Relieving Constipation After Surgery

Undergoing surgery is a significant event, and while recovering from surgery, many patients find themselves dealing with an unexpected and uncomfortable symptom: constipation. While constipation after surgery is common, it can be concerning, especially when coupled with the recovery process and the use of pain medications.

Understanding why constipation happens after surgery, how to manage it, and when to seek medical advice can help ensure a smoother recovery.

Recognizing Constipation Symptoms

Constipation means having fewer bowel movements than usual, typically fewer than three per week. However, it's not just about frequency. Other constipation symptoms include:

• Straining during bowel movements
• Hard, dry stools
• Feeling like you haven't fully emptied your bowels
• Abdominal pain or discomfort
• Bloating
• Nausea

While it's possible to pass gas after surgery even without a bowel movement, this doesn't necessarily mean your bowels are functioning normally. It indicates some gut activity, but not that stool is moving efficiently.

Why Constipation Happens After Surgery

Constipation after surgery is a common experience, and several factors contribute to it.

Changes in Diet and Activity Levels

During recovery, your diet might change. You might not be eating as much fiber as usual, or you might be consuming more processed foods. Reduced fluid intake can also contribute to harder stools. Furthermore, limited mobility or being bedridden after surgery means less physical activity, which plays an important role in stimulating bowel movements.

Effects of Anesthesia and Pain Medications

One of the primary causes of post-surgery constipation is the effect of general anesthesia on your digestive tract. Anesthesia can slow down the normal movement of your intestines, leading to sluggish bowel activity.

Pain medications, particularly opioids (like oxycodone), are another common cause of constipation after surgery. Opioids, also known as opioid anagesics, are very effective for pain relief, but they have a well-known side effect of causing constipation.

These pain medications work by slowing down the movement of food through your intestines and increasing water absorption, making stools harder and more difficult to pass. This is often referred to as opioid-induced constipation.

Gastrointestinal Procedures

“If you've had a gastrointestinal surgery, it could just be that your intestine is figuring out its 'new normal,’” explained Joshua Kays, MD, a general surgeon with Franciscan Health in Indianapolis and Mooresville. “If you had a piece cut out or reconnected, it's a new way of doing things, so the body can take a little while before it fully adapts to that.”

What Pain Medicines Cause Constipation After Surgery?

Examples of commonly used opioid analgesics after surgery include:

• Hydrocodone plus acetaminophen (Vicodin, Norco, Lortab)
• Oxycodone (OxyContin)
• Oxycodone plus acetaminophen (Percocet, Endocet, Tylox)
• Morphine (MS Contin, MSIR)
• Hydromorphone (Dilaudid)
• Fentanyl patch (Duragesic)

Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen may have constipation as a side effect.

How Long Does Constipation Last After Surgery?

The duration of constipation after surgery varies from person to person. For some, bowel movements may return to normal within a few days. For others, especially those taking opioid pain medications, it can last longer, sometimes for a week or more. General anesthesia typically wears off quickly, but its effects on the bowel can linger for a couple of days. The key is to address the issue promptly rather than waiting for it to resolve on its own.

Managing Constipation After Surgery

There are several steps you can take to relieve constipation and encourage regular bowel movements after surgery.

Always discuss these strategies with your healthcare provider or care team to ensure they are appropriate for your specific recovery.

Dietary Adjustments

• Increase Fiber Intake: Gradually incorporate fiber-rich foods into your diet. Examples include whole grains, fruits (like prunes, pears, apples with skin, berries), and vegetables. If tolerated, bananas can be helpful as they contain fiber.
• Stay Hydrated: Drink plenty of fluids, especially water. This helps soften stools and makes them easier to pass. Warm liquids, like prune juice or warm water with lemon, can sometimes help stimulate a sluggish bowel.
• Avoid Constipating Foods: Limit foods that can worsen constipation, such as highly processed foods, dairy products, and red meat.

