Passing Gas After Abdominal or Other Types of Surgery

Why focus on passing gas after surgery? If you can't pass gas, it could mean you are developing a condition called post-operative ileus (POI). POI means your intestines are not moving food through your body properly.

There is a risk of POI following abdominal surgery and some other types of surgeries. This condition can lead to a serious infection, such as peritonitis and sepsis, or complications associated with not eating by mouth, electrolyte imbalances, and malnutrition.

After surgery, you may be told to let your nurse know if you pass gas.

This article explains why it's important to pass gas after surgery and what it could mean if you cannot.

Importance of Gas After Surgery

You may have anesthesia to put you to sleep during surgery. The medication can slow down or even stop the gut from moving food and waste from your stomach through the digestive tract. When this slowdown happens, it's called a delay in gastric motility or POI.

A POI means that it takes your intestines longer to recover from anesthesia than the rest of you. The slowdown can be mild, or it can be severe enough to need medical treatment.

You may have had a bowel preparation to clean the stool out of your body before surgery. If so, it may be several days before you have a bowel movement. Gas may pass long before a stool does, showing that your bowels are working well.

If you had outpatient surgery, your healthcare team may even require you to pass gas before you go home. The staff doesn’t want to send you home with a POI that could become serious. That's the reason it's important to let them know when you pass gas.

Symptoms

A delay in gastric motility is usually brief. A more severe POI may call for a longer hospital stay. Severe symptoms can include:

• Nausea
• Bloating
• Vomiting
• Abdominal tenderness or pain
• Delayed or stopped passing of gas/stool

Sometimes people have nausea, vomiting, and pain after surgery. Because these symptoms can have different causes, it's a good idea to talk to your healthcare provider any time you have these symptoms while you are recovering.

Reasons You Can't Pass Gas After Surgery

Researchers have several theories about why postoperative ileus happens. POIs may be caused by different factors in different people.

Abdominal Surgeries

One theory is that POI happens when your intestines are handled during surgery. For example, your surgeon may move them out of the way to reach other body parts. Or you may have had surgery directly on your intestines.

If your intestines were handled, your body's immune system may be triggered. White blood cells and other types of cells may rush to the area, causing a slowdown.

Disruption to the Nervous System

Another theory involves your nervous system. Your nervous system has two "departments." The sympathetic nervous system (SNS) normally makes your intestines move less. The parasympathetic nervous system (PNS) makes your intestines move more. After surgery, your SNS may have more control for a short time. 

Electrolyte Imbalance

Surgery and fluid and electrolyte over-replacement post-surgery can cause an imbalance in your electrolytes. Electrolytes (such as potassium and calcium) are minerals needed for key functions in the body, such as normal digestion.

Side Effect of Medication

It's also possible that pain medications could raise your risk of a POI. Opioid medications can cause constipation after surgery. If you are taking opioid medications for pain relief, or if you already had issues with your intestines before this surgery, you have a higher risk of developing POI.

Prevention

Preventing a POI is not always possible, but there are ways to lower the risk. 

People who receive anesthesia by an epidural in their spine typically recover faster from a POI. Lighter types of anesthesia usually cut down on the risk of POI.

Less-invasive surgeries also have a lower risk of POI. These procedures typically use tools inserted through small incisions, such as laparoscopy. POIs may not last as long as they might with open surgeries with larger incisions. That may be because you are under anesthesia for a shorter time and there is less disruption to your body.

Two simple strategies to prevent a POI may be chewing gum and drinking coffee after surgery. Other effective solutions include:

• Limiting preoperative fasting to six hours for solid food and two hours for liquids
• Feeding soon after surgery and getting good nutrition before and after surgery

Walking after surgery may also help reduce the severity of symptoms and speed the return to normal.

Summary

Passing gas after surgery is important. If you can't pass gas soon after surgery, it may mean that a post-operative ileus, or gastric delay, is happening.

A post-operative ileus or POI occurs when there's a slowdown in your body's ability to digest food. It could be caused by changes in your nervous system or the after-effects of having your intestines handled. A POI could even happen because of the medications you're taking.

To lower your risk, maintain a healthy diet, and try chewing gum or walking after surgery.