Ashwin Lewis
Constipation is a common side effect of surgery, and it can take a few days for your bowels to wake up. This is often due to the effects of anesthesia and pain medication, which can slow down the movement of food through the intestinal tract. In addition, bed rest after surgery can slow down your bowels, and changes in your diet and fluid intake can also cause constipation. To wake up sleeping bowels after surgery, it is recommended to drink warm liquids, increase physical activity, and take laxatives or stool softeners.
| Characteristics | Values |
|---|---|
| What is postoperative ileus | Prolonged absence of bowel function after surgical procedures, usually abdominal surgery |
| How common is it | Up to 25% of patients will develop postoperative ileus after elective abdominal surgery |
| What causes it | The autonomic nervous system, hormones, and neurotransmitters such as nitric oxide, calcitonin-gene-related peptide, and corticotropin-releasing factor |
| What are the risk factors | Prolonged major surgical procedures, general anesthesia, opioid pain medications, and intestinal manipulation |
| How to prevent constipation after surgery | Drink plenty of fluids, eat soft foods, take a laxative or stool softener, and avoid gas-producing foods |
| How to relieve bloating | Simethicone can help relieve discomfort |
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What You'll Learn
Manage constipation with laxatives, stool softeners, and hydration
Constipation is a common issue after surgery, particularly abdominal surgery, which can cause postoperative ileus, or a prolonged absence of bowel function. This condition usually resolves with minimal intervention, but constipation can be managed with laxatives, stool softeners, and hydration.
Laxatives are products that help people empty their bowels, and there are many types. Stool softeners are a type of laxative, but not all laxatives are stool softeners. Stool softeners are gentle medications that typically contain docusate sodium and docusate calcium as active ingredients, which help to soften stools, making them easier to pass. Osmotic laxatives, for example, work by drawing water into the intestines to help soften the stool. Doctors often suggest stool softeners for people who should not strain while using the bathroom, especially after surgery. Bulk-forming laxatives, derived from plants, help form a watery gel in the intestines that add body and lubrication to the stool. Stimulant laxatives are fast-acting and can stimulate the intestines into having a bowel movement. Saline laxatives, which are magnesium-based, pull water into the intestines.
In most cases, a healthcare professional will know which type of laxative to prescribe based on a person's symptoms. Quick relief can be achieved with saline laxatives, while medium relief can be achieved with stimulant laxatives. Stool softeners and bulk-forming laxatives are slower-acting. It is important to note that laxatives should be stopped once stools are soft and easy to pass. If you are still unable to have a bowel movement without the aid of laxatives, consult your doctor.
In addition to laxatives, staying hydrated by drinking warm liquids can help your bowels move. It is also important to make dietary changes to treat constipation. Eating more fiber, such as fresh fruits, vegetables, and fiber-rich foods, can help regulate bowel movements. However, it is best to avoid gas-producing foods such as asparagus, Brussels sprouts, broccoli, cabbage, prunes, pears, and beans.
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Avoid gas-producing foods like asparagus, cabbage, and beans
After bowel surgery, it is common to experience a prolonged absence of bowel function, known as postoperative ileus. This condition is characterised by slow or absent gastrointestinal motility, resulting in delayed bowel movements and the passage of flatus. While postoperative ileus typically resolves with minimal intervention, there are several strategies you can employ to aid in your recovery and alleviate discomfort. One crucial aspect is adjusting your diet to avoid gas-producing foods, such as asparagus, cabbage, and beans.
Asparagus, a nutritious vegetable, is recognised as a gas-inducing food. While it offers various health benefits, consuming asparagus can lead to increased gas production in the digestive tract. This effect is attributed to the complex carbohydrates and fibres present in asparagus, which are not fully digested, leading to fermentation by gut bacteria and the subsequent release of gas. Therefore, it is advisable to limit or refrain from consuming asparagus while recovering from bowel surgery to prevent exacerbating postoperative ileus symptoms.
