Postoperative Constipation

There is a chance that you might suffer from constipation after surgery even if you had been having bowel movements regularly before it. Constipation leads to the formation of very hard stools which are very difficult to pass out of the large intestine (colon). This is why constipation patients suffer a great deal of pain during bowel movements. Vomiting, nausea, bloating, and abdominal pain are among the other symptoms that might be experienced by the patient.

What Causes Constipation After Surgery?

There are a number of triggers of constipation that occur during the recovery period of the patient after surgery. The following is a list of the common triggers and why they can be so tricky to deal with.

1. Pain Medication

The prescription pain relief medications are known to cause constipation and are among the major reason for constipation after surgery. Your risk of constipation will increase if you are advised to take high doses of pain medications or have been using them for a long period of time.

2. Anesthesia

Anesthesia is considered by most patients as a drug that induces sleep. It is in fact a drug that paralyzes the muscles of the arms and legs along with those of your intestines too while you are under surgery. Thus, no food is pushed along the intestinal tract as there are no muscle contractions. So, until the intestines remain paralyzed, the movement of feces ceases.

3. Diet Restrictions

Constipation can be caused also because of the diet restrictions that the patient has to endure after surgery. Often patients are asked by the doctors to eat a liquid diet in the days before the surgery or keep their stomachs empty for a day or two before the operation. This is done to facilitate the surgery and recovery process but it is not good news for your excretory system as it causes fluctuation in the fluid levels in the body that help in the excretion of stools by softening them and letting the waste pass out of the body easily.

4. Physical Inactivity

Regular exercise and an active lifestyle are among the necessary aspects of having smooth bowel movements. However, post-surgery patients are often advised bed rest as it is important part of the body’s recovery process. Thus, the physical inactivity in the wake of the surgery coupled with the sedentary lifestyle makes it hard to maintain proper bowel function and can result in constipation.

Treatment for Constipation After Surgery

If you want to minimize or reduce your discomfort or pain that might result due to less bowel movement after surgery, then the following measures can prove to be of great help to you.

1. Exercise

Start moving about and performing light exercise as soon as you can after your surgery. You can accelerate the healing process and bring back your bodily functions to normalcy simply by going out for a walk.

2. Restrict Use of Narcotic Medication

Narcotic medications are excellent pain relievers but they can cause constipation by slowing down the bowel movements. Thus, it is best to restrict the use of narcotic pain relievers like Percocet, Oxycontin and Norco and try to replace them with non-narcotic medication like Tylenol, Ibuprofen, or Aleve for controlling your pain after surgery.

3. Fiber Laxative

If you have suffered from constipation in the past, then it is important that you start thinking about using a fiber laxative after the surgery to reduce your chances of post-surgery constipation.

4. Stay Hydrated

Drinking at least 48 oz. of water and non-caffeinated fluids like apple cider vinegar and prune juice, which are effective natural laxatives  daily can also save you from constipation.

5. Consume Fiber-Rich Foods

Include fiber-rich foods in your diet like whole grains, fresh fruits, beans, vegetables, and bran cereals in your diet to stimulate the intestines and try to avoid foods like cheese, processed foods and meat as they contribute to constipation.

6. Avoid Large Meals

It is better to avoid having large meals at specific times of the day. Go for frequent but smaller meals throughout the day to aid your digestive process.

7. Constipation Medication

Over-the-counter treatment like milk of magnesia, mineral oil, or an enema can be used if the above measures do not help. A bottle of magnesium citrate will definitely work, but only use as a last resort. It usually causes a lot cramping before it works.

Skin Glue Wound Care Instructions

Your surgical site has been closed with skin glue, a “super glue” specially designed to replace the outer layer of stitches. DermaBond completely seals your incision site. Wound care and suture removal are not necessary making it very convenient. There won’t be ANYTHING to do to your surgical site closed with DermaBond. Our instructions will mainly counsel you on what NOT to do.

Instructions:

1. You may shower or bathe after 24 hours. Do not swim in chlorinated water. Chlorine dissolves the DermaBond.

2. You may cover your site with a band aid or non-stick dressing and tape, but do not apply anything to the site such as topical antibiotics, lotions, creams, or make up.

