if you're experiencing diarrhoea and your diet has not changed, it's unlikely this is the cause
• other health conditions, for example inflammatory bowel disease, irritable bowel syndrome (IBS), and diabetes.

It's a good idea to speak to your health and social care professionals if you have another condition that affects your digestive system. It's important they understand how you manage your condition, and what does and does not work for you.

Managing diarrhoea when you have a terminal illness

Here are things you can do that may help with diarrhoea:

Food and drink

• Drink more fluids, such as water and diluted squash.
• Eat solid foods when you feel able to.
• Avoid fruit juice or fizzy drinks, as these can make diarrhoea worse.

If you have questions about what to eat, speak to your nurse or doctor. They might advise you to eat simple carbohydrates such as toast or crackers for the first few days. If you had diarrhoea due to an infection, they may also suggest avoiding dairy for a short time.

Medicines

Your nurse or doctor can advise whether you can take anti-diarrhoea medicine, and explore other possible treatments. It's not recommended that you take anti-diarrhoea medicine without seeing a doctor or nurse first as, in some cases, it can make things worse.

When to see a healthcare professional about diarrhoea

Most cases of diarrhoea clear up within a few days without treatment.

You should talk to your nurse or doctor if you are worried about your diarrhoea, you feel unwell, or you are finding your diarrhoea hard to manage. You might need to provide a poo (stool) sample to be tested for different causes.

Overflow diarrhoea when you have a terminal illness

Overflow diarrhoea happens when watery poo leaks out around a blockage caused by long term constipation.

Long term constipation can cause poo to build up and cause a blockage in your rectum. The rectum is the last part of your large bowel. Because of this, the bowel leaks out watery poo around the blockage, from higher up in the bowel. This leak can look like diarrhoea.

Your healthcare professional may assess you, to work out the best treatment for you.

Bowel obstruction when you have a terminal illness

A bowel obstruction is when the bowel is partly or completely blocked. This means poo cannot move through the bowel. This can happen quite suddenly or develop gradually over days or weeks.

Symptoms of bowel obstruction can vary depending on the type of obstruction and where it is. Symptoms of bowel obstruction in people living with a terminal illness include:

• constipation, or a mix of constipation and diarrhoea
• tummy pain – this might be continuous, or may feel like a cramping pain that comes and goes
• feeling sick or being sick
• not passing wind (also called flatulence or farting)
• feeling bloated.

What causes bowel obstruction when you have a terminal illness?

Bowel obstruction can happen if the bowel is not working properly, or if something is physically blocking the bowel.

Causes of bowel obstruction in terminal illness include:

• the illness itself – for example, if you have cancer and a tumour that blocks the bowel
• severe constipation
• the bowel moving slowly, which can be caused by some medications, treatments, or other health problems
• complications of surgery.

Managing bowel obstruction when you have a terminal illness

Treatment for bowel obstruction depends on the situation and your illness. You may have painkillers and anti-sickness medicines given as injections, to help you feel better. In some situations, an operation is needed to treat bowel obstruction.

Bladder problems when you have a terminal illness

People living with a terminal illness may experience some bladder problems, including:

• pain – for example pain when peeing, or pain in or around your bladder
• needing to pee more often
• not being able to pee (known as urinary retention)
• not having control over when you pee (known as urinary incontinence)
• bladder spasms
• blood in your pee
• infections, known as urinary tract infections or UTIs – normally caused by bacteria entering the tube that carries pee out of the body (the urethra).

What causes bladder problems when you have a terminal illness?

Lots of things can affect the way your bladder works. Causes of bladder problems in people living with a terminal illness include:

• illness – for example cancer, conditions that affect the brain, spinal cord and nerves (neurological conditions), and diabetes
• treatments such as radiotherapy, chemotherapy, surgery, and some medications
• constipation
• infection.

Managing bladder problems when you have a terminal illness

It's important to remember your healthcare professionals will want to know about any problems you're experiencing and will want to help. Speak to your nurse or doctor if you notice changes in your bladder habits, or if you get any new symptoms.

