This article is co-written by Jonas DeMuro, MD. Dr. DeMuro is a certified pediatric surgeon, specialist in emergency surgery from New York. He graduated from Stony Brook University School of Medicine in 1996.
The number of sources used in this article is 18. You will find a list of them at the bottom of the page.
If you have surgery, keep in mind that after surgery, there is often constipation. Many painkillers (especially opioid analgesics) and the anesthesia used during surgery slow down the gastrointestinal tract and therefore can cause constipation. In addition, constipation can occur after surgery on the stomach or intestines, as well as due to a special diet. There are many ways to relieve constipation after surgery. It can be changes in lifestyle, diet or taking appropriate medications.
Causes of Constipation
80-90% of operations adversely affect intestinal motility, which becomes the main condition for the occurrence of constipation in humans. A brief explanation of such unpleasant consequences of surgical interventions:
- After anesthesia, the body tends to experience a cardinal imbalance of functioning, muscle weakness (mainly affects the intestines).
- Due to postoperative sutures and injuries, voltage is prohibited, defecation with straining is excluded.
- Physical passivity - lying down after surgery provokes a slowdown of the intestines. This means that the removal of contents from the body to the outside slows down.
- Change of the already usual regimen and diet (body stress).
- Taking a large number of drugs to prepare for surgery.
An important role is played by the psychological factor. After the operation, the patient experiences a stressful, sometimes depressive state, even nervous breakdowns are possible. The described number of reasons stimulates constipation.
List of operations that cause constipation
Usually constipation appears after surgery on the gastrointestinal tract. The list includes:
- Surgery to remove appendicitis. The patient is recommended to take food in small portions every 2-3 hours (cereals, mashed potatoes or food in finely ground form). The specified diet will help a person quickly restore the functioning of the digestive tract.
- The operation to eliminate hemorrhoids. The disease involves a number of reasons for the occurrence of constipation, is a pain syndrome, dysbiosis, scarring, disturbance of the microflora in the intestines and fear in the operated person about the divergence of the sutures. After removing hemorrhoids, rest is recommended, proper nutrition.
- After abdominal surgery. Adhesions (adhesions from the connective tissue, which leads to gluing of the serous surfaces of organs) provoke constipation in the abdominal cavity. It is advisable to restore active life position (playing sports) to the maximum in order to get rid of malaise. Doctors advise diversifying the diet with cereals from coarse grains (wheat), biokefir, vegetable salads and light soups.
- After laparoscopy (surgical intervention through the formation of a small hole). The operation eliminates injuries. True, this does not mean that constipation will bypass the patient. In the event of such an operation, you will need to abandon physical activity (gym, dancing, running, etc.) and hot procedures (sauna). Mandatory daily care for sutures and an antiseptic dressing.
- After resection. Laparoscopic cholecystectomy suggests removing a poorly functioning gallbladder. On the first postoperative day, it is forbidden to drink or eat. Over the next 24 hours, it is allowed to take unsweetened wild rose broth, switching to green tea, dried fruit compote or low-fat kefir. As for solid food, mashed potatoes, mashed vegetable soups, boiled fish are allowed on the fourth or fifth day. Fast recovery and treatment of constipation require a prescribed diet and proper nutrition.
- Removal of the uterus and the possible appearance of adhesions. The occurrence of constipation is often associated with a long operation, a large amount of lost blood, hidden bleeding, and a possible infection.
- After general anesthesia. People’s reactions to anesthesia are different. Some people react to anesthesia negatively. In addition, anesthesia has a bad effect on the liver and kidneys due to its inherent narcotic nature. Simple boiled water comes to the rescue.
Almost all surgical interventions in the human gastrointestinal tract entail constipation. To get rid of malaise, you will need to adhere to doctoral recommendations and protect your own health.
If you want to treat constipation yourself, you should focus on the advice of the article (with the permission of the doctor!). Methods of treating constipation can be divided into drug and folk.
Medication for constipation
Stool softeners will help to solve a painful situation. Emollients normalize emptying. To purchase them, you do not need special recipes by your doctor. Medications fill the stool with an optimal level of moisture, which facilitates bowel movements. Take tablets 1-2 times a day.
Laxatives for constipation in combination with softeners help to cope with the disease. Distinguish between stimulating and osmotic. The latter give the fluid in the body access to the intestines. The former are also effective. After a laxative stimulant, diarrhea and stomach cramps are possible.
