What to know about constipation after surgery

By | October 11, 2018
Surgical procedures are stressful on the body. As a result, they can cause unexpected side effects, including constipation.

Constipation does not affect everyone who has surgery, but it is a relatively common side effect of pain medications, anesthesia, and a lack of mobility.

Depending on which body part or parts the surgery involved, straining to have a bowel movement could compromise stitches or affect the body’s healing processes.

As the body is likely to be more sensitive or prone to damage than usual, it is best to use gentle constipation relief after an operation.

In this article, we discuss the symptoms of constipation after surgery and the available treatment options.

Bowel movements after surgery: What to expect

senior man in hospital bed speaking to consultant
Pain medications and anesthesia can cause constipation.

Many people experience constipation after surgery due to the following factors:

  • Medications. Pain medications, diuretics, muscle relaxants, and anesthesia can cause constipation in some people. Opioids, in particular, can reduce bowel movements.
  • Dietary changes. Some people may need to avoid food before surgery, while others may need to restrict or change their diet for some time after the operation. Too little fluid and food can cause constipation.
  • Lack of physical activity. Inactivity is a common cause of constipation. People recovering from surgery often need to rest for extended periods and avoid strenuous exercise. This lack of movement slows down the digestive system.

The symptoms of post-surgical constipation include:

  • a sudden decrease in bowel movements
  • passing fewer than 3 stools in a week
  • straining to pass stool
  • lumpy or hard stools
  • the sensation that the rectum is not empty, even after having a bowel movement
  • feeling as though there is a blockage in the rectum
  • needing help to empty the rectum, such as pressing on the stomach during a bowel movement
  • bloating or gas
  • pain in the stomach or rectum

Complications of constipation after surgery

Untreated constipation can lead to discomfort and potentially severe complications, such as:

  • A surgical incision reopening. This can occur if people have to strain to pass stool.
  • Hemorrhoids. These swollen veins in and around the anus are the result of straining to have a bowel movement.
  • Anal fissure. An anal fissure occurs when a large or hard stool causes skin in the anus to tear.
  • Fecal impaction. Chronic constipation can cause hard stool to become stuck in the intestines.
  • Rectal prolapse. Straining may cause part of the intestines to protrude from the anus.

Treatment and tips

female patient with drip walking in hospital
Walking or moving around will help encourage a bowel movement.

Untreated constipation can be uncomfortable and lead to complications, particularly after surgery.

However, it is vital to always ask a doctor before using constipation relief, as some methods may not be safe after certain medical procedures.

The methods for constipation relief below may be sufficiently mild for people to use after surgery, as long as they follow the advice of a doctor:

Keep the body moving

As soon as a doctor gives the go-ahead, people should start moving around. Going for short walks around the hospital or home or doing other physical activity will help move food through the intestines and stimulate a bowel movement.

Research has shown that insufficient physical activity and excessive sedentary behaviors correlate with constipation. Physical activity may prevent people from feeling constipated.

People who are unable to get out of bed can move their arms and legs where possible to promote circulation and help the bowels move.

Laxative medications

A doctor may prescribe a stool softener for people with post-surgical constipation.

These medications, which include docusate sodium (Colace), draw water from the intestines to moisten the stool. Moist stools are easier to pass.

Alternatively, a doctor may recommend a fiber laxative, such as psyllium (Metamucil or Konsyl) or methylcellulose fiber (Citrucel).

Doctors do not recommend fiber laxatives for people whose constipation results from opioid medication use, as they could cause severe abdominal pain and potential bowel obstruction.

Other medications for constipation include:

  • Stimulants, such as bisacodyl (Ducodyl or Dulcolax), which make the intestines contract to produce a bowel movement.
  • Osmotic drugs, such as magnesium hydroxide (milk of magnesia), to move fluids through the colon.
  • Lubricants, such as mineral oil.
  • Enemas and suppositories, which can soften the stool.

People should not take over-the-counter (OTC) remedies for constipation without speaking to a doctor first. Not all constipation medications are suitable for everyone, especially during post-surgery recovery.

Alternative pain relief

Many people take opioid drugs after surgery to reduce pain. According to estimates, up to 40 percent of people on these medications experience constipation.

For post-operative pain that is mild or moderate, OTC pain relievers offer an alternative treatment. Examples include ibuprofen (Advil) and acetaminophen (Tylenol).

People experiencing constipation as a result of using opioids should speak to a doctor to see if other medications would be more appropriate for their needs.

Magnesium

Magnesium is a muscle relaxant, and it is a primary ingredient in many laxative medications. It can relax the bowels to alleviate constipation.

According to some research, magnesium oxide is safe for people with mild constipation to use. Standard doses typically produce a bowel movement within 6 hours.

However, anyone wishing to take magnesium for constipation should speak to a doctor first, as some people have a higher risk of magnesium toxicity and other complications.

The doctor can also check whether the magnesium will interact with any other medications that people are taking.

Probiotics

Probiotics are beneficial bacteria and yeasts that play an important role in gut health.

A review of 14 studies on probiotic supplements found that some types may help treat constipation. These probiotics may increase the frequency of bowel movements and soften stools so that people can pass them more easily.

It is essential to speak with a doctor before taking probiotics for constipation after surgery.

What to eat before and after surgery

Food and fluid intake, both before and after surgery, plays a vital role in preventing and treating post-operative constipation.

The following dietary tips can help people maintain regular bowel movements, but it is always best to follow a doctor’s specific advice on pre- and post-surgery eating plans:

Drink plenty of fluids

Dehydration can cause constipation. It is crucial to drink water regularly throughout the day to stay hydrated. Diluted fruit juices, especially prune juice, can also help.

It is advisable to avoid caffeinated drinks, such as coffee, tea, and cola, as they can make dehydration worse.

Eat fiber-rich foods

tea being poured from teapot
People who are dehydrated should avoid caffeinated drinks.

Fiber helps stool pass through the digestive tract.

Adults eating a daily diet of 2,000 calories should aim to consume 25 grams (g) of fiber each day, according to the American Heart Association.

High-fiber foods include:

  • fruits
  • vegetables
  • whole grains
  • nuts and seeds
  • beans and lentils

People who do not have a good appetite after surgery can try drinking a smoothie comprising blended fruits and vegetables to boost their fiber intake.

It is also important that people increase their fluid consumption when they begin to eat more fiber.

Avoid certain foods

Some foods are more likely than others to cause constipation. People should limit or avoid the following foods until constipation resolves:

  • dairy
  • processed foods
  • refined grains, such as white bread, white rice, and white pasta

Snack regularly

Consuming food can stimulate a bowel movement. For this reason, eating small, frequent meals may help ease constipation.

How long does constipation after surgery last?

Most people with constipation following surgery will experience relief after a few days, especially if they receive treatment quickly.

Stool softeners and fiber laxatives tend to act within a few days, while stimulant laxatives and suppositories typically work within 24 hours.

The exact amount of time that it takes will depend on several factors, including:

  • a person’s overall health
  • the duration of anesthesia
  • the type of medication

A person should speak to a doctor if their constipation persists for more than a few days.

Outlook

Many people experience constipation after surgery due to pain medications, anesthesia, or a lack of movement following the procedure.

The outlook for people with constipation after surgery is generally good. Most people will feel better within a few days once they receive treatment.

Always speak to a doctor before taking medication for constipation, especially after surgery and when taking other medications, as some drugs can interact.

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