How to manage severe constipation after hernia surgery?

Management of Severe Constipation After Hernia Surgery

For severe constipation following hernia surgery, polyethylene glycol (17g with 8oz of water twice daily) is the first-line treatment, followed by stimulant laxatives such as senna if needed. 1

Initial Management Approach

1. First-line treatment:

   • Polyethylene glycol (PEG) 17g with 8oz of water twice daily 1, 2
   • Maintain adequate fluid intake
   • Monitor for response within 24-48 hours

2. If inadequate response:

   • Add a stimulant laxative such as senna 1, 3
   • Senna typically causes bowel movement within 6-12 hours 3

3. For persistent constipation:

   • Assess for bowel obstruction (critical safety step)
   • Consider adding osmotic laxatives like lactulose or magnesium-based products 1
   • Bisacodyl (available as tablets or suppositories) may be added 1, 4

Medication Details and Considerations

Polyethylene Glycol (PEG)

• Mechanism: Sequesters fluid in the bowel to soften stool 1
• Dosage: 17g with 8oz of water twice daily 1
• Advantages: Well-tolerated, non-habit forming
• Warning: Discontinue if you experience rectal bleeding, worsening abdominal pain, or diarrhea 2
• Not recommended for use beyond 1 week without medical supervision 2

Stimulant Laxatives

• Senna: Acts primarily on the descending and sigmoid colon 1
• Bisacodyl: Available as oral tablets or suppositories 4
• Both medications stimulate intestinal motility
• Warning: Stop use and consult doctor if rectal bleeding occurs or if no bowel movement after use 4

Special Considerations After Hernia Surgery

• Pain management: If taking opioids for post-surgical pain, consider:

  • More aggressive prophylactic bowel regimen
  • For opioid-induced constipation that persists despite standard measures, peripherally acting mu-opioid receptor antagonists like methylnaltrexone may be considered 1

• Activity level:

  • Encourage gentle physical activity within post-surgical restrictions
  • Immobility following surgery contributes to constipation

• Hydration:

  • Ensure adequate fluid intake (at least 8 glasses of water daily)
  • Dehydration from pre-surgical fasting and post-surgical recovery can worsen constipation

When to Seek Additional Medical Help

• Persistent constipation despite following the above regimen
• Severe abdominal pain
• Rectal bleeding
• Vomiting
• Signs of bowel obstruction (severe distension, inability to pass gas)

Important Caveats

• Avoid bulk-forming laxatives like psyllium as they may worsen constipation, especially in post-surgical patients 1
• Docusate sodium (stool softener) has not shown benefit and is not recommended 1, 5
• Limit use of laxatives to short-term relief; consult your doctor if constipation persists beyond one week 2, 4
• Enemas should be used sparingly and with caution in post-surgical patients 1

By following this stepwise approach, most patients should experience relief from post-hernia surgery constipation within a few days. The management focuses on preventing complications while providing effective relief of symptoms.