Constipation is a common problem many patients, particularly women, struggle with after plastic surgery. While everyone has their own bowel movement frequency, patients after surgery may lack any movement for days or even a week after their procedures. Such slowed intestinal motility is due to a variety of factors including the effects of anesthesia and taking pain medications, a decrease in food and fluid intake, less activity and the allocation of body resources towards the healing of the traumatized surgery sites.
The symptoms of constipation after surgery are well recognized and include painful bloating and abdominal cramping as well as difficulty in trying to pass a bowel movement and hard stools. Prior to surgery, patients are told not to have anything to eat or drink at least eight hours before the start of surgery. This means less fluid in the body which in turn means less fluid in the intestinal tract, creating hard and dry stools.
In addition, patients are typically inactive after surgery, some for a couple hours, others for a day or two depending on the extent of their procedure. Inactivity also increases the risk of constipation because daily activities such as walking act as a trigger for bowel movements. Anesthesia given during surgery is a major factor that may increase a patient’s risk of constipation after surgery. Anesthetics are a paralyzing agent, when muscles are paralyzed during surgery no contractions are pushing food along the intestinal tract in preparation for a bowel movement. Pain medications, like anesthetic drugs, also slow down many body functions including the intestinal tract.
While constipation is common after any surgery, it can reach the point in some patients (particularly after major body contouring procedures) that it can lead to a trip to the emergency room to find immediate relief. For many others, it results in a phone call to their plastic surgeon to ask what to do.
Prevention of constipation is always the best approach. For those prone to constipation problems (women in particular), one should begin the week before their plastic surgery doing some preventative steps. These include a high fiber diet, plenty of fluids (3 to 4 glasses of water daily) and taking an oral stool softener (Colace 100mg) every morning. This approach is particularly important before such procedures as tummy tucks, liposuction and Mommy Makeovers (combined breast and abdominal procedures) which can cause considerable body trauma and really slow someone down after surgery.
After surgery prevention is still important and this begins with early activity. Physical activity is a trigger for a bowel movement so the sooner a patient is up and walking after surgery the better. Fluid remains a key component of a bowel movement, and when it is missing, stool becomes hard and dry causing constipation. Increased fluid intake will also help the body create softer stools. Water and electrolyte intake after surgery is more important than fluid in the first few days so make that a point of emphasis. While you are taking antibiotic and pain medications, do not forget to continue the stool softener. Laxatives may also be considered such as MiraLax or Enulose. These will help increase the amount of water in the intestinal tract and stimulate a bowel movement. Enulose 1 tablespoon should be mixed with 2 glasses of water up to three times a day as needed.
In almost all cases, these before and after surgery manuevers will prevent an unpleasant episode of constipation after plastic surgery. But should you forget to do any of these steps and find yourself with an uncomfortable constipation problem, a suppository (Dulcolax) can provide a rapid resolution.
Dr. Barry Eppley
Lora Dillman, RN