Director of Education, VitaMedica
Are you worried about pain and downtime following a surgical procedure? If so, this may be the least of your concerns.
That’s because a common issue after surgery is not pain management but post surgical constipation.
Even if you have regular bowel movements prior to surgery, you’re likely to experience post surgery constipation. Why? Because pain medications, anesthetic agents, alterations to diet, dehydration, stress and reduced physical activity can work against your body’s normal routine of elimination.
Unfortunately, most surgeons fail to mention post op constipation to their patients. If you’re lucky, the nurse or patient coordinator will give you the head’s up and provide a few recommendations.
The good news is that you can take steps NOW to prevent post-op constipation from sidelining you after surgery.
1. Drink Plenty of Water
Dehydration is a common cause of constipation. By the time you get home from surgery, you haven’t had much to drink in the past 24 hours. You should be drinking eight to ten 8-ounce glasses of filtered water each day. Drinking lots of water after surgery helps to rehydrate your body and flush out the toxins. But, make it a goal to start drinking more water 7 days before your surgery and continue after your surgery.
2. Be Mindful of Pain Meds
A frequently overlooked cause of constipation (and nausea) is narcotic medications which are routinely prescribed for pain after surgery. Pain meds include codeine (Tylenol #3), oxycodone (Percocet) and hydromorphone (Dilaudid). If you need to manage post operative pain, then by all means take your pain meds. But, keep in mind that it may be possible to substitute a less constipating medication like ibuprofen (a non-steroidal anti-inflammatory drug) to manage your pain. For a recent surgery, my doctor gave me the option of getting either a narcotic or non-narcotic pain medication.
3. Replenish Your Beneficial Bacteria
After anesthesia, it can take a few days for your digestive system to start working normally again. The beneficial bacteria that line your digestive tract play an important role in getting things moving. But, their job is made much more difficult if you’ve been prescribed an antibiotic, which is routine after surgery. Antibiotics not only kill the bad bacteria, but the good bacteria too.
You can repopulate your gut with beneficial bacteria by eating yogurt and drinking kefir, foods that naturally contain probiotics, and by supplementing with a probiotic.
Yogurt. Some yogurts are heat-treated after fermentation which kills the beneficial bacteria. So, when purchasing, look for the “Live & Active Cultures” seal which ensures that refrigerated yogurt contains at least 100 million cultures per gram at time of manufacture. To save calories and limit fat and added sugars, opt for plain, non-fat yogurt. Horizon’s plain, non-fat yogurt contains 5 live and active cultures at 18 billion CFUS per serving. Each 1 cup serving has just 110 calories and provides 11 grams of protein.
Kefir. Like yogurt, kefir is a fermented milk product found in the dairy section. However, kefir has a consistency of thin yogurt and a taste that is sour, carbonated and slightly alcoholic. Think of it as a creamy, probiotic, yogurt-like smoothie. Kefir is 99% lactose-free and gluten free which is ideal for those with lactose and gluten intolerance.
Kefir is starting to become available in natural product stores and supermarkets across the U.S. One of the bigger brands is Lifeway. They offer 14 low-fat flavors that provide 2.5 to 4 billion CFUs of 12 live and active probiotic cultures per one cup serving. Unless you buy plain, the sugar content is high. But, if you’re not eating much a few days following surgery, don’t worry too much about the calories and sugar content.
Probiotic Supplement. In addition to eating probiotic containing foods, you can directly add beneficial organisms to your gut by taking a probiotic supplement. Take a supplement like VitaMedica’s Probiotic-8 which is formulated with Streptococcus thermophilus plus a broad range of probiotic species from the Bifidobacterium (B. bifidum, B. longum, B. lactis) and Lactobacillus (L. acidophilus, L. casei, L. rhamnosus, L. salivarius) families.
The timing of antibiotics and probiotics is important. To learn more, read our companion article:
Through a combination of probiotic foods and supplements, you want to aim in getting 30 billion or more probiotic organisms a day.
4. Up Your Fiber Intake
Eating foods that contain fiber keeps your digestive system running optimally and nourishes the beneficial bacteria in your digestive tract. Getting plenty of dietary fiber (bulk forming laxatives) also promotes regularity, an important concern after surgery.
One of the easiest ways of increasing fiber is by eating several prunes a day. Just a ½ cup of prunes provides 6 grams of fiber or almost 25% of your daily dietary fiber requirements. Aim to eat three prunes a day, starting the day before your surgery, and continuing for a week after surgery.
Many fruits and vegetables are also a good source of fiber. Good fruit options include berries (raspberries, blackberries, and blueberries) pears, oranges, guava and apples. Good vegetable options include spinach, Swiss chard, squash, Brussels sprouts, broccoli, cauliflower, sweet potato, avocado, and jicama.
Other good sources of fiber include bran (oat, wheat, corn and rice bran), beans and peas (garbanzo, black, kidney, navy, pinto and white beans, lentils, split peas and Edamame), whole grains (barley, quinoa, teff, wheat berry, bulgur) nuts and seeds (flaxseed, almonds, sunflower, pumpkin).
Be sure to eat plenty of these health promoting, high fiber foods after surgery. However, keep in mind that too much fiber, too quickly can lead to bloating, gas and cramping. So, if you’re not accustomed to eating a fiber-rich diet, gradually increase the amount of fiber that you’re consuming each day to allow the beneficial bacteria in your digestive tract time to adjust to the change.
5. Take a Stool Softener/Laxative
After surgery your stool can be dry and it can be difficult to eliminate. A number of over-the-counter medications and supplements are available which address constipation.
Stool softeners like Colace and Phillips Liquid Gels are emollient laxatives that add moisture to stool to allow for strain-fee bowel movements. Stimulant laxatives like Senokot and Dulcolax trigger rhythmic contractions of the intestinal muscles to eliminate stool. Combination products like Senokot-S, Peri-Colace and SurgiLax combine the benefits of both laxatives and stool softeners. Suppositories, which are inserted into the rectum, have different mechanisms of action. These medications speed up stool movement by stimulating the bowel muscles and usually work very quickly.
When should you take a medication for constipation after surgery? That depends on what’s normal for your body. But, since just about everyone seems to get constipated after surgery, taking a stool softener or laxative once you get home from surgery seems like a good idea. Certainly, if you haven’t had any movement after a day, then start taking one of these products. Just be sure to contact your doctor if you constipation continues for more than several days.
I strongly suggest that you purchase one of these products BEFORE your surgery so you have it on hand when you need it!
6. Get Moving
After surgery, you may not feel like moving around too much. While your surgeon will want you to be careful not to overdo things, you need to start moving. Even if this means walking around the house or yard. Aside from preventing blood clots from forming, physical movement encourages your intestines to start working again.
Let’s face it – recovering from the actual surgery is enough to focus on without having to deal with the negative side effects of constipation. But, by putting these 6 tips into practice, you can prevent this problem from even occurring.
Do you have any other tips or ideas that you’ve used to prevent post-op constipation? Let us know!
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.