Lubricating drugs are a less well-known method of dealing with complicated bowel movements, which does not mean the absence of a result. The principle of operation is similar to softeners, a simple passage of the stool through the digestive tract is provided by lubrication of the intestinal walls. Mineral oil and fish oil are considered more common and affordable.
Candles or enemas also help to cope with constipation. In most cases, the main component of the suppository is glycerin with bisacodyl, which easily penetrates the muscle structure of the rectum, stimulating easy contraction. Enema is supposed to be set only with the permission of the doctor, since after a series of operations it is contraindicated.
Regarding folk remedies in the treatment of constipation - therapy is based on proper nutrition and consumption in a greater concentration of certain foods. It is necessary to increase the level of fluid in the body. It is believed to drink a universal norm of water and more (from two liters per day): boiled water, coffee and decaffeinated teas (the best option is a laxative). It is forbidden to use carbonated drinks, fruit nectars, alcohol and energy drinks.
Fiber in supplements softens the stool and facilitates its movement through the digestive tract. Dietary fibers are used in different ways: in the form of capsules, chewing sweets or powder - no more than two times in knocking with the permission of a doctor.
It is worth to refrain from food causing constipation:
- Products with a high concentration of potassium and calcium.
- Milk (cheese, sour cream, yogurt, not including fat-free kefir).
- Fruits (grapes and bananas).
- Sweets (chocolate, caramel, etc.).
- Concentrated Nectars.
- Flour and butter products.
- White bread and pastries (sweet and salty).
- White rice.
- Semi-finished products, etc.
Prunes are an essential component in the treatment of constipation, because its natural sugar sorbitol and fiber have a laxative effect. It is permissible to drink warm juice from prunes - a glass a day.
Traditional medicine suggests treating constipation with senna leaves and buckthorn bark, chamomile broth, pumpkin or carrot juice. That's just no folk remedies will not eliminate the congestion without clearly defined rules. In the case of food, this is a strict diet.
Features of diets and general recommendations
The diet should be called the most effective means of combating postoperative constipation, which is prescribed by the attending physician. And not in vain, because exclusively proper nutrition will be able to strengthen the effect of medicines and give the body the strength to deal with sore. The diet consists of products whose composition is saturated with certain substances, vitamins and minerals, which can easily cope with constipation:
- Oatmeal and buckwheat (in combination with slices of prunes and a spoonful of honey is not only useful, but also tasty).
- Whole grain bread, bran and diet bread.
- Vegetable and fruit salads (excluding legumes and quinces).
- Steamed lean meat (chicken or turkey).
- Boiled fish.
In addition, it is allowed to sign up for acupressure. Thanks to the identification and activation of certain points, stagnant food moves along the gastrointestinal tract. To conduct a massage procedure, it is recommended to sign up with an experienced master and not do it yourself, so as not to harm yourself.
Physical activity is seen as a key part of the diet. It is important to force yourself to move from the moment the doctor allows you to walk. Systematic exercise normalizes the colon, and light aerobics in the fresh air stimulates regular stool. It is advisable to devote walking 3 hours a week, at least. And in parallel to engage in certain sports that are allowed after the operation.
Try to visit the bathroom regularly. Listen to the body and signs of urge to empty. Do not put off going to the toilet. Later, such checks will immediately attract severe constipation. At the end of time, bowel movements will acquire an individual mode, and the intestines will be able to be released daily at approximately the same time.
To prevent the occurrence of constipation, timely consultation of the attending physician before the operation and discussion with the doctor of the likelihood of occurrence of constipation will help. Together, optimize the functioning of the gastrointestinal tract and exercise to the maximum. Problem situations have arisen - immediately contact a gastroenterologist so as not to aggravate the situation. Maintain a stable state of health and invest physical labor in it, because it is the most valuable human capital.
Causes of constipation after surgery
After surgery, many patients suffer from constipation, and a number of provoking factors can contribute to this:
Drugs that are prescribed before the procedure are used during and after surgery, can cause constipation. This can be seen as a side effect of the medications taken.
- Diet Changes
Before and after surgery, patients are advised to limit their diet, adhere to a specific diet. In some cases, the patient's well-being does not allow eating in the traditional way. In the formation of constipation, fluid deficiency will also play a role.
- Low physical activity
A decrease in physical activity is a common cause of constipation, which may be characteristic not only for patients after surgery. But after surgery, long-term treatment is required, limitation of physical exercises. Small physical activity negatively affects intestinal motility.
