Preventing constipation after gynaecological surgery
Constipation is common and will affect many patients after gynaecological surgery. In some cases, it can get so severe that patients need to be readmitted to hospital after surgery to manage the pain and exclude further complications.
Constipation can be due to the effects of anaesthesia, pain medication (narcotics), and decreased physical activity. Anti-nausea medication can also cause constipation.
Patients with pre-existing constipation need to pay special attention to this issue as they have a higher risk of constipation occurring after surgery. Any intervention (surgery, medication) will worsen any pre-existing constipation.
Here, I would like to share some tips for my patients to prevent constipation after gynaecological surgery:
- Stay hydrated: Drinking plenty of fluids can help keep stools soft and easier to pass. However, its important fluids contain electrolytes as well. Tea, coffee and fruit juices contain electrolytes and can be consumed in addition to water. As a general rule, drink about 8 cups of water per day. However, drinking unreasonable amounts of pure water (without electrolytes) can lead in very extreme cases to water poisoning and brain oedema.
- Eat fibre-rich foods: Incorporating fibre-rich foods into the diet can help promote bowel regularity. There are two types of fibre: non-soluble and soluble. The non-soluble fibres can help promote bowel activity, whereas soluble fibre can potentially further clog you up further because they can withdraw water from your bowels and stop bowel movements.
Examples of non-soluble fibres are listed below.
- Whole grains: oats, quinoa, barley, and brown rice
- Fruits: apples, pears, berries, oranges, and bananas.
- Fruit juices such as pear juice and prune juice
- Double-pulp orange juice works amazingly well because it’s the pulp of the oranges that do the work.
- Vegetables: broccoli, spinach, kale, carrots, and sweet potatoes..
- Legumes: beans, lentils, and chickpeas
- Nuts and seeds: Almonds, chia seeds, flax seeds, and pumpkin seeds
- Protein-rich foods: Patients who had major surgery for ovarian cancer, may have lost large amounts of protein before, during and after surgery. For those patients focus on consuming protein-rich diets and protein containing supplements (such as Sustagen).
Additional tips include:
- Get moving: Walking and other forms of light exercise can help stimulate bowel movements and prevent constipation. It is not always easy to get the balance right by pushing yourself a little - but not too much. In the early phases of post-surgical recovery I suggest to stay out of bed as much as you can, but go to bed to have a rest. Once rested, get up again. The intervals between rest periods will eventually become longer.
- Take stool softeners: Stool softeners are medications that can help soften stool and make it easier to pass. Stool softeners can be bought at pharmacies over-the counter without a medical prescription.
- Enema: Once constipation has developed patients may consider giving themselves small enemas to release a “plug” that may have developed as a consequence of long-standing constipation.
- Listen to your body: Pay attention to your body's signals and respond to them promptly. If you feel the urge to have a bowel movement, don't delay.
Any of the above methods should apply only upon your surgeons recommendation.
Methods to prevent constipation should only be used when patients pass wind. If patients do not pass wind, this may be a sign of an underlying major problem and those patients should contact the surgeon or the emergency department specified by the surgeon prior to surgery.
Overall, I always recommend combinations of the above activities and foods. This includes staying well hydrated; eating the right types of fibre; engaging in gentle physical exercise that should increase every couple of days; and take stool softeners that you can buy from your local pharmacy if needed.
It's important to discuss any concerns about constipation with your surgeon or GP, as they can provide advice and treatment options based on your individual needs.
If you wish to receive regular information, resources, reassurance and inspiration for up-to-date care that is sound and in line with the latest research, please subscribe to my blog via the form above, or like Dr Andreas Obermair on Facebook.