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Yesterday the hospice nurse said Mom is beginning the transition to the active dying stage. At the time, Mom's breathing was shallow and slow and she did not detect any bowel sounds. A couple hours later mom woke up, she was talking and able to eat a few bites of lunch. Besides an occasional pebble, she hasn't had a definable BM in 9 days, even with laxative and fiber supplement. The hospice nurse also said she was "not quite there yet" as in active dying. Mom has always had sleep apnea, so it's difficult to tell if her breathing patterns mean anything at all. I know there's no time table or crystal ball and I have probably already answered my question, but I'm just confused and concerned.

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After my son had surgery for a perforated intestine he developed a scar tissue blockage- one of the signs was no bowel sounds. Not treated it can eventually lead to death. However, if your mother is not eating or drinking, this too can greatly reduce any sounds.

When my mothers hospice nurse called to let me know my mom was "transitioning" he cited her oxygen level which was at about 70%. He said that at that level moms major organs would begin to shut down and said to expect my moms passing in a few days to a week. Mom passed away about 18 hours later.

Right after the hospice nurse called me I went to see my mom. Mom was fully dressed, sitting in her recliner, asleep. It could have been any other day if it weren't for her breathing. You mentioned your mothers sleep apnea- saying you couldn't tell anything because of that. If your mother begins the type of breathing that hospice folk refer to - you'll know it. There is a name for it that I can't recall right now - but the breathing pattern is very distinctive. It's a shallow type of breathing and the rise and fall of the chest if very pronounced - then the breathing will suddenly stop - after an eternity it begins again and the random pattern repeats. The first time it happened while I was there - I thought my mom had passed away - right before me as I sat with her. The next time it happened I counted - up to 30 before it started again. My husband has sleep apnea and there was no way I could confuse the two.