Symptoms of constipation after surgery
Often there is confusion between true constipation and delayed bowel movements. Symptoms of true constipation that occurs after surgery include:
- sudden termination of the urge to defecate,
- defecation less than 3 times a week,
- Strong stress required
- the chair is hard
- lack of sensation of complete bowel movement,
- persistent bloating, flatulence,
- the appearance of pain and other discomfort in the intestines.
Possible complications of constipation
Doctors remind that in some cases constipation can be considered as a serious threat to recovery and recovery after surgery, which can lead to a number of complications:
- with strong stress during the act of defecation, there is a possibility of seam divergence,
- due to intestinal tension, the likelihood of developing hemorrhoids increases,
- formation of anal fissures,
- rectal prolapse.
Doctor's advice: how to alleviate the condition
Despite the high risks of complications, before using any method to alleviate the condition, especially when it comes to taking medications, you must first consult a doctor.
Only a doctor can determine the safety of certain methods and give recommendations. For patients after surgery, it is necessary to select mild ways to get rid of constipation, which will not only reduce the likelihood of their development, but also help to recover faster after surgery.
Movement is life
Only after the doctor gives approval, you can begin physical activity: take walks in the ward, ward, or even in the hospital. Such actions will stimulate the intestines, therefore, the problem of constipation can be solved gently and independently.
Numerous studies have shown that inadequate physical activity, a sedentary lifestyle are associated with constipation and other problems.
In some cases, doctors may prescribe medications that help stimulate intestinal motility and relieve constipation in patients. The mechanism of action of these drugs may be different, but in most cases it is possible to find a drug that is suitable in each case.
Medication is not the only way to get rid of constipation. Your doctor may recommend certain nutritional principles, such as the inclusion of fiber-rich foods in your diet.
Patients should remember that self-medication for constipation can be dangerous. For example, if the cause of constipation is associated with taking opioid drugs, taking a laxative can cause severe pain in the abdomen and worsen the patient's condition after surgery.
Probiotics are beneficial bacteria and other microorganisms that play an important role in maintaining intestinal health. A review of more than 14 scientific studies showed that taking probiotics after surgery helps to cope with constipation.
Probiotics can stabilize the frequency of bowel movements and soften stools. But before taking probiotics, it is extremely important to consult with your doctor first.
Proper nutrition and drinking regimen also play an important role in the prevention of constipation after surgery. After the intervention, the doctor gives nutritional advice that is suitable for the particular patient and depends on many factors.
Dehydration can cause constipation. After surgery, it is important to drink water in small portions and often, if there is no medical contraindication. The doctor can recommend not only drinking water, but also, for example, juices, fruit drinks, dried fruit compotes.
Caffeinated drinks, sweet soda. Even mineral water with gas may be banned.
Studies have shown that for full intestinal function, adults, whose daily diet consists of 2000 calories, should receive about 25 grams of fiber every day. Record-keeping products by its content include fruits, vegetables, whole grains, some nuts and seeds, and legumes.
It is important that, along with fiber intake, you need to normalize your drinking regimen.
Duration of constipation after surgery
As a rule, stool stabilization occurs a few days after surgery; normalization of nutrition and physical activity can accelerate the process. It’s difficult to establish the exact time it takes to recover, everything will depend on several factors:
- general condition of the patient after surgery,
- the duration, complexity and type of surgery, it is important to consider the area of operation,
- what medications were recommended after surgery.
The problem of constipation after surgery is familiar to many, but, as a rule, this condition is short-term, amenable to correction. It is strictly forbidden to take medications and even food products with a pronounced laxative property on their own without first consulting a specialist.
Atony after surgery
Atony of the intestine, that is, a decrease in smooth muscle tone, can occur due to the introduction of anesthesia. With anesthesia, all the muscles of the body, including the intestines, relax. After surgery, substances can still affect the body for some time, so constipation is observed in the patient for several days.
With a decrease in peristalsis, the food lump moves worse from the upper intestines to the lower ones. With atony, a decrease in wave-like movements of the intestinal wall is observed. Insufficient reduction causes stagnation of feces. Losing water, feces harden, damaging the mucous membranes.
Symptoms of constipation
With constipation, the patient needs a bowel movement, but cannot go to the toilet. Constipation after surgery is accompanied by the following symptoms:
- The patient feels full intestines, heaviness in the abdomen.
