Laxatives After Laparoscopic Surgery: Safe?

Constipation is a common side effect of surgery, often caused by pain medication, changes in diet, and reduced mobility. Laxatives are sometimes used to treat constipation after surgery, but it is important to consult a doctor before taking any medication, as some methods may not be safe after certain procedures.

What are the causes of constipation after surgery?

Constipation is a common side effect of surgery, and it can add to the discomfort of the healing process. There are several factors that may cause constipation after surgery:

• Pain medications: Opioids, which are often prescribed for pain control after surgery, are known to cause constipation. They slow down the movement of food through the intestinal tract, giving the body more time to remove water, resulting in drier stools. Other pain medications, such as diuretics and muscle relaxants, can also contribute to constipation.
• Dietary changes: Before surgery, patients may be instructed to avoid eating or drinking, and their diet may be restricted or changed after the operation. Insufficient fluid intake and lack of food can disrupt the body's normal elimination process and lead to hard, dry bowel movements.
• Inactivity: People recovering from surgery often need to rest and avoid strenuous exercise, which can slow down the digestive system. Anaesthesia can also paralyse muscles and stop movement in the intestinal tract, further contributing to constipation.
• Inflammatory stimulus: Trauma or infection in the body can trigger an inflammatory response, which may impact bowel function and contribute to constipation.
• Electrolyte, fluid, or glucose imbalance: Disruptions in fluid balance or glucose metabolism can affect intestinal motility and contribute to constipation.

It is important to manage constipation after surgery to prevent discomfort and potential complications. Lifestyle and dietary changes, such as increasing fluid intake, consuming high-fibre foods, and engaging in physical activity, can help prevent and treat constipation. Adjusting medication may also be necessary, such as limiting the use of narcotic pain relievers or switching to alternative pain relief options.

What are the symptoms of constipation after surgery?

Constipation is a common side effect of surgery, even if you had regular bowel movements before the operation. It can be caused by a number of factors, including medication, dietary changes, and lack of physical activity.

The symptoms of post-surgical constipation include:

• A sudden decrease in bowel movements
• Passing fewer than three stools in a week
• Straining to pass stool
• Lumpy or hard stools
• The sensation that the rectum is not empty, even after having a bowel movement
• Feeling as though there is a blockage in the rectum
• Needing help to empty the rectum, such as pressing on the stomach during a bowel movement
• Pain in the stomach or rectum

Untreated constipation can lead to discomfort and potentially severe complications, such as a surgical incision reopening, haemorrhoids, anal fissures, faecal impaction, and rectal prolapse.

What are the complications of constipation after surgery?

Constipation is a common side effect of surgery, and it can lead to several complications if left untreated. The first issue is the discomfort caused by constipation, which can be severe. However, more pressing complications can also arise, such as:

• A surgical incision reopening due to straining during bowel movements.
• Hemorrhoids, which are swollen veins in and around the anus, resulting from the straining.
• Anal fissures, tears in the skin of the anus caused by large or hard stools.
• Fecal impaction, where chronic constipation causes hard stools to become stuck in the intestines.
• Rectal prolapse, where straining causes a part of the intestines to protrude from the anus.

These complications can be uncomfortable and may prolong recovery time, so it is important to take steps to prevent and treat constipation after surgery. This includes staying hydrated, consuming fibre, and increasing physical activity as advised by a doctor. Laxatives and stool softeners may also be recommended by a doctor to provide relief.

How can constipation after surgery be treated?

Constipation after surgery is a common issue, affecting up to 30% of women in the days following a procedure. It can be caused by a number of factors, including anaesthesia, pain medications, dietary changes, and reduced physical activity. To treat constipation after surgery, the following steps can be taken:

• Increase fluid intake: Dehydration can cause constipation, so drinking plenty of water and other fluids can help. Aim for at least four glasses of water per day.
• Avoid caffeine: Caffeinated drinks can contribute to dehydration, so it is advisable to avoid coffee, tea, and caffeinated sodas.
• Consume fibre-rich foods: Fibre aids in stool passage, so adults should aim for 22-34 grams of fibre per day. Good sources include bran, beans, apples, pears, prunes, squash, sweet potatoes, spinach, and collard greens.
• Increase physical activity: As soon as possible, start moving around and taking short walks to stimulate bowel movements. Exercise helps move food through the intestines.
• Use laxatives and stool softeners: Under a doctor's guidance, laxatives and stool softeners can be used to pull water into the intestines and soften stools, making them easier to pass.
• Consider suppositories: If laxatives and stool softeners are ineffective, suppositories can be inserted into the rectum to soften stools and trigger intestinal muscles, aiding stool passage.
• Take dietary supplements: Some supplements, such as fibre, kefir, and carnitine, may help ease constipation. However, always consult a doctor before taking any supplements.
• Adjust pain medication: Opioid medications are a common cause of constipation, so alternative pain relievers such as ibuprofen or acetaminophen may be considered.

It is important to consult a doctor before taking any medication or supplements for constipation after surgery, as some methods may not be safe for everyone. Additionally, a gradual approach is recommended, starting with gentle treatments and adjusting as needed.

How can constipation after surgery be prevented?

Constipation is a common side effect of surgery, even if your bowel movements were regular before the operation. It can be caused by several factors, including the use of anaesthesia and pain medications, dietary changes, and lack of physical activity. Here are some ways to prevent constipation after surgery:

Before Surgery

• If you suffer from chronic constipation, inform your doctor and medical provider so they can make a note in your chart.
• Discuss any medication-related concerns with a pharmacist before surgery.
• If you have concerns about anaesthesia causing constipation, request a consultation with the anesthesiologist before surgery.

After Surgery

• Stay hydrated by drinking plenty of water. Aim for at least four glasses of water per day to prevent constipation.
• Avoid caffeine, as it can be dehydrating.
• Consume fibre-rich foods such as bran, beans, apples, pears, prunes, squash, sweet potatoes, spinach, and collard greens. Aim for 22 to 34 grams of fibre per day.
• If you have a poor appetite after surgery, try a smoothie made with blended fruits and vegetables to boost your fibre intake.
• Increase your fluid intake when consuming more fibre.
• Start moving and exercising as soon as your doctor gives you the go-ahead. Even short walks can help stimulate bowel movements.
• Adjust your medication if possible. Opioids and other postoperative narcotics can slow down gut motility, so try to limit their use if you can tolerate the pain.
• Take a stool softener, such as docusate (Colace), to make stool easier to pass.
• Take a fibre laxative, such as psyllium (Metamucil), to help with constipation.
• If laxatives and stool softeners are ineffective, suppositories may help trigger intestinal muscles and ease bowel movements.
• Consult your doctor about dietary supplements such as fibre, kefir, and carnitine, which may help with constipation.
• Avoid supplements that can worsen constipation, such as iron.
• Be gentle with your body and start with mild constipation relief methods before progressing to additional medications as needed.
• Be flexible and keep in mind that different laxatives work differently, and their effects vary among patients.

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