3. If the skin glue begins to peel do not peel it off or pick at it. Please allow it to fall off naturally. This can take up to 2 weeks. If it starts to peel after 2 weeks, then you can peel it off like a band aid.  If the Dermabond does not come off after two weeks then cover it liberally with petroleum jelly. Massage it into the skin to loosen the bond between the Dermabond and the skin. Gently peel away the substance and clean the area to remove the excess. Petroleum jelly is the best choice for use around the eyes or other delicate areas of skin. Alternatively, users can apply fingernail polish remover or acetone to a cotton swab and use it to remove the dried Dermabond around less sensitive areas.

4.  The surgical wound closed with skin glue will NOT look cosmetically pleasing for at least 2-3 weeks in most cases. The way the glue closes the wound causes redness and puckering of the surgical site. This is normal.

 

I typically provide a prescription for Percocet or Norco (a bit milder) to each patient who is discharged home after surgery. Both are very effective at “taking the edge off” of post-operative pain, but it is very common to continue to have some pain. Both of these medications can be taken one or two tablets at a time as frequently as every 4 hours. I usually recommend taking at least one before going to bed the first night, even if there is no pain at the moment, since pain can often arise during the night and disturb sleep. Both medicines also can have the side effects of nausea, vomiting, constipation, and itching. Having these side effects does not mean you are allergic to the medicine, but it does mean you might want to limit your use of them as soon as the decrease in pain permits.

Ice is usually even more effective than pain medications. You can ice your incision and surgical sites for 20 minutes at a time every four hours. This is usually helpful for the first 2-5 days after surgery.

Patients often see a small amount of blood-staining on their incisions after discharge from the hospital or surgery center. While this may look alarming, it is very rarely a serious problem. It is acceptable and safe to apply pressure to the site of bleeding with a sterile 4×4 gauze that can be purchased at any drugstore. 5 minutes of firm pressure will stop most minor episodes of bleeding. If active bleeding continues, please call to inform us.

 

Most fever in the first 2-3 days after surgery is due to congestion of the lungs. If you experience low-grade fevers after discharge, the first step is to try to be out of bed, walk, cough, and breathe deeply as much as possible to open the lungs. If you experience persistent fever of greater than 101 degrees, please call to inform us.

Most incisions are covered with a product similar to superglue called Dermabond. These incisions can be washed in the shower on the day after surgery. Letting water run over the incision and washing gently with soap and water is very safe beginning at that time. Soaking in a swimming pool or bathtub should be reserved for at least 14 days after surgery until more healing has occurred.

I typically recommend eating lightly on the night after surgery. Chicken soup and Ginger Ale are my usual recommendations, although any comparable light fare would be similar. Usually on the day after surgery all the anesthesia medications have been processed out of your system, and return to your usual diet can be accomplished without difficulty. If you still have some nausea, continue to proceed slowly with small meals. Also, choose lighter foods until the queasy feeling has completely resolved. These symptoms are almost always the result of the medications used to put you to sleep, and your body will rid itself of them eventually.

I recommend driving when you have been off prescription pain medicines for at least 24 hours, and when you think that your reaction time if faced with a sudden crisis in traffic would not be compromised by pain from your surgery. This is often achieved 2-7 days after surgery.

 

Many patients notice some mild redness around their incisions, and worries about infection is frequent. For operations, such as thyroid, parathyroid, Robotic, or laparoscopic operations, wound infections are extremely uncommon. Most infections occur between 5 and 10 days after surgery. They are characterized by pain, intense redness, and often drainage of yellow fluid or pus. Fever of 101 or greater can also accompany these signs. If these occur, we prefer to see you in the office within the next 48 hours. Taking antibiotics by mouth is often sufficient treatment, but at times we open a portion of the incision in the office to allow the fluid to drain.

 

By the time you are discharged home it is expected that you will be sore, but you should be able to walk on your own. You are encouraged to be up and about as much as you can tolerate. Expect your energy level to be decreased for at least a week after surgery, but do not hesitate to be as active as you can. We generally recommend no lifting greater than 15 pounds for 4 weeks after open abdominal surgery or open hernia repairs. This time period is reduced to 2 weeks for Robotic hernia repairs. It is acceptable for all patients to leave home and go where you like, as long as you have a driver, beginning the day after discharge. Walking up stairs is also not going to harm you in any way.

I prefer to see patients in the office between 7 and 14 days after most operations. There are exceptions, and I will communicate that to you as needed. The follow-up appointments should be made for you before leaving home. If no appointment was made or you need to change it, please call our office at (706) 353-1630 for the appointment.