Constipation After Surgery

What Exactly Does Constipation Mean?

Man With Constipation
Constipation Is Often Painful. Peter Dazeley/Photographer's Choice/Getty Images

What is Constipation?

Constipation is defined as the inability to pass feces or having difficulty passing feces because it is dry or hardened. Some sources define constipation as having three or fewer bowel movements per week, but that is a generalization. If you normally have 2 or 3 bowel movements per day, 3 per week would indicate constipation. If three movements per week is normal for you there is no reason for concern if you have three per week.

There is no hard and fast rule for bowel movement frequency.  "Normal" stool or bowel movements are soft, formed, are controlled (meaning no "accidents") and are not painful.  If these criteria are met, the number of times per week are less important and may not be meaningful.

Constipation becomes more severe the longer it lasts. As the length of time between bowel movements increases, more water is absorbed back into the bloodstream, causing the stool to harden in the colon (large intestine). The discomfort increases, along with the damage that can be done by the straining needed to have a bowel movement.

Surgery patients are far more likely to have bouts of constipation than the average person. In fact, after surgery, you may be given a stool softener to prevent constipation before it happens.  If you are not, stool softeners are available at your local drug store.

Constipation After Surgery - Why Worry?

Why is Constipation a Big Deal After Surgery?

Constipation can progress to impaction, which is when the stool is so hard and dry that you cannot have a bowel movement. The hardened stool must be removed by enemas, digital disimpaction (where the doctor or nurse use their fingers to help dislodge the hardened stool) or (in advanced cases) surgery.

Severe, prolonged cases of constipation can cause enough damage that segments of the intestine must be removed, which often means that the patient will need a colostomy. Constipation and impaction, along with the straining patients do to try to force a bowel movement, can also cause unusual heart rhythms, rectal prolapse, hemorrhoids and shortness of breath.

In surgery patients, this straining can cause stress on incisions, both internal and external, and in extreme cases, it can cause the incisions to open. Open heart surgery patients can be at particular risk from heart rhythm changes during straining due to constipation as the heart is still recovering from surgery and cannot tolerate the changes in the heart that straining can cause.

For patients who have had surgery in the gastrointestinal tract, such as colon surgery or weight loss surgery, constipation can cause damage to the surgical area.

Why Does Constipation Strike After Surgery?

What Causes Constipation After Surgery?

Surgery patients are prone to constipation for multiple reasons:

Pain Medication: The primary reason for constipation after surgery is that the prescription drugs given for pain relief can cause constipation. If you must take large or multiple doses of pain medication or you have taken the pain medication for an extended period of time, you will be at risk for constipation.

Food and Drink After Surgery: As part of your preparation for surgery, you may have been instructed not to eat or drink. After surgery, you may have been told to drink minimally and perhaps not eat at all for a day or two. The combination of too little fluid and no food intake can work against your body’s normal routine of elimination.

Too little fluid in the body means less fluid in feces, resulting in hard, dry stools. Food works to stimulate the digestive system and keep things moving along. With no food being eaten, the “food in, food out” mechanism doesn’t work as well.

Your dietary choices, along with your intake level, also may have changed after surgery. Even the food provided in the hospital may be a major change from your normal diet and can cause constipation.

Inactivity: Getting up and walking or being active is one of the triggers for a bowel movement. Suddenly spending most of your time in bed resting can help to trigger a bout of constipation.

Anesthesia: Most patients think of anesthesia as something that puts us to sleep. Anesthesia, though, also paralyzes the muscles: your intestine is paralyzed during surgery along with your arms and legs. This stops the muscle contractions to push food along the intestinal tract. Until your intestines "wake up" there is no movement of feces.

Preventing and Treating Constipation

Preventing and Treating Constipation

Surgery patients are far more likely to have a bout of constipation than the average person. If you are prone to constipation you should mention this to your surgeon as you will be at a greater risk for constipation. A stool softener may be prescribed. Prevention is key after surgery because constipation can be very painful.

Medications: If your surgeon has prescribed a medication for constipation or recommended an over-the-counter treatment, such as a stool softener or an enema, it should work to relieve your symptoms. You may want to take a mild stool softener prescribed by your surgeon as a preventative measure, rather than waiting until symptoms develop. Do not use over-the-counter treatments without first discussing it with your doctor. Your surgeon needs to be aware of your symptoms and all medications you are taking.

Common medications are often available in both prescription and over the counter forms, such as polyethylene glycol (Miralax).  When a medication is the same in both prescription and over the counter formulations, in most cases the best one to buy is the least expensive option if all other variables (dose, size of package) are the same. 

Drink More Fluids: Increasing your intake of fluids, avoiding caffeinated beverages and focusing on beverages (water and juice) can help keep you well-hydrated and decrease the risk of constipation. Fluids will also help your body to recover after you develop constipation.

Eat More Fiber: Focusing your food intake on healthy, whole foods, such as fresh fruit and vegetables, will help decrease the risk of constipation. It will also help improve symptoms if constipation does develop. When possible, try to eat high-fiber foods. Lean protein is important when recovering from surgery, but it should not be your only source of nutrition. A very low carb diet can also cause constipation.

Regular Meals and Snacks: The body is designed to eliminate food when more food is introduced.  This is one reason why a bowel movement after breakfast is common: food goes in so stool must go out.  For this reason, small and frequent meals can encourage regular bowel movements. 


Constipation. National Digestive Diseases Information Clearinghouse. July 2007

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