Constipation After Surgery
Overcoming This Common Occurrence

By Dr. Shrey Lakhotia, BDS

Constipation after surgery is quite common. There are numerous reasons for this.

Constipation is generally not caused by the surgical procedure itself, but by certain factors which come into play after surgery.

Why Constipation After Surgery Is Common

1. Pain Medications

Constipation is a frequent side effect of opioids (narcotic pain relievers) which are prescribed often after surgery.

These pain relievers decrease the peristaltic activity (wavelike contractions) of the colon that are responsible for moving waste through the colon.

2. Limited food and drink after surgery

Prior to undergoing surgical treatment, the patient is usually instructed not to eat or drink. After surgery, patients may be instructed not to drink much, and may be advised not eat solids for a day or two. Not enough fluid in the body means less fluid in feces, resulting in hard, dry stools.

Since bulky solid food is what helps the colon to move feces along, a lack of food bulk means that stool is not moved through the colon. It is the colon’s job to remove fluid from feces to turn it from wet mush into a formed stool.

When stool remains longer than a day in the colon, too much water can be extracted, making the stool dry and hard. By the time it reaches the rectum, it is difficult to expel.

This combination of too little fluid and no food intake for 2 or 3 days is a major reason why constipation after surgery is common.

3. Physical inactivity

Getting up, walking and engaging in physical activity plays a supportive role in having normal bowel movements.

After surgery, the patient usually spends most of their time in bed, contributing to constipation.

4. Anesthesia

Most surgical procedures are conducted under general anesthesia. This paralyzes muscles throughout the body, not just the location being operated on.

The paralyzing of the intestinal muscles impairs bowel movements. When under anesthesia, they are unable to contract and push food along the intestinal tract.

Ways to Avoid Constipation After Surgery

Basic constipation remedies may not work

Post-surgery constipation is unlike other forms of constipation. Therefore, the treatments that may be applicable for common constipation are inappropriate for patients prescribed opioid analgesics.

For patients confined to bed-rest, normal bulk-forming laxatives like fiber and Psyllium are not very useful. In constipation caused by pain relievers, the colon is not able to contract and keep stool moving along. 

Taking fiber to help with constipation will likely have a negative effect, by creating a bulk of feces that the colon is unable to move, resulting in possible obstruction and potential stool impaction.

Post-surgery constipation remedy

Magnesium hydroxide and magnesium sulfate are effective for constipation associated with opioid therapy and surgery. desirable trace minerals as well. Therefore, unlike most other laxatives, I feel that sea minerals are suitable for on-going constipation relief.

This story of an RN's constipation discovery is relevant.

Conclusion, constipation after surgery

For patients recuperating after a surgery, the distress of constipation can only add to any discomfort they may already face.

Therefore, advance planning is in order to answer the challenge of post surgery constipation.

References:

Management of Opioid-Induced Gastrointestinal Effects in Patients Receiving Palliative Care(Christopher M. Herndon, Phar.D., Kenneth C. Jackson II, Phar.D., Pamala A. Hallin, Phar.D.; School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, Texas; Division of Clinical Affairs, Ortho-McNeil Pharmaceutical, O'Fallon, Illinois)

Managing Opioid Induced Constipation in Ambulatory-Care Patients (Clyde R. Goodheart, MD, MBA, MS; Stewart B. Leavitt, MA, PhD)

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