Laxatives And Surgery: Safe Or Not?

Before undergoing surgery, it is important to be aware of the medications and supplements that could interfere with the procedure and recovery. Laxatives, for example, can cause dehydration and electrolyte abnormalities, which may cause problems with anaesthesia. However, constipation is a normal side effect after surgery, and some doctors recommend taking stool softeners like Colace a few days before surgery to help prevent this.

Laxatives can cause dehydration, which may cause problems with anaesthesia

Laxatives are often recommended to treat constipation, a common side effect of surgery. However, it is important to note that laxatives can cause dehydration, which may lead to problems with anaesthesia.

Laxatives are typically used to treat constipation, a condition characterised by infrequent or difficult bowel movements. They work by drawing water into the intestines, softening the stool, and stimulating intestinal contractions to promote bowel evacuation. While laxatives can be effective in treating constipation, they can also have side effects, including dehydration.

Dehydration occurs when the body loses more fluids than it takes in, and it can have serious consequences. In the context of surgery, dehydration can affect the way anaesthesia works and may increase the risk of complications. Anaesthesia is a crucial component of surgery, as it allows patients to remain comfortable and free from pain during the procedure. However, if a patient is dehydrated, the body's absorption and metabolism of anaesthetic drugs can be altered, leading to potential problems with the anaesthesia.

Additionally, dehydration can impact the circulation of anaesthetic drugs throughout the body, affecting their effectiveness. In some cases, dehydration may even require adjustments to the dosage or type of anaesthesia administered. Therefore, it is essential to maintain adequate hydration before and after surgery to ensure the safe and effective administration of anaesthesia.

To prevent dehydration and minimise the risk of complications, it is recommended to increase fluid intake and focus on a gradual approach to treating constipation. Starting with gentle laxatives, such as stool softeners or plant-derived laxatives, and gradually progressing to additional medications as needed, can help prevent dehydration while effectively managing constipation. It is also important to be flexible, as different laxatives work differently, and their effects can vary among patients.

Thyroid issues can create anaesthesia issues

Thyroid issues can create unique anaesthesia-related challenges. The anaesthetist must be prepared for potential difficulties at any stage, from preoperative to postoperative care.

Preoperative Challenges

Deranged thyroid physiology requires optimal preparation. An enlarged thyroid gland can also lead to a difficult airway, which is a significant concern for the anaesthetist. Preoperative examination should include a multidisciplinary approach involving an endocrinologist, surgeon, cardiologist, radiologist, and anaesthetist to ensure precise diagnosis and optimal preparation.

Intraoperative Challenges

Administering anaesthesia to patients with thyroid issues can be complex. General anaesthesia with endotracheal intubation is the safest approach. The nature of thyroid surgery requires a free space around the patient's head, and a simple PVC tube can get kinked under the drapes, so an armoured endotracheal tube or a Ring, Adair and Elwyn (RAE) tube is preferred to prevent respiratory obstruction.

Postoperative Challenges

Postoperative complications related to thyroid surgery are common and can be life-threatening. These include haematoma formation, which can cause acute airway obstruction, and nerve injuries such as damage to the recurrent laryngeal nerve, which can lead to vocal cord paralysis and respiratory difficulties. Hypocalcaemia, pneumothorax, and thyroid storm are other potential postoperative complications that require prompt recognition and management.

Laxatives can cause electrolyte abnormalities

Laxative misuse can result in chronic diarrhoea, which can cause fluid loss and electrolyte abnormalities. For example, hypokalemia (low potassium) can occur due to high potassium levels in stool water and hormonal changes resulting from intravascular depletion. This can lead to neuromuscular dysfunction, gastrointestinal dysfunction such as ileus and constipation, and an inability of the kidneys to concentrate urine.

Hyponatremia (low sodium) is another possible electrolyte abnormality caused by laxative misuse. This can be caused by hypovolemia, which is a result of increased water loss due to diuretics and laxatives. Excess water consumption, sometimes used to induce vomiting, can also contribute to dangerous drops in serum sodium levels. Hyponatremia can have serious neurological and respiratory effects.