Cabbage, a member of the cruciferous vegetable family, is another well-known gas-producing food. Cruciferous vegetables, including cabbage, broccoli, and Brussels sprouts, contain raffinose, a complex carbohydrate that contributes to gas formation. When consumed, the body struggles to break down raffinose, resulting in gas and bloating. Hence, it is recommended to avoid cabbage and other cruciferous vegetables during the recovery period after bowel surgery to minimise digestive discomfort.
Beans are notorious for their gas-producing properties and are often referred to as the "musical fruit." They contain complex carbohydrates and fibres that are resistant to complete digestion, leading to gas production by gut bacteria. Soaking beans overnight and discarding the soaking water before cooking can help reduce gas production, but it may not eliminate the issue entirely. As such, it is generally advisable to steer clear of beans while recovering from bowel surgery to prevent aggravating postoperative ileus symptoms and ensure a smoother transition back to regular bowel function.
In addition to avoiding these specific gas-producing foods, it is beneficial to follow a diet that promotes digestive comfort during your recovery. This includes gradually introducing high-fibre foods, opting for cooked vegetables, limiting carbonated beverages, and considering lactase supplements if you are lactose intolerant. Remember that individual tolerance varies, so consulting a gastroenterologist can provide personalised advice tailored to your specific needs.
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Understand the causes of postoperative ileus
Postoperative ileus is a common complication following surgery, particularly abdominal surgery. It is characterised by a prolonged absence of bowel function, with slow or absent gastrointestinal motility. This can result in abdominal distension, bloating, nausea, and vomiting.
The condition usually arises after abdominal surgery, with the most common type being elective colorectal resection. It can also occur after retroperitoneal and extra-abdominal surgery, as well as after general anaesthesia alone. The likelihood of postoperative ileus increases with the duration of the surgery and higher intra-abdominal pressure during minimally invasive surgery.
The autonomic nervous system plays a significant role in the development of postoperative ileus. The sympathetic system inhibits gastrointestinal motility, and increased sympathetic stimulation after surgery can lead to ileus. Additionally, hormones and neurotransmitters, such as nitric oxide, calcitonin-gene-related peptide, and corticotropin-releasing factor, may induce the condition.
Postoperative pain medications, particularly opioids, can also contribute to the development or worsening of postoperative ileus due to their inhibitory effect on gut motility. Other drugs, such as anaesthesia, psychotropics, anticholinergics, and antiemetics, are also risk factors. Underlying endocrine disorders, metabolic issues, and cardiopulmonary failure can increase the risk of postoperative ileus.
The management of postoperative ileus typically involves supportive care, focusing on electrolyte replacement, intravenous fluids, ambulation, pain control, and analgesics adjustment. Pharmacists play a crucial role in medication review and providing alternative pain regimens to reduce opioid exposure. Physiotherapists are also important in early ambulation and diet progression.
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Manage pain without opioids
Opioid medications are commonly used to manage pain after surgery, but they can cause constipation, abdominal pain, and bowel dysfunction. To wake up sleeping bowels and manage pain without opioids, consider the following:
Firstly, it is important to distinguish between postoperative ileus and more severe conditions. Postoperative ileus is a common benign complication after abdominal surgery, characterised by slow or absent gastrointestinal motility. It usually resolves within 72 hours with supportive treatment and minimal intervention.
To manage pain and promote bowel function without relying heavily on opioids, there are several strategies you can employ:
- Opt for laparoscopic procedures: When possible, choose laparoscopic surgical techniques as they have been proven to reduce the likelihood of postoperative ileus and the need for opioid pain management.
- Manage pain with non-opioid medications: Anesthesiologists often carefully construct a pain medication plan that may include acetaminophen (Tylenol), nonsteroidal anti-inflammatories (ibuprofen), anesthetic medications, and medications for nerve pain. These can help manage pain while minimising opioid use and their side effects.
