How to Prevent Constipation after Surgery
A Detailed Guide to Protect your Booty
Are you planning to have any type of surgery? If you’re going into an operating room, it doesn’t matter which part of your body will be going under the knife: you’re at risk for constipation. There are common practices universal to all operations that clog up your pipes and land a good number of people back into the emergency room. But you can easily avoid this problem. With this simple guide, you can almost eliminate the risk of post-surgery constipation. In this article you will:
- Learn the reasons why constipation after surgery happens
- Learn ways of preventing constipation after surgery
- Learn what commonly used medications do not work well to prevent post-surgery constipation
Here are reasons why constipation occurs after surgery:
1) During the operation and in the recovery room, most people are given opioid pain medication, primarily through an IV, to treat moderate or severe pain. Intravenous opioids include morphine, Dilaudid and fentanyl. After surgery, patients are often prescribed opioid pain medication to take by mouth at home, including codeine, Vicodin®, Norco®, and Percocet®. All of these medications cause constipation by slowing down the movement of your intestine.
2) Changes in your diet before surgery can be another culprit. It is common to get specific instructions to change how you normally eat or drink before your surgery, like only having liquids the day before or not having anything to eat or drink after midnight the night before surgery. For this reason, temporary dehydration may occur. This, along with not eating or only having liquids, means that you are getting less fiber than usual. Both these factors contribute to constipation.
3) Changes in your diet after surgery can also contribute to the problem. Although many people don’t have dietary restrictions after operations, being under anesthesia can make you lose your appetite for several hours and maybe even days. Some people can even have nausea or vomiting. Not eating or drinking normally means that you are not getting enough fiber and you can get dehydrated, both leading to constipation.
4) Lying in a bed more than usual—which happens before, during and after surgery—combined with the medications and diet changes, all work together to slow down your colon and make your poop turn to rock.
No one likes to be constipated.
Let’s face it, it’s not a pleasant feeling when you don’t poop for days, then strain on the toilet to finally pass something large enough to cause damage. An ounce of prevention is worth a pound of cure, so:
- Assume you will be constipated.
- Plan and prepare accordingly.
Post-surgery is one of those unique situations where the temporary use of laxatives can make a world of difference. Always consult with your doctor, and recognize that if you wait several days after surgery to take a laxative, the constipation might be too severe for these over-the-counter options. It is always important to discuss all medications you plan on taking with your doctor. Ask your doctor if you can start the laxative immediately after surgery. *
Here are go-to post-surgery laxatives:
- Senna: Senna is an herb that acts as a “stimulant laxative,” meaning it increases the activity of the intestine to cause you to have a bowel movement. It comes in many forms, but senna pills are easy to take and are sold over the counter at almost all pharmacies. Since opioid pain medications slow down the activity of the intestine, it makes sense to take a medication to help reverse that side effect. Long-term use of a stimulant laxative is not a good idea since it can make your colon “lazy” and not function properly, however temporary use immediately after surgery is acceptable. In general, if you are able to eat a normal diet, taking senna soon after surgery works the best. Senna usually works within hours to produce a bowel movement, but this is less predictable when you are taking different medications after surgery. Try not to wait several days to start taking senna, as often it is too late by then. Just like with all medications or supplements, check with your doctor before starting new treatment.
- Magnesium: Magnesium is an important mineral that our body needs. We get magnesium from some foods that we eat, especially foods that are high in fiber such as broccoli, almonds and whole grains. There are also magnesium-based medications used to treat constipation including milk of magnesia (magnesium hydroxide), magnesium citrate and magnesium oxide. They work by drawing water into the intestine, putting it into the class of “osmotic” laxatives. Magnesium products in low doses appear to be safe, but if taken in very large doses, can lead to problems such as irregular heartbeat, low blood pressure and even death. It can also affect other medications you might be taking, therefore it is important to discuss using magnesium with your physician and pharmacist before initiating therapy. Most over-the-counter magnesium laxatives work very well to help with the constipation related to surgery, but sometimes they work too well and lead to diarrhea. Make sure you are somewhere with easy access to a bathroom, just in case.
- Bisacodyl: Bisacodyl (generic name) is sold under brand names such as Dulcolax®. Much like senna, it is a “stimulant laxative,” meaning it makes your intestines move more quickly to push out the stool. This is another good choice to start taking as soon as your doctor says you can take a laxative after surgery. It comes in pill form and as a suppository, which is a good choice for people who cannot or are not allowed to swallow pills. Studies have shown that it works as a laxative, but like most of these medications, you should use this on a short-term basis only.
- Enema: Enemas strike fear in many people, but FEAR NOT! It’s nowhere near as big a deal as you may think. An enema is just a way to get some liquid into your rectum by placing a specially designed device through your anus. If you have never done one, it might seem like a painful, unpleasant, uncomfortable, complicated and lengthy procedure. But in reality, it’s simple, takes just a few seconds and is highly effective. The small ready-made bottles you buy at the pharmacy are much easier than the hose/large rubber container type. Those recommended positions illustrated in some instructions are generally not necessary to place the enema. It’s very similar to the insertion of a tampon, requiring a slight squat. Some extra lubrication on the enema’s tip (or on your anus) will make it a breeze. In certain cases, there is no substitute for a good enema. For example, if someone has not pooped for a few days, the beginning of the poop waiting to come out can become rock hard. Passing that hard stool can lead to much pain and problems like anal fissures. Inserting a little liquid to break up the rock-hard stool will help make its passage much easier. Enemas come with different liquids. Most come with saline, but there are also mineral oil options. You can also use warm water in the reusable enema containers. They all work. But since saline can sometimes be irritating, so try a mineral oil or water enema instead.
Here are commonly recommended constipation medications that do not work well for post-surgery constipation:
- Docusate: Docusate (generic name) most commonly referred to as Colace® (brand name) is not really a laxative, but is classified as a stool softener. Although this medication is commonly prescribed, it is not recommended for several reasons: 1) there is no good medical evidence that it works 2) even if it has an effect, which is very questionable, it is minimal and cannot combat the intestinal slowing caused by the opioid medications. Skip docusate to save money and space in your pillbox for something more effective.
- PEG: Miralax® (brand name) is basically a chemical called polyethylene glycol (PEG) and it has gained tremendous popularity as a laxative. This product is an “osmotic laxative” meaning it works by pulling water into the stool, making it softer. This is very similar to the action of natural fiber in foods and supplements. Therefore, the effect seen by this medication is not immediate, causing a bowel movement in a day or more. Is this medication strong enough to battle the constipation related to having an operation? Maybe for some people not prone to constipation. But for most people, other laxatives are better to prevent constipation after surgery.
Post-surgery constipation is an avoidable problem. Recovering from surgery can be difficult as it is. If you can prevent adding constipation worries to your recovery, you’ll be much happier.
*Tell your doctor or pharmacist if you are allergic to any medication or if you are pregnant or nursing. Also discuss any interactions with other medications and restrictions due to your medical conditions or from the operation you will undergo.
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