I'm sorry your going through this very difficult time - it can be excruciating. Take care.
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If she's dying from kidney disease or liver disease, then the body releases toxins which will affect her mind/mental clarity and breathing; her breathing will become more labored as the toxins continue to build-up. She'll have some good moments but eventually, she'll just stop all together...it can be a while. If you haven't done so already, please talk to the hospice nurse about pain management. She may be in pain but can't verbalize. It wouldn't hurt to consider just a few drops of morphine but this can slow down her bowel function even more so you have think about her quality of life at this point. Does it matter if she has no bowel movements but is in no pain? I'm only speaking for myself, I want my mother to have absolutely no pain if possible and if this means slowing down the bowels even more than they already are, then I'm good with this because she's already in active dying process. As for no detectable bowel sounds, you can for a very long time - like a month or even longer like up to eight weeks or maybe even longer with no sounds which means no muscle contraction which means no bowel movements. What may happen is that she'll develop fecal impaction which can lead to bowel perforation and left untreated can lead to sepsis and then ultimately death. I know with death from kidney disease, the patient just closes their eyes and goes to sleep - and doesn't wake-up again. To put your mind at ease, it's the least painful way to go because her brain is flooded with toxins so she's not "feeling" what's actually going on. As for the urine odor, this can be a sign of kidney failure. If you haven't witnessed the dying process before, it can be a long while or it can be days...it's all dependent on the body and how it chooses to respond. The best you can do is just be at her side and hold her hand and kiss her and tell her in her ears that you love her and make sure she is as comfortable as possible. I remember reading years ago hearing is the last thing a person experiences before actually dying. I don't know if this accurate, but I'll never forget this. Your lucky to be with her because you'll have peace knowing you did all that you could for her - and most importantly - she knows this. I believe people who are in the active dying process, can feel the love of family and friends nearby - and this gives them a tremendous amount of comfort as their body prepares to transition to "other side" or whatever they believe. :-)
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The end stage breathing that Rainmom was referring to is called Cheyne-Stokes breathing or simply, "end stage breathing".  It's also sometimes referred to as "agonal breathing" or "agonal respiration".  
It's the body's response to lack of oxygen and the organs shutting down due to lack of oxygen/circulation. You may see very shallow breaths, gasping, or long periods without a breath at all, which may lead you to think they're gone - then they'll suddenly take another breath. It's just the body slowly shutting down. I've always thought of it this way: we are born and have to learn to breathe - then we breathe for many, many years before we die. The body simply takes a while to let go of that natural reflex that its been doing for so long.
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Absolutely agree with above - but I'll take it a step further. The shut-down of the body is a complicated multi-factoral process of catabolic and metabolic breakdown. Imagine when you injure yourself; you see a red swollen bruise. Underneath this bruise is a very, very complicated process of an internal war to heal that injury. The actual injury is a result of toxins released from the physical impact. These toxins signal the body it needs help now at the site of injury. The body doesn't like these toxins and responds by sending a bunch of oxygen other repair cells to fight the circulating toxins and repair this physical injury at the bruised site. This is basically what's happening to your mother. Her organs haven been "bruised" internally due to whatever disease process is taking her, then these organs are releasing toxins to let the rest of the body know that they're in trouble - to help them now - so oxygen (and its nutrients) and other repairing cells from the immune are rushing like mad to this organ's site to fight this breakdown/injury while simultaneously trying to catch these toxins that continue to circulate as other organs are also shutting down from the internal disease process, thus releasing even more and more toxins. Our bodies don't want to die, actually. That's why the body will send oxygen and other repair cells to any injured site. The body will desperately attempt to fight and fight the toxins by pumping as much oxygen as it can - but if your mother has conditions related to anemia then this one reason why there's not enough oxygen for the ultimate fight. But these toxins don't care so they keep building up from non-stop multi-organ breakdown. Toxins/food/water/medicine, etc is expelled though the kidneys and the rectum so with the little urine output and reduced bowel motility, the toxins continue to build-up. The body will continue to pump out that oxygen and its nutrients for as long as it can depending it's reserve system. It's a viscous cycle with no timeline, unfortunately. Eventually, all organs shut-down. Those labored breaths means your mother's body is trying to hold-on to that oxygen in its fight for survival against the toxins from the all-over cellular/tissue death. Your mother's body still has some will which can explain why she's going in and out but ultimately, there's just way too much catabolic and metabolic breakdown from whatever disease process is taking her body. And then it's death. This is how the hospice doctor explained to me what was going on with my father because I never experienced the death of a family member - and it absolute torture for me to see him struggle for breaths. I actually still have nightmares from this experience.
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Does she have hypothyroid disease or high blood sugar (either from an infection or from diabetes)? When both of these are not effectively managed, they slow down the muscle contractions so a much delayed bowel movement can happen. My mother has both issues, I'm very well educated in this area. :-) She didn't have a good BM - for three weeks, then all of sudden she passed A LOT of stuff at three separate times - before then, it was little pieces her and there. Unfortunately, hospice doesn't approve a lot of diagnostic testing. They probably removed all of her medications, right? But in the dying process, in general, everything just slows down. My mother isn't on hospice yet so I don't know if they will approve Lactulose. It's by prescription only. This is used to get the bowels going. Google it to read up on it or call your local pharmacist to ask about this. Call the hospice now and see if they will order it. Ask them if they will order an x-ray of the abdomen. Some hospices will, but some won't. Maybe your mother's won't because they've decided she's in the active dying stage. It doesn't hurt to ask them. My thoughts are with you. It's very hard to see a loved one go through the dying process.
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Thank you for your responses and suggestions. However, I do not think tests or x-rays are necessary at this point as mom is so close to the end. Perhaps my question is more about how long can a person live without any detectable bowel sounds. I am also confused because mom will experience a few signs of the active dying stage then they disappear. For example, She will be lucid for a few hours then turns on a dime and starts calling for her sister and her breathing becomes labored. A few hours later she's just fine again. And there's the fact that her urine has a very strong odor. We encourage her to drink, but she is not getting nearly enough and I'm sure her kidneys are suffering because of it. It's like watching a horror movie while riding a roller coaster.
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