A gastric sleeve surgery involves the surgical removal of nearly 80 percent of the stomach. This causes a dramatic alteration in the anatomy of the stomach, which in turn causes multiple changes. This includes an increased feeling of being full and reduced hunger. At the same time, gastric sleeve surgery also causes several side effects, such as constipation, nausea and diarrhea. But why is it common to experience constipation after gastric sleeve surgery? Read on to find out.
Constipation After Gastric Sleeve Surgery: Is It Common?
A gastric sleeve surgery is a type of surgical procedure in which almost 80 percent of the stomach is removed, which causes a dramatic alteration in the overall anatomy of the stomach. This change in anatomy further leads to a number of changes, including feeling full and less hungry. However, this type of surgery also causes several unwanted side effects, one of which is constipation. Some people also experience diarrhea and nausea.(1, 2, 3)
The side effect of constipation is especially observed in the weeks and months that follow your weight loss surgery, and during this time, you are likely to find it challenging to drink as much water as you used to or eat as much food as you used to. You will also need to change your diet dramatically while also taking medications that are known to further increase the risk of developing constipation.(4)
Does Everyone Experience Constipation After Gastric Sleeve Surgery?
Experiencing constipation after gastric sleeve surgery (which is also known as bariatric surgery) is quite common and also normal. However, this is just a temporary side effect. A small-scale study carried out in 2020 found that six months after a bariatric surgery, many patients were experiencing less constipation than they had before undergoing the surgery. The research study looked at 124 participants who had morbid obesity, meaning an average body mass index (BMI) of around 44, and who underwent gastric sleeve surgery. Out of these 124 individuals, those who commonly experienced constipation before undergoing the surgery, nearly 45 percent of them witnessed an improvement in their symptoms.(5) For those people who did not experience constipation before undergoing the surgery, just 21 percent reported having constipation when they went for the six-month check-up after the surgery.
The findings of this study suggested that weight loss surgery can have many beneficial effects for those people who suffer from chronic constipation, though more research is still needed to firmly confirm these claims.
However, there is no evidence to show that gastric sleeve surgery causes more constipation as compared to other types of weight loss surgery. However, it is known that constipation is a common side effect after undergoing bariatric procedures.(6)
Why Do People Experience Constipation After Gastric Sleeve Surgery?
There are several reasons why weight loss surgeries like gastric sleeve surgery leave you more constipated than usual. These include:
Digestion Process Changes: Bariatric surgery, such as gastric sleeve surgery, causes changes in the anatomy of the stomach. Since certain digestive juices and hormones are manufactured in the stomach, the surgery has an impact on the manner in which the body digests food.(7) This changes the speed at which the digested food travels through the body, thus influencing the gut microbiome. All these changes have an impact on your bowel movements.
Decrease in Fiber Consumption: Fiber has a vital role to play in constipation and the formation of stool. It is responsible for helping your stool absorb water, which works to soften the stool. At the same time, fiber adds bulk to your stool, allowing it to pass from the body more easily. After the surgery, you primarily eat soft foods or protein drinks, which means you do not get sufficient amount of fiber to keep your bowel movements regular, thus causing constipation.(8, 9)
Less Intake Of Water: As mentioned above, stool needs moisture or water to help soften it and allow it to move through the body smoothly. In the weeks after your gastric sleeve surgery, you may find yourself feeling more nauseous or feeling very full. In fact, you might end up feeling so full that you find it difficult to eat and drink. You may also stop having carbonated drinks or other beverages that keep you hydrated.(10)
Pain Medications: Immediately after your surgery, you might have to take opioid pain relievers prescribed by your doctor. Opioids are drugs that are known to cause constipation as a side effect.(11, 12)
Dietary Changes After Surgery: After undergoing gastric sleeve surgery, your stomach becomes roughly 80 percent smaller in size than it used to be.(13) This is why you start to get full faster, but at the same time, it means that every bite of food matters. You have to eat highly nutritious food. This also means that your dietary habits become dramatically different than what it was before the surgery. This may have an impact on your bowel movement, causing constipation.
Lack of Physical Activity: It is common for people to take some time to return back to their normal level of physical activity after undergoing any type of surgery. The same is the case with people who undergo a gastric sleeve surgery. However, if you find yourself feeling weak or nauseous due to the changes in your dietary habits, you may further not want to move around as much as you should. This is also a contributing factor to your constipation.(14, 15)
Is It Possible To Treat Constipation That Occurs After Gastric Sleeve Surgery?
Yes, it is possible to treat constipation, which generally happens after you undergo gastric sleeve surgery. If you find that it has been over three days since you had your last bowel movement, you can first try some over-the-counter laxatives. These include:
- Stool softeners like Colace
- Oral osmotic like Milk of Magnesia
- Stimulant laxatives like Dulcolax
If you are taking these over-the-counter laxatives, you should follow the manufacturer’s instructions. It is also not recommended to use these laxatives for over three weeks. However, if you find that these laxatives do not help you have a bowel movement within 24 hours, you should contact your surgical care team and let them know about your constipation.
Is It Possible To Prevent Constipation After Gastric Sleeve Surgery?
Here are some tips to prevent constipation following any type of weight loss surgery, such as gastric sleeve, gastric bypass, or any other.
