Laxatives And Surgery: Safe Or Not?

There are varying opinions on whether it is advisable to take laxatives before surgery. Some medical professionals advise against it, citing potential dehydration and electrolyte abnormalities that could interfere with anaesthesia. However, others suggest that mild laxative use before surgery is generally acceptable, provided it does not affect the body's salt balance and electrolytes, particularly potassium. It is recommended that you consult with your chosen surgeon about this.

Laxatives can cause dehydration, which can be dangerous before surgery

Taking laxatives before surgery can be dangerous as they can cause dehydration, which can have several negative impacts on the body's ability to undergo a surgical procedure.

Firstly, dehydration can affect the body's ability to go under and wake up from anaesthesia. This is because dehydration leads to reduced blood flow, which can make it difficult for nurses to find a "good" vein for IV "sticks". This process can be painful and stressful for the patient, especially when combined with the anxiety and overwhelm that often accompany surgery.

Secondly, dehydration before surgery can increase the risk of post-operative nausea and vomiting. This is due to the combination of strong anaesthesia medications administered on an empty stomach and dehydration.

Additionally, dehydration can lead to an increased risk of surgical complications and a more challenging recovery. For example, dehydration can cause a delay in defecation, which can impact the patient's overall recovery process.

To avoid dehydration before surgery, it is important to follow your doctor's instructions and stay adequately hydrated. Modern medical research suggests doing away with the traditional "no food or drink after midnight" rule and instead allowing patients to safely hydrate and nourish themselves up to two hours before surgery. This new approach is based on Enhanced Recovery After Surgery (ERAS) programs, which aim to enhance patient recovery and make surgery safer and easier.

In conclusion, laxatives can cause dehydration, which can negatively impact surgery and anaesthesia. Therefore, it is crucial to consult with a doctor and carefully consider the potential risks before taking laxatives before surgery.

Electrolyte abnormalities may be caused by laxatives, which can cause problems with anaesthesia

Laxatives can cause electrolyte abnormalities, which can, in turn, cause problems with anaesthesia. Electrolytes are minerals that control important physiological functions of the body. They are present in your blood, bodily fluids, and urine, and you also ingest them through food, drinks, and supplements. Electrolyte abnormalities occur when your body's mineral levels are too high or too low, which can negatively affect vital body systems.

For example, an imbalance in sodium levels can lead to hyponatremia or hypernatremia. Hyponatremia is caused by too little sodium in the body, which can result from vomiting, diarrhea, alcohol use disorder, thyroid or adrenal disorders, liver, heart, or kidney failure, certain medications, or syndrome of inappropriate secretion of antidiuretic hormone (SIADH). On the other hand, hypernatremia is caused by too much sodium in the body, which can be due to severe dehydration, inadequate water consumption, or excessive loss of bodily fluids.

Similarly, an imbalance in potassium levels can lead to hypokalemia or hyperkalemia. Hypokalemia occurs when potassium levels are too low, which can be caused by severe vomiting or diarrhea, certain medications, including laxatives, diuretics, and corticosteroids, or gastrointestinal loss. Hyperkalemia, on the other hand, is caused by high levels of potassium and can be triggered by severe acidosis, certain medications, or adrenal insufficiency.

Other electrolyte abnormalities include hypercalcemia and hypocalcemia (imbalance in calcium levels), hyperchloremia and hypochloremia (imbalance in chloride levels), hypermagnesemia and hypomagnesemia (imbalance in magnesium levels), and hyperphosphatemia and hypophosphatemia (imbalance in phosphate levels). These abnormalities can have various causes, including certain medications, diseases, or fluid loss due to vomiting, diarrhea, or sweating.

It is important to note that mild electrolyte abnormalities may not cause any noticeable symptoms and can go undetected until a routine blood test. However, severe abnormalities can lead to serious problems such as coma, seizures, and cardiac arrest. Therefore, it is crucial to maintain proper hydration and seek medical advice if experiencing common symptoms of an electrolyte imbalance.