- Increase fluid intake: Fluids can help prevent constipation and aid in recovery. Drink plenty of water and juice to stay hydrated and lower the risk of constipation. Avoid caffeinated beverages as they can have a dehydrating effect.
- Adjust your diet: Increase your fibre intake by consuming fruits and vegetables in their natural state. This can help soften stools and promote bowel movements. However, avoid bulk fibre supplements after surgery, as they can worsen constipation if not accompanied by adequate water intake.
- Stimulate bowel function: Physical activity can help trigger a bowel movement. Even gentle movements or walks can stimulate your digestive system. Additionally, gas passing is a sign that your bowels are returning to normal, so don't hold back!
- Use laxatives and stool softeners: Start with gentle laxatives, such as plant-derived laxatives containing sennosides. Stool softeners can also be used in combination with laxatives. Remember that different laxatives work differently, so be flexible and consult your care team for guidance.
- Address trapped gas: Trapped gas can cause bloating and discomfort. Techniques such as simethicone can help relieve this issue.
Remember, it is important to consult your doctor or care team before, during, and after your surgery. They can provide personalised advice and address any specific concerns you may have about managing pain and bowel function without relying heavily on opioids.
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Take steps to prevent constipation before surgery
Constipation is a common side effect of surgery, and it is much easier to prevent it than to treat it. Here are some steps you can take before your surgery to prevent constipation:
Firstly, understand the causes of post-surgery constipation. This will help you identify the specific steps you need to take to prevent it. The most common causes of post-surgery constipation are the prescription drugs given for pain relief, particularly opioids. Opioids slow down the movement of food through the intestinal tract, giving the body more time to remove water, resulting in drier and harder stools. Additionally, opioids may decrease the urge to have a bowel movement. Other causes of post-surgery constipation include the effects of anesthesia, which can paralyze the muscles and stop movement in the intestinal tract, and inactivity during the recovery period.
Secondly, discuss your concerns about constipation with your surgeon or care team before the surgery. They can address your concerns and make adjustments to your pain medication plan to minimize constipation. Anesthesiologists carefully construct pain medication plans using different types of drugs, including acetaminophen (Tylenol), nonsteroidal anti-inflammatories (ibuprofen), opioids, anesthetic medications, and medications for nerve pain. By expressing your concerns, they may be able to minimize the use of opioids, which are the most common cause of constipation.
Thirdly, stay properly hydrated before and after your surgery. Dehydration can contribute to constipation, as it results in less fluid in your stools, making them harder and drier. However, be sure to follow your surgeon's instructions regarding fluid intake, as there may be specific guidelines to follow depending on your surgery.
Finally, understand that your diet may change after surgery, and these changes can contribute to constipation. For example, you may be instructed to fast before surgery and only drink small amounts of fluid afterward. Food stimulates the digestive system and keeps things moving, so not eating can disrupt your body's normal elimination routine. Additionally, the food provided at the hospital may be significantly different from your regular diet, which can also impact your bowel movements.
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Frequently asked questions
Postoperative ileus is a prolonged absence of bowel function after surgery, usually abdominal surgery. It is a common postoperative complication and is characterised by an abnormal pattern of slow or absent gastrointestinal motility.
The autonomic nervous system plays a role in postoperative ileus, with increased sympathetic stimulation inhibiting gastrointestinal motility. Other factors include hormones, neurotransmitters, and the use of opioid pain medication.
Constipation is a common side effect of surgery due to the use of anaesthesia and opioid pain medication. To prevent constipation, ensure you are properly hydrated, eat fibre-rich foods, and engage in physical activity.
Speak to your doctor about taking a laxative or stool softener. Avoid fibre supplements unless recommended by your doctor, as they can worsen constipation without adequate fluid intake.
Avoid gas-producing foods such as asparagus, brussels sprouts, broccoli, cabbage, prunes, pears, and beans.
