Constipation after surgery is a common problem. It is not confined to a particular type of surgical procedure. Doesn’t matter whether you are having a gallbladder surgery, hysterectomy or hernia operation. However, certain types of procedures carry a higher risk of postoperative constipation. Hemorrhoid surgery is a good example of that.
There are many causes of postoperative constipation. Some causes are directly related to the particular procedure. However, the majority are indirect causes.
Pain is the number one cause. Pain at the site of operation can affect the ability to pass stools. If the surgery is around the anus, for example, hemorrhoidectomy, you will get severe problems in emptying your bowel. Pelvic surgeries such as hysterectomy also have a higher risk.
Procedures involving the abdominal wall such as hernia repair will cause pain when you strain to pass stools. So, you tend to avoid toilet calls. The stools stay for a longer time in the rectum. Most of the water in the feces get absorbed by the rectum. That will cause hard stools.
The second cause is pain medications. Opioid medications such as morphine, oxycodone, and codeine can cause severe postoperative constipation. They slow down the peristaltic movement of the bowel. In addition, these painkillers increase the tone of the anal sphincter. Furthermore, they inhibit the defecation reflex that is necessary for normal defecation.
Going to have an elective surgery such as gallbladder removal? How would you feel? Can you be happy and relaxed? Definitely not. You will get lots of stress. That will cause many changes in hormone levels in your body. The hormonal changes will persist even after the procedure. The stress hormones will make you constipated.
Lack of physical activity after surgery is another cause of post-surgical constipation.
Procedures directly involving the intestine such as hemicolectomy can cause paralytic ileus. That means paralysis of intestinal muscles. The bowels stop their movements for one or two days. So they can’t move the feces towards the anus.
Severe constipation after abdominal surgery can be a sign of mechanical bowel obstruction. In that case, you will have vomiting, abdominal pain and distension. That is an emergency situation.
Eating fibre rich foods and drinking plenty of water are not enough to relieve the postoperative constipation. Doing more exercise may not be possible. Sometimes it is not advisable.
Regular use of a stimulant laxative or a stool softener for at least a few days is important. Some people need a combination of both such as Coloxyl with Senna. Constipation due to opioid painkillers needs a stimulant laxative such as Bisacodyl. Osmotic laxatives such as Lactulose also an effective remedy. Bulk-forming laxatives such as psyllium husk should be avoided in the treatment of opioid-induced constipation.
Bottom line:
Constipation after surgery is a serious problem. It can cause lots of pain and discomfort. It can also cause serious postoperative complications. So, taking laxatives with the advice of your healthcare provider is important.