Tips for Managing Constipation After Surgery

Unfortunately, constipation is a common side effect of surgery. It can happen for a few different reasons: the anesthesia used during the procedure, pain medications you’re taking or how much and what you’re eating and drinking.

Opioid medications are often used to manage pain after surgery, but they commonly cause constipation. Studies show that 40 to 95% of patients taking these medications will experience this side effect. To minimize it, anesthesiologists at HSS carefully construct a pain medication plan using different types of drugs, including acetaminophen (Tylenol), nonsteroidal anti-inflammatories (ibuprofen), opioids, anesthetic medications and medications for nerve pain. This is done to maximize pain relief and minimize the use of opioids, as well as their side effects.

Steps to Take Before Surgery

If you have concerns before your surgery about constipation, the best thing to do is to ask your surgeon or care team about it. Some other things to try:

• If you suffer from chronic constipation and have a special medication that works particularly well for you, tell both your doctor and the medical provider who is reviewing your medications with you before surgery, so that they can make a note in your chart.
• Before surgery, reach out to one of your hospital’s pharmacists to discuss any medication-related concerns. After the surgery, at HSS, you can request that a clinical pharmacist visit you at your bedside.
• If you have specific concerns regarding anesthesia causing constipation and wish to discuss them with the anesthesiologist, you may request a consultation before surgery.

Steps to Take After Surgery

At HSS, we conduct a thorough medication education session when preparing to send patients home. A nurse goes over all prescriptions, explaining how to take each medication to effectively manage constipation at home. Wherever you have your surgery, be sure you know how to properly take your medications to avoid this side effect before you go home.

If additional questions arise, at HSS, our clinical pharmacists are available to come to patients’ rooms to give further explanation. During follow-up phone calls at home, patients can speak with the nurse and bring up any additional concerns or questions.

At home, there are a couple of general rules to follow to help prevent or manage constipation:

• Don’t take fiber supplements. While it’s true that that having enough fiber in your diet helps maintain proper bowel function, taking bulk fiber supplements after surgery poses a danger of actually making constipation worse if you don’t drink enough water.
• Focus on a gradual approach. Start gently with laxatives and then move on to using additional medications as needed. At HSS, we usually start with a combination of a stool softener and a gentle plant-derived laxative that contains an ingredient called sennosides, which come from the leaves of the senna tree. Additional over-the-counter medications may be used as needed.
• Be flexible. Keep in mind that different laxatives work differently, and the effects of each laxative vary among patients.

Bloating in the belly after surgery is quite common and could be a result of trapped gas or excess fluids. The fluids will leave your body naturally within a few days; trapped gas may resolve as you have a bowel movement. There are techniques to relieve this discomfort, including simethicone; ask your care team about this if you need additional help.