Prolonged laxative abuse is also associated with chronic kidney disease. Renal function can be reduced by volume depletion, hypokalemia, rhabdomyolysis, and hyperuricemia (excess uric acid in the blood). Repeated bouts of hypokalemia can lead to a condition called hypokalemic nephropathy, which may be irreversible and result in chronic kidney disease or hemodialysis.

Therefore, it is important to be cautious when using laxatives and to always consult a doctor, as they can have significant effects on electrolyte levels and lead to serious complications.

Bowel prep is recommended the day before surgery

The Day Before Surgery

On the day before your surgery, it is recommended to take an oral antibiotic as prescribed by your doctor. This could be neomycin, erythromycin, or a combination of both, depending on your specific circumstances. Additionally, it is important to drink only clear liquids throughout the day. This includes water, juices without pulp, sports drinks, black coffee or tea without milk, soft drinks, carbonated beverages, and hard candies. It is important to avoid red dye, Jell-O, and other gelatin products.

Cleaning Out Your Bowel

Cleaning out your bowel, also known as the colon or large intestine, is a crucial step before surgery. This is typically done by drinking a special liquid called a colon lavage solution, which you will need to prepare by mixing a prescribed powder with water. It is important to carefully follow the mixing instructions and you can add lemon juice to improve the taste. Start drinking the solution between 10 a.m. and 1 p.m. the day before your surgery, drinking one full cup every 10 minutes. Bowel movements usually start within 30 to 60 minutes after the first cup, and you may experience mild stomach cramps or a feeling of fullness. If you experience any discomfort or vomiting, be sure to contact your medical team.

Further Instructions

You can expect to receive further instructions from the Anesthesia Department regarding pre-surgical guidelines and when to stop drinking liquids. Additionally, you will receive a phone call from the hospital's Operating Room or Ambulatory Surgery Center to provide you with the check-in time and remind you when to stop drinking liquids. It is important to plan ahead and ask any questions you may have to ensure a safe and successful surgery.

Constipation is a normal side effect after surgery

Constipation is a common side effect of surgery. It can happen due to the anesthesia used during the procedure, pain medications, dietary changes, and reduced mobility following the operation.

Causes of constipation after surgery

• Anesthesia: The anesthesia you receive before surgery can cause constipation.
• Pain medications: Opioid medications are often used to manage pain after surgery, but they commonly cause constipation. Studies show that 40 to 95% of patients taking opioid medications will experience constipation.
• Dietary changes: Your doctor may instruct you to avoid food or drink before surgery or put you on a restrictive diet after the operation. Too little fluid and food can affect your bowel movements and make you more likely to become constipated.
• Reduced mobility: After surgery, you may need to stay in bed or avoid strenuous exercise during your recovery. This lack of movement can slow down your digestion and make it harder to pass stool. Inactivity is a common cause of constipation.

Tips for relieving constipation after surgery

• Drink more water: Dehydration makes constipation more likely. Water helps break down food in your stomach and aids digestion. Aim for at least four glasses of water per day.
• Avoid caffeine: Caffeinated drinks are dehydrating, which can worsen constipation. Avoid coffee, tea, caffeinated sodas, and chocolate.
• Increase fiber intake: Fiber helps you pass stools and stay regular. Most adults should consume between 22 and 34 grams of fiber per day. Good sources of fiber include bran, beans, apples, pears, prunes, squash, sweet potatoes, spinach, and collard greens. If you have a poor appetite after surgery, try a smoothie with blended fruits and vegetables.
• Increase physical activity: As soon as your doctor clears you for physical activity, start moving around as much as possible. Even short walks can help. Exercise helps move food through your intestines and stimulates bowel movements.
• Medications: Your doctor may recommend stool softeners or laxatives. Stool softeners make it easier to pass stool, while laxatives pull water into your intestines to help stool move along the intestinal tract. If these don't work, suppositories may be an option.
• Dietary supplements: Some supplements, such as fiber, kefir, and carnitine, may help ease constipation. However, talk to your doctor before taking any supplements, as some (like iron) can make constipation worse.

Frequently asked questions