From the Guidelines
Constipation following hysterectomy can be effectively managed with a combination of increased fluid intake, dietary fiber, and gentle laxatives, as recommended in the most recent guidelines 1. To manage post-hysterectomy constipation, it is essential to start with a combination of stool softeners and gentle laxatives. The patient should take docusate sodium (Colace) 100 mg twice daily as a stool softener along with polyethylene glycol (MiraLAX) 17 grams mixed in 8 ounces of water once daily. Increasing fluid intake to at least 8-10 glasses of water daily and gradually incorporating fiber-rich foods into the diet can also help. Some key points to consider:
- Physical activity, even gentle walking for 15-20 minutes several times daily, can help stimulate bowel function.
- If constipation persists after 3 days of this regimen, consider adding a stimulant laxative like bisacodyl (Dulcolax) 5-10 mg orally or as a suppository.
- Constipation after hysterectomy occurs due to several factors including anesthesia effects, pain medications (especially opioids), reduced physical activity, and direct manipulation of the bowels during surgery.
- The bowel can become temporarily sluggish (postoperative ileus) following abdominal surgery.
- If severe constipation persists beyond a week or is accompanied by severe pain, vomiting, or abdominal distension, contact your healthcare provider immediately as this could indicate a more serious complication, as suggested by 1. It is crucial to prioritize the patient's morbidity, mortality, and quality of life when managing constipation after hysterectomy, and the approach should be based on the most recent and highest-quality evidence available 1.
From the Research
Constipation Status Post Hysterectomy
- Constipation after hysterectomy is a potential complication, with studies suggesting that it may be related to hormonal alterations, iatrogenic causes, or variations in recto-bladder sensitivity 2.
- The exact type of constipation that develops after hysterectomy is not well understood, with a need for prospective studies to compare bowel function before and after operations 2.
- Strategies for preventing constipation include laxatives, exercise, and increased fluid and fibre intake, with individualised care and support increasing patients' outcomes 3.
Prevention and Treatment of Constipation
- A quasi-experimental study found that actively involving patients in their own care, including individualised nursing care plans and daily dialogues, significantly reduced constipation rates after surgery 3.
- The use of senna with docusate has been shown to decrease time to first bowel movement after pelvic reconstructive surgery, with subjects using senna with docusate being less likely to use magnesium citrate 4.
- Other studies have investigated the use of laxatives and stool softeners in preventing and treating constipation, with varying results 5, 6.
Management of Constipation
- The management of opioid-induced constipation in hospice patients often involves the use of laxatives and stool softeners, with newer agents providing additional options for patients who do not respond to first-line therapies 5.
- A comparison of sennosides-based bowel protocols with and without docusate found that the sennosides-only protocol was more effective in inducing laxation, with fewer patients requiring additional interventions 6.