- Appetite and sleep are upset.
- Signs of intoxication appear: vomiting and nausea occur due to accumulated toxins.
- Ухудшается настроение.
- Снижается аппетит.
Отвердевшие каловые массы могут стать причиной не только травмы слизистых, но и внутреннего кровотечения. Не исключено появление анальных трещин, через которые инфекции без труда проникают в организм.
Muscle tone after anesthesia is restored over time. At the stage of recovery, it is important to prevent prolonged constipation.
Treatment for constipation
Strong laxatives for constipation should not be used often, since the body quickly gets used to excipients, and under the influence of medications, the intestines are worse at managing their functions. It should be remembered that the task of a laxative is to alleviate the suffering of the patient by making bowel movement possible. A laxative does not cure the cause of constipation, but helps to cleanse the body and restore the natural microflora.
Quick-acting drugs have the greatest effect on constipation caused by flaccid peristalsis. Not intended for prolonged use. The drug is taken in the evening, so that in the morning there is a chair. Liquefying drugs are contraindicated in case of anal fissures, uterine bleeding, hemorrhoids during exacerbation. The drugs in this group include:
The drugs are available in the form of tablets, syrups, suppositories, drops.
Prebiotics are drugs of delayed action. The main task of prebiotics is to restore the normal intestinal microflora. Drugs in this group are safe for nursing mothers and children. A laxative with a weak effect does not act instantly, but, unlike irritating drugs, prebiotics can be used for a long time. The main thing is to adhere to the instructions. Of the prebiotics, Dufalac, Goodluck, Exportal can be noted.
To restore normal bowel function, you can take laxatives that do not cause lazy bowel syndrome. Fast-acting drugs are good when urgent bowel cleansing is required. Osmotic laxatives can be used for a long period - up to three months. Salt preparations protect feces from dehydration. Holding water, medicines of this group prevent the hardening of the food lump. The drugs of the group include Mukofalk, Osmogol, Lavacol, Mikrolaks enema.
Natural and herbal preparations increase fecal masses, accelerating bowel movements due to the occurrence of reflex function. Do not use drugs with irritable bowel syndrome, with a lethargic intestine, intestinal excipients may not have the desired effect. Of the preparations of the group, the most famous are Agar-agar, wheat bran, flaxseed, etc.
Massage for constipation
For problems with emptying, a hardware or manual massage can be prescribed. To improve peristalsis, you can master the technique of self-massage. Massage movements are performed in a horizontal position. When lying down, maximum relaxation of the abdominal cavity is achieved.
Sessions are held for 10 minutes twice a day: 30 minutes after breakfast and 1.5 hours after lunch. Start the massage by stroking the right iliac region, gradually moving to the left side. Stroking is replaced by circular rubbing movements with a slight pressure.
Immediately after waking up, acupressure can be performed. Fecal stagnate in the area just below and to the left of the navel. Sometimes the patient feels a solid body in this place. Massage is carried out with three fingers. It is necessary to perform circular movements in a clockwise direction for 2-3 minutes. During the day, several such self-massage sessions are needed.
Gymnastics with constipation
To improve intestinal motility, daily exercises can be performed. It is useful to walk a lot, to make light runs, if the doctor permits. Intense physical activity is prohibited during the healing period of the joints.
- Lie on a hard surface. Raise your legs, throw behind your head. Repeat 25–20 times.
- Sitting on your knees while exhaling abruptly draw in your abdominal muscles. Relax on inhalation.
- Perform a simple exercise "bicycle" - circular movements of the legs, as if you were pedaling.
It is worth remembering that physical activity and massage may be contraindicated after certain types of abdominal surgery. All actions must be agreed with the doctor.
Nutrition for constipation
To improve the passage of feces, the patient should drink 2-3 liters of liquid, preferably purified or mineral water without gas.
Beetroot dishes, vegetable oil, prunes, dried apricots, compotes have a laxative effect. Food should be organized in a fractional way, 5-6 meals a day in small portions. For constipation, the body needs meals containing fiber, bran bread, cereals from whole grains and oatmeal, honey, jam, natural juices, dairy products. Avoid gas formation vegetables such as legumes, cabbage, eggplant, radish. It is necessary to exclude products with a fixing effect: semolina and rice porridge, astringent fruits (pears, pomegranates), rich broths of meat and fish.