Having surgery is stressful enough, but the constipation that often comes afterward can make the experience even more unpleasant. If you're preparing to have surgery or are already in the recovery phase and having trouble having a bowel movement, this article will help you understand what causes constipation after surgery and what you can do to get back to having normal bowel movements again.
What Causes Constipation After Surgery?
Unfortunately, there are a number of factors that increase your chances of developing postoperative constipation.
Food and Fluid Intake
Many types of procedures require that you not eat or drink anything immediately prior to the procedure and eat and drink only minimally afterward. Such dietary changes can throw your body off and affect your normal bowel habits. What's more, not drinking enough water adds less fluid to your feces. This can lead to hard stool, which makes it more difficult to have a bowel movement.
Many types of procedures require the use of general anesthesia. Besides putting you to sleep, general anesthesia also paralyzes your muscles. That includes the muscles that control peristalsis. And it can take several days after surgery for the intestines to fully wake up again.
Narcotic Pain Medication
One of the most common causes of constipation after surgery is the use of narcotic pain medications. Similar to the way general anesthesia paralyzes the gut, narcotics slow the gut down. This results in increases in both transit time and absorption of fluid into the bloodstream. Which means it not only takes longer for food to move through the gastrointestinal (GI) tract, but stool is also harder and more difficult to pass.
Lack of Physical Activity
It may not be the first side effect that comes to mind, but the physical inactivity that comes with surgery also plays a role in postoperative constipation. This is because exercise increases blood flow and stimulates the central nervous system, which helps the gut function normally. This is also what makes exercise helpful in the treatment of chronic constipation.
Individuals who are prone to having difficulty achieving regular bowel movements are more likely to suffer from postoperative constipation.
Symptoms of Constipation
While everyone's bowel habits are different—and every individual recognizes what's normal for them—there are certain symptoms of constipation to look out for when you've had surgery.
- Passing fewer than three bowel movements a week
- Straining during bowel movements
- Having hard stools
- Experiencing a sudden drop in the number of bowel movements
- Increased gas
- Abdominal pain
- Rectal pain
- Feeling of incomplete emptying
7 Ways to Prevent and Treat Constipation After Surgery
If you're still a few days out from a planned surgical procedure, the good news is that you have time to tune up your colon so it's better prepared to deal with the side effects of general anesthesia, narcotic prescription drugs, and postoperative inactivity.
How do you do this?
Make sure you're eating a high-fiber diet that's rich in fruits, vegetables, and whole grains. And be sure you're drinking plenty of water too.
The more fiber and fluid you can get into your system prior to surgery, the less chance you'll have of experiencing hard stools after your procedure.
If you missed the opportunity to up your fluid and fiber intake prior to surgery, there are still some things you can do to help stave off postoperative constipation.
1. Drink Plenty of Fluids
Making sure you're getting plenty of fluids every day is just as important after surgery as it is before. While water is usually best, fruit juices like prune juice can also be helpful in the management of constipation.
While most experts recommend drinking approximately 64 ounces of fluid each day, if you're taking narcotic pain medications after your surgery, you'll need to be drinking even more than that.
In addition, although it's traditionally been thought that caffeine following surgery is a recipe for dehydration and constipation, studies are beginning to suggest that, on the contrary, caffeine may actually help prevent constipation.
For example, a meta-analysis published in the journal Scientific Reports found that drinking a cup of coffee the morning after surgery reduces the:
- Amount of time it takes to have a bowel movement
- Amount of time it takes for gas to return
- Length of time it takes to return to solid food
- Length of hospital stay
What's more, a meta-analysis published in the Cochrane Database of Systematic Reviews found that chewing gum after surgery may also help wake up the GI tract by stimulating the same reflexes associated with eating and thus hasten the return to normal bowel movements.
2. Increase Fiber Intake
In the same way that increasing fiber intake prior to surgery can help you avoid postoperative constipation, upping fiber intake after surgery can also help you keep your GI tract running normally.
In addition to fruits and vegetables, fiber supplements like psyllium powder (found in Metamucil) can also be helpful. Just remember that increasing fiber intake without also increasing fluid intake can lead to constipation. So don't forget to stay hydrated.
When you're recovering from surgery, it's also a good idea to limit or avoid foods—think dairy products and processed foods—that are known contributors to constipation.
3. Eat Frequent Smaller Meals
Instead of overwhelming your system with three large meals, try eating frequent smaller meals instead. Eating smaller portions of food regularly throughout the day can also help keep your GI tract stimulated and encourage regular bowel movements.
4. Try Probiotics
The human GI tract is made up of trillions of different types of microorganisms, both good and bad. When the GI tract is functioning normally, the good microorganisms keep the bad ones in check. And this, in turn, helps keep us healthy and our bowel movements soft and regular.
So taking a probiotic supplement or eating plenty of probiotic-rich foods, including yogurt, sauerkraut, kimchi, and kefir, may help you avoid constipation after surgery. In fact, a meta-analysis published in the American Journal of Clinical Nutrition found that probiotics can "improve whole gut transit time, stool frequency, and stool consistency."
5. Get Moving
We discussed earlier that physical inactivity after surgery is one of the main contributors to postoperative constipation. So anything that gets you up and moving after your procedure will help get your GI tract functioning normally again.
Of course, if you've just undergone an operative procedure, we're not talking lots of heavy aerobic exercise. But, if it's all right with your health care provider, even walking around the hospital or your house can help get things moving again.
6. Keep Extra Help on Hand
Sometimes dietary changes and physical activity aren't enough to overcome postoperative constipation, so your health care provider may prescribe a stool softener, such as Colace (docusate), or recommend an over-the-counter laxative, such as:
- Senokot (senna)
- MiraLAX (polyethylene glycol)
- FiberCon (calcium polycarbophil)
- Milk of Magnesia (magnesium hydroxide)
Laxatives—especially stimulant laxatives—are most often used only as needed, but stool softeners can be used proactively to head off symptoms of constipation before they begin.
For all but the most severe cases of constipation, the combination of stool softener and laxative should be sufficient to achieve a normal bowel movement. However, if more help is needed, a suppository, such as bisacodyl (Dulcolax), or Fleet enema can be used as well.
7. Take Amino Acids
They may not be the first thing that comes to mind when thinking about ways to prevent and treat postoperative constipation, but amino acids are involved in almost every biological process that goes on in the body and play a crucial role in gut health.
In fact, amino acids help maintain proper functioning of the GI tract and even support healthy gut flora—which, as we discussed earlier, is vital for maintaining normal bowel movements.
What's more, studies show that taking in a balanced supply of amino acids has the added benefit of helping speed recovery from surgery.
When to Contact a Health Care Professional
With proper care, postoperative constipation can be reduced or even eliminated. However, some people may experience severe constipation after surgery that's difficult to treat. Without proper attention, prolonged chronic constipation can lead to complications, including:
- Fecal impaction
- Anal fissures
- Rectal prolapse
In addition, excessive straining while trying to have a bowel movement can cause heart rhythm abnormalities in susceptible patients or excessive stress on surgical incisions.
Therefore, if, after several days, you don't find constipation relief with conservative measures or you experience sudden abdominal cramping or pain or blood in your stool, don't hesitate to contact your health care provider immediately.