- Stay well hydrated: You should aim to drink at least six glasses of water every day after the surgery. If you find it challenging to drink full glasses of water, you can opt for drinking water from small, kid-sized cups that are easier to consume.
- Increase the intake of fiber: Eating high-fiber foods such as whole grains, fruits and vegetables can help prevent constipation. If you are unable to consume these foods, you can think about taking fiber supplements if required. You should ideally be getting at least 15 grams of fiber each day.
- Remain physically active: After the surgery, try to take short walks as much as your body allows. Once you feel better and with the go-ahead from your doctor, you can adopt an exercise routine that includes both strength and cardio training.
Constipation typically peaks in the days immediately following gastric sleeve surgery. This is the phase when your body is still adjusting to the changed size of the stomach and the changed diet. This is known as early-stage constipation and usually settles within a few weeks. However, some people tend to develop long-term constipation, which can last for months and sometimes even years after the surgery. If you find that you are still experiencing constipation a month after your surgery, you should bring it up with your doctor.
Constipation after gastric sleeve surgery is quite common and also normal. It can happen for a variety of reasons, including physical changes in your stomach and digestive tract, lack of physical activity, and an insufficient amount of fiber and fluid intake. However, it is possible to treat and also prevent this type of constipation following any kind of weight loss surgery. Always check with your doctor before taking any type of over-the-counter laxatives or any other medications after your surgery to help with your constipation.
- Sileri, P., Franceschilli, L., Cadeddu, F., De Luca, E., D’Ugo, S., Tognoni, V., Camperchioli, I., Benavoli, D., Di Lorenzo, N., Gaspari, A.L. and Gentileschi, P., 2012. Prevalence of defaecatory disorders in morbidly obese patients before and after bariatric surgery. Journal of Gastrointestinal Surgery, 16(1), pp.62-67.
- Jesmi, F., Akbarnejad, S., Pishgahroudsari, M., Eghbali, F., Pazouki, A. and Hosseini-Baharanchi, F.S., 2020. Constipation by WEXNER Score in Patients with Morbid Obesity after Gastric Bypass Surgery. Annals of Bariatric Surgery, 9(1), pp.10-17.
- Fysekidis, M., Bouchoucha, M., Bihan, H., Reach, G., Cohen, R., Benamouzig, R. and Catheline, J.M., 2016. Decreased prevalence of nonspecific functional bowel disorders and increased constipation in patients after sleeve gastrectomy or gastric banding. Bariatric Surgical Practice and Patient Care, 11(4), pp.158-164.
- Chang, J., Nguyen, N., Sampath, S. and Alizadeh-Pasdar, N., 2018. Prevention and management of complications after bariatric surgery. BC Medical Journal, 60(3), pp.156-159.
- Ostruszka, P., Vávra, P., Tulinský, L. and Ihnát, P., 2020. Changes in bowel habits after laparoscopic sleeve gastrectomy. Videosurgery and Other Miniinvasive Techniques, 15(3), pp.469-477.
- Potoczna, N., Harfmann, S., Steffen, R., Briggs, R., Bieri, N. and Horber, F.F., 2008. Bowel habits after bariatric surgery. Obesity surgery, 18(10), pp.1287-1296.
- Endocrine Society (2022) Bariatric surgery, Endocrine Society. Endocrine Society. Available at: https://www.endocrine.org/patient-engagement/endocrine-library/bariatric-surgery (Accessed: October 25, 2022).
- Yang, J., Wang, H.P., Zhou, L. and Xu, C.F., 2012. Effect of dietary fiber on constipation: a meta analysis. World journal of gastroenterology: WJG, 18(48), p.7378.
- Voderholzer, W.A., Schatke, W., Mühldorfer, B.E., Klauser, A.G., Birkner, B. and Müller-Lissner, S.A., 1997. Clinical response to dietary fiber treatment of chronic constipation. American Journal of Gastroenterology (Springer Nature), 92(1).
- Yurtdaş, G., Acar-Tek, N., Akbulut, G., Cemali, Ö., Arslan, N., Beyaz Coşkun, A. and Zengin, F.H., 2020. Risk factors for constipation in adults: a cross-sectional study. Journal of the American College of Nutrition, 39(8), pp.713-719.
- Prichard, D., Norton, C. and Bharucha, A.E., 2016. Management of opioid-induced constipation. British Journal of Nursing, 25(10), pp.S4-S11.
- Webster, L.R., 2015. Opioid-induced constipation. Pain Medicine, 16(suppl_1), pp.S16-S21.
- Types of weight-loss surgery (no date) National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Department of Health and Human Services. Available at: https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/types#gastric-sleeve (Accessed: October 25, 2022).
- Tuteja, A.K., Talley, N.J., Joos, S.K., Woehl, J.V. and Hickam, D.H., 2005. Is constipation associated with decreased physical activity in normally active subjects?. Official journal of the American College of Gastroenterology| ACG, 100(1), pp.124-129.
- Wilson, P.B., 2020. Associations between physical activity and constipation in adult Americans: Results from the National Health and Nutrition Examination Survey. Neurogastroenterology & Motility, 32(5), p.e13789.