Surgery Constipation

By Dr. Julia Lizy, MBBS (KEMU)

The Surgery Constipation Problem - Finding a Solution

This article focuses on constipation in post-op patients –  patients who have recently undergone surgery. 

Although there are numerous types of surgeries, most of them easily lead to constipation.

Further, if proper care is not taken, rectal bleeding and hemorrhoids can occur, while rectal cancers, toxemia and other lethal conditions may also result from prolonged fecal obstruction.

Constipation may be worsened if there are other complications arising out of surgery.

How does surgery constipation happen?

There are multiple factors that may lead to constipation after surgery. Some of these factors include:

Immobility
This is a major cause of post-op constipation. It is more evident in cases when the surgery is not directly concerned with the abdominal area.

For instance, a cast applied after a leg bone fracture may keep the patient immobilized for weeks. This immobilization may lead to restricted bowel movements.

General Anesthesia
Many surgeries involve general anesthesia. Even if the surgery does not directly involve the abdominal area, anesthesia can cause decreased bowel activity.
   
Laparotomy
A laparotomy (surgery involving a large incision through the abdominal wall to gain access into the abdominal cavity) can directly interfere with intestinal activity.

     1.    Such a patient has no oral intake of foods or fluids before and
            after surgery.

     2.    Bowel activity following a laparotomy is completely restricted
            for 2-3 days after the surgery.

     3.    Bowel movements may start as soon as 12-24 hours after
            surgery, but may be delayed to as long as 4-5 days. The delay
            in bowel movement can result in mild, moderate, or severe
            constipation.

Role of Diet
It is common knowledge that constipation can both be avoided and cured by consuming a fiber rich diet. The low fiber diet commonly eaten following surgery can aggravate constipation.

Interference from medications
Certain medicines, including pain-relief medication, may also act to inhibit peristalsis needed for normal bowel movements. When pain meds are taken, nerves in the colon are not as able to initiate contractions of the colon for successful elimination.

How to Cope with Surgery Constipation

Here is some information that may be useful regarding curative and preventive measures of post-op constipation:

General measures

As discussed above, surgery patients are at an increased risk of constipation. However, if a patient has a positive history of constipation or obstruction, this should be disclosed to the surgeon.

There are few common things that must be followed by all the patients after surgery. An increase in fluid intake and a diet rich in fiber are essential. Dehydration and a diet low in fiber decrease peristalsis and increase the risk of constipation.

Specific Medication

If a bout of constipation is observed, then constipation medication should also be started. In cases where the patient has a history of constipation and is high risk, the surgeon can prescribe constipation medication as a preventive measure.

Use of Magnesium

As a medical professional, I find magnesium has been used to treat constipation.

At present, there are numerous magnesium preparations that are beneficial in numerous ways.

A magnesium preparation will not only increase peristalsis and decrease the risk of constipation, but it will also:

1. Help prevent gastric ulcers, which are common after surgical stress, especially when the oral   food and fluids are withheld from the patient.
   
   
2. Correct the metabolic balance of acid-base and fluid-electrolytes.
   
   
3. Prevent the development of respiratory acidosis (the inability of the lungs to remove all the carbon dioxide the body produces) due to inadequate ventilation.

(Return from Surgery Constipation to Causes of Constipation)