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Postoperative Constipation: Causes, Symptoms, and Treatment Options

Jan 27

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Constipation is a common condition that affects many people at some point in their lives. Though usually temporary, it can cause discomfort and frustration. Constipation accounts for approximately 2.5 million doctor visits and over 700,000 emergency room visits annually in the U.S., with a significant number related to older adults and patients using opioid medications. After surgery, constipation is likely the most common encountered complication. In this post, we’ll explore what constipation is, what causes it, and how to manage it effectively. The following information is adapted from American Society of Colon And Rectal Surgeons.


What Is Constipation?

Constipation refers to infrequent or difficult bowel movements. It may include:

  • A decrease in the volume of stool

  • The need to strain to have a movement

  • A sense of incomplete evacuation

  • The need for enemas, suppositories, or laxatives to maintain regularity

For most people, normal bowel movement frequency can range from three times a day to three times a week. Some people can go a week or more without discomfort or negative effects. Diet plays a key role in bowel habits. While the average American consumes 12 to 15 grams of fiber daily, 25 to 30 grams of fiber is recommended, along with 60 to 80 ounces of fluids, to support proper bowel function. Regular exercise also helps with colon health.

About 80% of people experience constipation at some point, and brief episodes are normal. However, if bowel movements occur less than three times weekly for a prolonged period, it might be considered chronic constipation.


What Causes Constipation?

Several factors can contribute to constipation, including:

  • Diet: Inadequate fiber or fluid intake

  • Lifestyle: Sedentary habits or lack of physical activity

  • Changes: Travel, pregnancy

  • Ignoring the urge: Delaying or ignoring the need for a bowel movement


More serious causes include blockages or narrowing in the colon, which require medical attention or surgery. Other contributing conditions may include:

  • Spinal cord injuries

  • Diabetes

  • Scleroderma

  • Nervous system disorders (e.g., Parkinson's disease, multiple sclerosis)

  • Endocrine disorders (e.g., thyroid disease)


Can Medications Cause Constipation?

Yes, many medications can slow down bowel movements and lead to constipation, including:

  • Painkillers (opioids): Examples include Percocet, Vicodin, Oxycodone, Tramadol, Morphine

  • Antidepressants and tranquilizers

  • Blood pressure medications

  • Diuretics

  • Iron and calcium supplements

  • Aluminum-containing antacids

If you are taking any of these medications and experiencing constipation, discuss this with your doctor to explore alternatives or supportive treatments.


CONSTIPATION AFTER SURGERY

Constipation after surgery is a common issue that many patients face during recovery. Several factors can contribute to post-surgical constipation:

  • Pain Medications (Opioids): Opioids, commonly prescribed after surgery for pain relief, are well-known to slow down bowel movements, leading to constipation.

  • Reduced Physical Activity: After surgery, patients are often less active, and physical inactivity can slow down the digestive system.

  • Dietary Changes: Surgery may require a change in diet, often leading to a lower fiber intake, which can contribute to constipation.

  • Anesthesia: The effects of general anesthesia can temporarily slow down the movement of the intestines (known as postoperative ileus), causing constipation.


Tips for Managing Post-Surgical Constipation:

  • Increase Fiber Intake: As soon as your doctor approves, add high-fiber foods like bran, whole grains, fruits, and vegetables back into your diet.

  • Stay Hydrated: Drinking plenty of fluids is crucial to keeping your stool soft and easy to pass, at least 6-8 glasses of water daily should be consumed. Additional water intake after surgery is very helpful.

  • Gentle Exercise: If possible, light walking or other gentle activities can stimulate your digestive system.

  • Stool Softeners or Laxatives: Your doctor may recommend stool softeners like docusate or gentle laxatives like MiraLAX to help relieve constipation without straining.

  • Avoid Straining: Straining can be harmful after certain types of surgery, particularly abdominal or pelvic surgeries. Let your healthcare provider know if you're having difficulty with bowel movements.

Always consult your doctor if constipation after surgery persists or worsens, especially if accompanied by pain, bloating, or nausea.


Diagnosing the Cause of Constipation

To treat constipation effectively, identifying the underlying cause is key. Your doctor will typically start with a digital examination of the anorectal area. Additional tests, such as a colonoscopy or imaging studies, can help rule out serious conditions like polyps or tumors or narrowing.

Other tests may include marker studies, where you swallow a capsule with markers that show up on x-rays to track the movement of stool through your intestines. Your doctor might also evaluate the function of the anus and rectum through physiological tests.


How Is Constipation Treated?

Most cases of constipation can be managed with simple lifestyle and dietary changes. Here’s how to get relief:

  • Increase Fiber Intake: Foods like bran, whole grains, fruits, and vegetables can help. Fiber supplements are also a good option and can provide additional benefits like lowering cholesterol and reducing the risk of colon polyps.

  • Stay Hydrated: Aim for 60 to 80 ounces of fluids daily to keep things moving smoothly.

  • Exercise Regularly: Physical activity promotes healthy digestion.

In some cases, your doctor might recommend:

  • Stool softeners: Such as Docusate, which helps water and fats mix into the stool.

  • Laxatives: For more persistent constipation, laxatives like Senna, Bisacodyl, or MiraLAX can stimulate bowel movements, but should be used under medical guidance.

  • Enemas: Used as a last resort, enemas hydrate and stimulate the bowel directly.

For some people, scheduling a regular time each day for a bowel movement or biofeedback therapy to retrain anal sphincter muscles can also be helpful. Surgery is rarely needed.


Common Stool Softener and Laxative Options

  • Prune juice: A natural option that’s high in fiber and acts as a laxative. Pineapple juice is considered a type of prune juice that is better tolerated. 

  • Docusate: Softens stools by allowing water and fats to mix with them.

  • Bisacodyl (Dulcolax): Stimulates the colon to contract.

  • Senna: A natural laxative that speeds up the movement of stool.

  • MiraLAX: Draws water into the colon to ease bowel movements.</