Managing Constipation After Surgery: Tips and Techniques

Surgery is always a stressful experience for the patient and takes a big toll on the body. One of the common side effects of surgery is constipation, which can occur as a complete shock for the patient if they do not expect it. Constipation after surgery increases the discomfort associated with the healing process; however, there are different ways to manage constipation after surgery.

Some of the common symptoms of constipation are ^{(1, 2)}:

• Having an abrupt decrease in the bowel movements.
• Experiencing lesser than three bowel movements in a week.
• Having to strain during bowel movements.
• Increased gas or bloating.
• Experiencing hard stools.
• Having rectal or abdominal pain.
• A feeling of incomplete emptying even after having a bowel movement.

If these symptoms are present after the surgery, then your doctor will guide you in managing the constipation.

Some of the contributing factors to constipation after surgery are ^{(1, 2)}:

• Having general anesthesia.
• The use of narcotic pain relievers, like opioids ⁽²⁾.
• Trauma or infection.
• Prolonged inactivity experienced after having the surgery.
• Having fluid, electrolyte or glucose imbalance.
• Dietary changes where there is less intake of fiber.

Changes in diet and lifestyle go a long way in preventing constipation after surgery or reducing its duration ^{(1, 2)}.

Get Up and Move About: As soon as your doctor gives you the go-ahead, get moving. You can start by walking for few minutes daily. In case of knee replacement surgery, then physiotherapy or exercise is going to be a part of the treatment program, which will help with constipation after surgery. This can also help with the overall healing process after the surgery along with reducing the risk of blood clots.

Medication Adjustments: The narcotics given after surgery reduce the motility of the gut, which leads to constipation, so it is better to limit the use of these. According to studies, about 40% of patients experience constipation when they take opioids and this is known as opioid-induced constipation ⁽³⁾. If the postoperative pain is bearable, then with the approval of the doctor, use painkillers, such as acetaminophen or ibuprofen instead of narcotics to prevent constipation after surgery.

Diet Pre and Post Surgery: Consuming a fiber rich diet before the surgery helps in decreasing the overall risk of constipation and also in turn helps in preventing constipation after surgery. Drinking lot of fluids before and after surgery helps in preventing and managing constipation after surgery. The addition of prune juice or prunes to post-surgery diet helps in constipation after surgery. A fiber rich diet consists of: fresh fruits, whole grains, beans and vegetables.

Foods to avoid after surgery to reduce the risk of constipation are: dairy products, processed foods and rice or white bread.

Constipation Treatments Beneficial after Surgery: Taking a stool softener, such as docusate after the surgery helps in managing the postoperative constipation. Taking a fiber laxative, such as psyllium is also beneficial. In case of severe constipation, there may be need of stimulant laxatives, such as enemas or suppositories to start a bowel movement. In case over-the-counter laxatives are not effective, then prescription drugs which draw water into the intestines to stimulate a bowel movement can be given.

Constipation can be painful and can cause potentially serious complications if treatment is not sought. Some of the complications occurring as a result of constipation are: hemorrhoids, anal fissures, rectal prolapse and fecal impaction.

Constipation often responds to treatment or subsides with time. If it persists, then however, medical consultation should be sought. Medical help should also be taken in case of: rectal pain, rectal bleeding, abdominal pain unrelated to surgical incision and abdominal pain accompanied with nausea and vomiting.

There are various factors that decide the time it takes to recover from constipation and these are: the patient’s activity levels, overall health, the diet and the duration spent under anesthesia and the use of narcotics for pain relief. Fiber laxatives and stool softeners are effective in providing relief within some days. If these do not work, then the doctor will prescribe other options, such as suppositories and stimulant laxatives. If these also fail to produce a bowel movement within 24 hours, then further medical advice should be taken.

Constipation need not always cause serious complications; however, it can cause severe discomfort and pain. Depending on the type of surgery, constipation can also cause reopening of the surgical incisions. If you are already suffering from constipation, then it is important to let your doctor know before the surgery.

Some of the preventive measures that can be undertaken to prevent constipation after surgery are:

• Letting the doctor know beforehand about your constipation.
• Creating a pre-surgery and post-surgery diet and treatment plan with your dietician and doctor.
• Discussing the various options to manage constipation after surgery.
• Intake of lots of fluids before and after the surgery.
• Keeping a good supply of high-fiber foods, laxatives or stool softeners on hand to be used after the surgery.

References:

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