Constipation after Bariatric Surgery
By: Laura DeAndrade, ANP-BC
One of the most common complaints following any type of bariatric surgery is constipation. Constipation is generally described as having fewer then 2-3 bowel movements per week. In addition to this, patients who suffer from constipation also complain that stool is very difficult to pass. Constipation can lead to other issues including hemorrhoids, anal fissures, fecal impaction or rectal prolapse.
After bariatric surgery of any kind it is very common to not drink enough water. Bowel habits are very dependent on the water we drink. Since a lot of water intake can also be included in food and this food quantity is drastically reduced after surgery, it’s a double-edged sword. Getting at least 64oz of water per day is necessary to sustain normal bowel habits. The first line of defense should be to increase your water intake. Carry water with you at all times and sip on it throughout the day. If you have problems remembering to drink water at regular intervals throughout the day, there are many apps available via your smart phone that can help remind you when to drink water.
Other methods to assist with the treatment of constipation include:
- Adding a dietary fiber supplement. The high protein and low carbohydrate diets following surgery are seriously lacking in fiber. Adding Metamucil or other dissolvable form of fiber will usually also help. Just remember to take these supplements daily, not only when you are constipated. You may also add a stool softener such as Colace (generic form called docusate sodium).
- Increasing exercise. Exercise will increase bowel motility. Abdominal exercises can help prevent and treat constipation but any form of exercise is usually sufficient.
- Avoid foods that may be contributing to your constipation such as bananas, rice, cheese and other dairy products, and caffeine products.
- Avoiding the use of narcotics. Narcotics slow down the motility of the bowel and can exacerbate issues with constipation.
- If you are taking iron supplements you may need to temporarily stop until constipation is no longer an issue. Always check with your healthcare provider first before stopping any medication. Iron supplements are available in many forms and some forms are better tolerated than others.
In general, if you have not used the bathroom in 3 days you need to take something in order to stimulate your bowels. Milk of Magnesia is an acceptable laxative for use as are many available over the counter options. If you are finding that you need to take a laxative more than twice a week to move your bowels then you should be using a daily fiber and/or stool softener to try and fix the problem.
It is important to remember that bowel function is not always related to bariatric surgery alone. If you have a sudden change in your bowel habits a few months after surgery or the condition is not easily treated, you need to discuss further diagnostic testing with your healthcare provider.