It is recommended to consult a doctor before stopping or starting any medication before surgery

Laxatives are available in mild forms that are generally considered safe to use before surgery. However, it is still important to consult a doctor before taking them. This is because laxatives can cause dehydration, which may create problems with anaesthesia. Additionally, laxatives can affect the body's electrolyte balance, which may also cause issues.

If you are experiencing constipation, it is recommended to increase your water intake to 8-10 glasses per day. Stool softeners, such as Colace, can also be used to help prevent constipation without changing your normal activity. These are different from laxatives as they do not have the same dehydration and electrolyte-related side effects.

It is always best to consult your doctor about any specific concerns or questions you may have regarding your surgery and any medications you are taking or planning to take. They will be able to provide personalised advice and recommendations to ensure your safety and well-being before, during, and after the procedure.

Thyroid issues can cause anaesthesia problems, so it is important to optimise general health before surgery

Thyroid issues can cause anaesthesia problems, so it is important to optimise your general health before surgery.

Thyroid disease is common, and many patients with thyroid issues will require surgery at some point in their lives. This may be directly related to their thyroid, such as a thyroidectomy, or it could be for another reason. Either way, it is important to ensure that thyroid issues are well-managed before surgery.

If you are experiencing hyperthyroidism, you may be prescribed carbimazole to help you achieve a euthyroid state. This is preferable to propylthiouracil and methimazole, which were more commonly used in the past. Carbimazole increases vascularity in the thyroid, which can lead to higher bleeding during surgery, and it may also decrease your white blood cell count, making you more vulnerable to post-operative infections. Beta-blockers are often used in conjunction with carbimazole to aid cardiovascular stability.

If you are experiencing hypothyroidism, you may be given thyroxine to help balance your thyroid function. Hypothyroidism may result in a decreased capacity to metabolise drugs, so it is important to ensure your thyroid function is as close to normal as possible before surgery. This will also help to prevent complications such as depressed myocardial function, impaired baroreceptor function, decreased spontaneous ventilation, abnormal baroreceptor function, reduced plasma volume, anaemia, hypoglycaemia, and impaired hepatic drug metabolism.

In rare cases, people with hypothyroidism may experience myxoedema coma, which can lead to severe lethargy, hypothermia, bradycardia, and hypoxemia due to alveolar hypoventilation. This can progress to congestive heart failure and pericardial effusion if untreated.

In addition to managing your thyroid function, it is important to be aware of potential airway management issues. An enlarged thyroid gland can cause compression on the trachea, which may result in tracheomalacia. This can cause acute airway obstruction, which is a medical emergency.

Other potential complications of thyroid issues during surgery include:

• Laryngeal edema
• Nerve palsies
• Tracheomalacia
• Hypocalcemic tetany
• Pneumothorax
• Haemorrhage
• Thyroid storm

Bowel preparation is important before surgery to reduce post-surgery constipation and gas pain

To reduce the likelihood of constipation after surgery, it is recommended to maintain proper hydration by drinking 8-10 glasses of water a day. Staying hydrated is crucial in preventing constipation as dehydration is one of its causes. Additionally, drinking prune juice can help stimulate bowel movements.

Starting a few days before surgery, you can take a stool softener like docusate sodium (Colace) to make stools easier to pass. This can be continued after surgery until normal bowel movements resume. Stool softeners are generally safer than laxatives, especially for those taking opioid medications, as they do not require a change in regular activity.

If constipation does occur after surgery, there are several treatment options. Taking Milk of Magnesia, which contains magnesium hydroxide, can help move fluids through the colon. Stimulant laxatives, such as bisacodyl (Dulcolax), can be used to induce bowel movements. However, it is important to consult a doctor before taking any over-the-counter remedies for constipation, as some medications may not be suitable during post-surgery recovery.

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