Constipation After Surgery

Your body endures a lot during surgery. It may not be surprising, then, to hear that people often have bouts of constipation after surgery. Constipation occurs when stools are dry or hard and you have trouble passing them.

Constipation is very common after surgery and is caused by pain medications, changes in diet, inactivity, and stress. Between 40% and 95% of patients report constipation as a side effect of taking opioids for pain relief after surgery.

This article will discuss the causes of constipation after surgery, some complications of this problem, and how to prevent and treat constipation.

What Causes Constipation After Surgery?

There are a few reasons why surgery patients are prone to constipation. The most common culprit is the prescription drugs given for pain relief.

Pain Medication

Opioids are a powerful type of pain medication. These drugs are often given after surgery for pain control. Unfortunately, constipation is a well-known side effect of all opioids.

Opioids slow the movement of food through the intestinal tract. This gives the body more time to remove water which can lead to a drier than typical stool.

Opioids may also increase the amount of water absorbed from the gastrointestinal tract.

Finally, opioids may decrease the urge to have a bowel movement. This also allows more time for the body to remove water.

Food and Drink After Surgery

You may have been instructed not to eat or drink before surgery. After surgery, you may have been told to drink only small amounts. You may also have been told not to eat at all for a day or two.

Too little fluid in the body means less fluid in your stools. This can cause hard, dry bowel movements.

Food stimulates the digestive system and keeps things moving. If you aren't eating, “food in, food out” doesn’t work as well.

Your food choices may have also changed after surgery. Even the food you ate in the hospital may be a major change from your normal diet. These kinds of changes can cause constipation.

Inactivity

Physical activity can help trigger a bowel movement. After surgery, you spend most of your time in bed recovering. This can slow down your bowels.

Anesthesia

Anesthesia paralyzes your muscles. This stops movement in the intestinal tract. Until your intestines "wake up," there is no movement of stool.

It can take your bowels and GI tract a few days to fully recover from the paralyzing effect of anesthesia and resulting post-surgery constipation.

How to Relieve Constipation After Surgery

It's much easier to prevent constipation than deal with it once it starts. These tips will help you stay regular and avoid discomfort as much as possible.

Medications

Your surgeon may prescribe a stool softener to take along with your pain medication. Be sure to follow your surgeon's instructions even if you have never had constipation before.

It is also important not to use over-the-counter (OTC) treatments without first discussing them with your healthcare provider. There is a large variety of OTC medications for constipation and some may are not the right choice after surgery. For example, a bowel stimulant may be too hard on your body after surgery. 

Common types of anti-constipation therapies include:

• Enemas
• Stool softeners
• Laxatives
• Fiber supplements
• Magnesium citrate
• Glycerin suppositories

Drink More Fluids

Drinking more fluids can help prevent constipation. Avoid caffeinated beverages. Instead, choose beverages like water and juice. These will keep you well hydrated and lower your risk of constipation.

Fluids can also help you recover after developing constipation.

Remember to take your pain medication with water. Keep drinking water throughout the day.

Eat More Fiber

What you eat can increase or decrease your risk of constipation. Increase your fiber intake by eating fruits and vegetables.

It is best to eat fruits and vegetables in as close to their natural state as possible. A whole orange, for example, provides more fiber than pulp-free orange juice.

You can also add fiber to your diet with fiber supplements. Remember, though, that adding supplemental fiber can increase constipation if you're not drinking enough water.

Avoid foods known to cause constipation. Cheese, for example, can cause constipation. So can a diet with lots of meat and few fruits and vegetables.

Regular Meals and Snacks

Your body naturally eliminates stool when more food is introduced. This is why many people have a bowel movement after breakfast. Food goes in, so stool must go out. This is also why small, frequent meals can help you have regular bowel movements.

Physical Activity

Physical activity can decrease the risk of constipation. This can be something as simple as walking. It is important, though, to follow your surgeon's instructions if you have limits on exercise.

Dietary Supplements

Your healthcare provider may recommend a fiber supplement, such as Citrucel, FiberCon, or Metamucil to treat constipation. Be sure to drink plenty of water when taking a fiber supplement to avoid worsening constipation.

Complications of Constipation

You will feel more comfortable if you can avoid post-surgical constipation. There are also other reasons why you will want to prevent it.

Constipation can progress to impaction. This occurs when the stool is so hard and dry that you cannot have a bowel movement.

When this happens, the hardened stool must be removed in another way, such as:

• Enemas, where a doctor injects liquid into your rectum to help remove the stool
• Digital evacuation, where a doctor uses fingers to dislodge the hardened stool
• Surgery, in advanced cases

Severe, prolonged constipation can cause permanent damage. Sometimes, segments of the intestine must be removed.

This often means the patient will need a colostomy. With this procedure, a surgeon creates an opening in the abdomen that allows stool to pass into a collection device. 

Constipation and impaction can lead to straining. Straining to force a bowel movement can cause other problems, such as:

• Unusual heart rhythms
• Rectal prolapse, in which the rectum pushes out of the anus
• Hemorrhoids, swollen veins in the rectum or anus
• Shortness of breath
  

In surgery patients, straining can cause stress on incisions (the cut the surgeon made during the procedure).

Straining may stress both internal and external incisions. In extreme cases, it can cause the incisions to open. 

Open heart surgery patients can be at particular risk. For these patients, straining to have a bowel movement may cause heart rhythm changes. 

When to Contact a Healthcare Provider

Talk with a healthcare provider if constipation is accompanied by any of the following:

• Blood in your stool or you are bleeding from your rectum
• Serious stomach pains or you are unable to pass gas
• Vomiting
• Fever
• Weight loss without trying
• Lower back pain
• Fiber, fluids, exercise, and OTC remedies haven’t helped
  

Summary

Constipation occurs when you have fewer bowel movements than what is normal for you. It is common after surgery.

Pain medication, what you eat and drink, inactivity, and anesthesia can all contribute to post-surgery constipation. 

It is best to avoid developing constipation since it can lead to impaction. This is when your stool is so hard that you cannot pass it. Straining can also lead to problems like unusual heart rhythms and hemorrhoids.

You can help prevent constipation after surgery by taking medications as recommended by your doctor or surgeon. Drinking more fluids and eating more fiber can also help. Eat regular meals and snacks and stay active if your doctor approves. 

If you do develop constipation, increase your fluid intake and eat more fiber. Your doctor can recommend medications that may also help.