Constipation After Surgery

Why It Occurs, and How to Treat It

Man With Constipation
Peter Dazeley/Photographer's Choice/Getty Images

Given the stress the body endures during a surgical procedure, among other things, it may not be surprising to hear that surgery patients are far more likely to have bouts of constipation—an inability to pass stool, or difficulty passing stool because it's dry or hardened—than the average person. 

Causes of Constipation After Surgery

Surgery patients are prone to constipation for multiple reasons, the primary reason being the prescription drugs given for pain relief.

Pain Medication

Opioids are a powerful type of pain medication and are frequently given after surgery for pain control. Unfortunately, all opioids have a well-known side effect of causing constipation.

One way in which opioids promote constipation is that they decrease the movement of food through the intestinal tract, which gives the body more time to remove water. This can lead to a drier than typical stool.

It's also believed that opioids may actually increase the amount of water that is absorbed from the GI tract. Finally, opioids may decrease the urge to have a bowel movement, which again allows more time for the body to remove water.

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 your stools, resulting in hard, dry bowel movements. 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 significant 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. So suddenly spending most of your time in bed resting after surgery does not assist your bowels in moving stool along. 

Anesthesia

People think of anesthesia as something that puts us to sleep. Anesthesia, though, also paralyzes your muscles, which stops food from being moved along the intestinal tract. In other words, until your intestines "wake up," there is no movement of stool.

Complications From Constipation

Beyond simply feeling more comfortable, there are other important reasons to address post-surgical constipation. 

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 dis-impaction (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 prolapsehemorrhoids, 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.  Furthermore, open heart surgery patients can be at particular risk from heart rhythm changes while straining to have a bowel movement. 

What's Normal?

Since it's important to "keep things moving" after surgery (and always, for that matter), it may be helpful to review what healthy bowel movements are (and what might be a sign of a problem).

When it comes to defining constipation, there is no hard and fast rule for bowel movement frequency. In other words, if you normally have two or three bowel movements per day, three per week would indicate constipation. On the flip side, for some people, three bowel movements per week is their "normal."

Furthermore, "normal" stool or bowel movements are soft, formed, and controlled (meaning no "accidents"), and are not painful. 

Unfortunately, stool tends to become harder and harder as the length of time between bowel movements increases. This is because more water is absorbed back into the bloodstream, causing the stool to dry out in the colon.

Preventing Constipation After Surgery

Obviously, it's ideal to prevention constipation after surgery, rather than develop it and have to treat it. Here are some tips to optimize your bowel health, so you can avoid as much discomfort as possible.

Medications

Your surgeon may prescribe a stool softener to take along with your pain medication to prevent constipation. If this is the case, please follow your surgeon's advice, even if you have never experienced constipation before. It's much easier and more comfortable for you to prevent constipation than deal with it once it starts. 

On the flip side, it's important to not use over-the-counter treatments without first discussing them with your doctor. There is a huge range of over-the-counter medications for constipation, and some of them may not be right for you. For example, a bowel stimulant may be too aggravating for your body. 

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 recover after you develop constipation.

Remember to also take your pain medication with water and continue to drink water throughout the day. The recommended daily intake of water is typically about 64 ounces, which may not be enough when taking opioids. 

Eat More Fiber

What you eat can increase or decrease your risk of constipation. Increase your fiber intake by eating fruits and vegetables, preferably as close to their natural state as possible. A whole orange will do a better job of providing fiber for your diet than orange juice with the pulp removed.

You can also add fiber to your diet with fiber supplements, but remember that adding supplemental fiber can increase constipation if too little water is consumed.

In addition, avoid foods known to cause constipation. For many people, cheese can lead to constipation, as can a diet full of meat with minimal fruit and vegetables.

Regular Meals and Snacks

The body is designed to eliminate stool when 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.

Physical Activity

Physical activity, such as walking, has also been shown to decrease the risk of constipation. Of course, be sure to follow the instructions of your surgeon regarding your limits on exercise.

Treating Constipation After Surgery

If you have developed constipation, the advice for preventing constipation still applies to you.

Increasing your water intake is essential, as are dietary changes to add fiber to your meals. In addition, there are many over the counter and prescription treatments for constipation. But if you have recently had surgery, you should consult your physician prior to using them.

Constipation relieving agents vary in how gently or aggressively they treat constipation and can cause considerable abdominal distress. Too much medication or overly stimulating treatments can cause cramping, pain, and diarrhea.

With that, common types of anti-constipation therapies include:

  • Enema
  • Stool softener
  • Laxative
  • Fiber supplement
  • Magnesium citrate
  • Glycerine suppositories

A Word From Verywell

Constipation should never be ignored, especially after a stressful experience like surgery. But don't worry if you do develop constipation, even if you tried hard to prevent it. With your doctor's help, and possibly some medication, you can get your bowels back on track. 

Sources:

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.) Constipation.

Trads M, Pedersen PU. Constipation and defecation pattern the first 30 days after hip fracture. Int J Nurs Pract. 2015 Oct;21(5):598-604

Continue Reading