They can check if there's a specific cause and recommend appropriate treatment. The treatment you have will depend on the problem you're experiencing, but could include:

• painkillers
• antibiotics (medicines used to treat infection)
• inserting a catheter – this is a tube that carries pee from the bladder to a drainage bag, and can be used to treat urinary retention and incontinence.

It's a good idea to speak to your health and social care professionals if you have another condition that affects your bladder. It's important they understand how you manage your condition, and what does and does not work for you.

Catheters

If you need a catheter and live at home, a district nurse or specialist nurse may be able to insert this for you. Some people may need to have their catheter inserted in hospital by a doctor.

Your healthcare professional will give you information about catheter equipment and care, and talk to you about who will help you care for your catheter. If appropriate for your situation, they may also show you or your carer how to manage your catheter.

You can generally get catheter equipment on prescription from pharmacies. Visit Bladder & Bowel Community for information about catheter care and equipment.  

Incontinence when you have a terminal illness

Incontinence means not having control over when you go for a poo (stool or bowel incontinence) or when you pee (urinary or bladder incontinence).

Having incontinence can affect people emotionally, socially, and sexually. It may also affect people financially, for example if they need to buy incontinence products or do more washing. Find out if you can get financial help like benefits or grants.

Lots of people avoid seeking help because they feel embarrassed or anxious. But it's important to know the healthcare professionals looking after you are used to helping people with incontinence. And there are many products and ways to help manage your symptoms with dignity.

Continence assessments

You might need a continence assessment. This could be done by a district nurse if you have one, or you may be referred to a continence team. The assessment may include:

• a review of your symptoms
• some physical examinations
• looking into treatment options.

Some examples of treatment include using a catheter to manage urinary incontinence, or having a bowel management plan to manage stool incontinence. Treatment should be based on your needs and preferences, to make sure you're happy and comfortable with the suggested treatment options.

The person doing the continence assessment will:

• tell you how to get incontinence products such as pads and pants
• advise you on how to manage incontinence at home
• look at how to make it easier for you to go to the toilet – this might include ordering equipment like a commode or toilet seat raiser.

Read Bladder & Bowel UK's information about incontinence and continence products.   You can also contact the Bladder & Bowel UK helpline on 0161 214 4591.

If you are caring for someone who has incontinence, you might find it helpful to read our information on helping someone to use the toilet.

Bowel and bladder problems at the end of life

Thinking about the end of life can be hard. If you do not feel ready to read this information, you can come back to it at any time.

The bowel and bladder problems we speak about on this page can also affect people in the final stages of their illness. Everybody is different – some people may experience some or none of these problems.

Towards the end of life, people may struggle to pee or to get up to use the toilet. How this is managed will depend on the person's situation and preferences. For example, they may use a commode, bedpan, pads, or have a catheter fitted.

Some people may go for a poo less frequently towards the end of life. This can happen if someone is eating and moving about less, which is normal when someone is in the last few days of their life.

End of life bowel incontinence and bladder incontinence may also happen, as the person's muscles relax.

The final days and hours of life

Bowel and bladder problems can change in the final days and hours of someone's life. This is because, at this stage, people tend to sleep more and are likely to have all their care in bed.

Bowel and bladder problems that do happen at this stage can be managed with good nursing care, that focusses on making sure the person has dignity and comfort.

Getting support

Dealing with bladder and bowel problems can feel isolating and upsetting. If you would like to speak to someone about how you're feeling, contact the Marie Curie Support Line on 0800 090 2309. Read more about the Marie Curie Support Line.

If you feel it would be helpful to speak to one of our Information and Support Nurses, please let the Support Line know and they can arrange a call back for you.

Useful websites

• Bladder & Bowel UK – provides information about bladder and bowel problems, and offers confidential advice on their specialist helpline.  
• Bladder & Bowel Community – provides support, information and guidance for people with bladder and bowel conditions, their carers, relatives, and friends.  
• NHS website – constipation