Lifestyle Changes

• Gentle Movement: As soon as your healthcare provider allows, try to get up and move around. Even short walks can help stimulate your intestines and encourage bowel movements.
• Listen to Your Body: Don't ignore the urge to have a bowel movement. Delaying can make constipation worse.
• Establish a Routine: Try to have a bowel movement at the same time each day, such as after a meal, when your colon is most active.

What Over-the-Counter Medications Can Help With Constipation?

For constipation specifically caused by pain medications, your doctor might recommend specific strategies or medications designed to counteract the effects of opioids on the bowel.

Many over-the-counter (OTC) options can help relieve constipation. It's important to consult with your healthcare provider before taking any new medication, especially after surgery.

Stool Softeners

Medications like docusate sodium (Colace, Dulcolax) draw water into the stool, making it softer and easier to pass. These are often recommended preventatively, starting when you begin taking opioid pain medications. Taking these while on pain medication can ease stool movement through the colon. They are generally considered gentle and typically take 1 to 3 days to work.

Stimulant Laxatives

Medications like bisacodyl (Correcol, Dulcolax) or senna (Senokot) directly stimulate the muscles in the intestines to contract and move stool along. These stimulant laxatives work within 6 to 12 hours and are usually for short-term use. These medications should be used with caution, as they can cause cramping.

Saline Laxatives

Saline laxatives may be taken orally or with an enema, depending on their type, and typically work within 30 minutes to 3 hours. Saline laxatives include magnesium citrate (Citroma), magnesium hydroxide (Milk of Magnesia, Phillips) and sodium phosphate (Fleets, Phospho-Soda).

Bulk-Forming Laxatives

Bulk-forming laxatives like Metamucil, Citrucel, Fibercon and BeneFiber should not be used for constipation caused by pain medications. They can be used once you are no longer taking pain medications to promote regularity. They must be taken with plenty of water.

Addressing Constipation Pain

Constipation can cause significant abdominal pain, cramping, and bloating. When your stomach hurts due to constipation, the primary goal is to relieve the constipation itself.

• Laxatives: Appropriate laxatives can help stimulate bowel movements and reduce pain. Consult your surgeon's directions.
• Heat Therapy: A warm bath or a heating pad on your abdomen can help soothe muscle cramps and discomfort.
• Gentle Massage: Gently massaging your abdomen in a clockwise direction may help stimulate bowel activity.
• Pain Relievers: For pain not directly related to the constipation itself but generally part of recovery, ask your doctor which pain relievers are best for your situation. Non-opioid options like acetaminophen may be suitable for general pain relief and won't cause constipation. However, for the specific pain of constipation, addressing the bowel movement itself is key.

When to Worry and Seek Medical Attention

While constipation after surgery is common, there are times when it can signal a more serious issue. You should contact your healthcare provider or seek immediate medical attention if you experience:

• Severe abdominal pain or cramping that doesn't improve with laxatives or pain relief, or worsens significantly.
• Bloating and tenderness that is extreme or increasing.
• Nausea and vomiting, especially if you're unable to keep fluids down.
• No bowel movement for several days (e.g., 5-7 days) despite trying home remedies and over-the-counter laxatives, particularly if accompanied by other concerning symptoms.
• Fever or chills.
• Rectal bleeding.
• Signs of an actual bowel obstruction, such as inability to pass gas, severe distension of the abdomen, or forceful vomiting.

Your care team will guide you on specific signs to watch for based on your surgery type and recovery. Do not hesitate to reach out to them with any concerns.

In rare cases of severe symptoms like excruciating pain, persistent vomiting, or inability to pass gas after several days, your healthcare provider might advise you to go to the emergency room (ER) for evaluation to rule out a complete bowel obstruction, which is a medical emergency. However, this is distinct from typical post-surgical constipation.

Preventing Constipation After Surgery

Preventing constipation is often the best approach. Before surgery, discuss the potential for constipation with your doctor. They may recommend starting a stool softener or other preventive measures as soon as you begin taking pain medications. Planning your diet and activity levels post-surgery can also make a difference.

Remember, your healthcare provider and care team are your best resources for managing your recovery, including how to get rid of constipation. Don't hesitate to ask questions and report any symptoms that concern you.