From the Guidelines
Post-surgical constipation is most commonly caused by opioid pain medications, anesthesia, and reduced physical activity, as evidenced by the most recent study in 2022 1. The causes of post-surgical constipation can be multifactorial, including:
- Opioid pain medications, which slow intestinal motility by binding to receptors in the gut
- Anesthesia, which temporarily paralyzes the intestines
- Reduced physical activity, which reduces the natural stimulation that helps move stool through the colon
- Dehydration, which leads to harder stools that are difficult to pass
- Dietary changes during recovery, which can lead to reduced appetite or restricted diets According to the study published in the World Journal of Emergency Surgery in 2022 1, the anesthetic regimen administered during surgery and the surgical duration can also affect the likelihood of postoperative constipation. To manage post-surgical constipation, patients should stay hydrated, begin gentle movement as soon as medically cleared, and consider preventative measures such as stool softeners or mild laxatives, as supported by the guidelines for perioperative care in elective colonic surgery 1. Some key preventative measures include:
- Staying hydrated with 2-3 liters of fluid daily
- Beginning gentle movement as soon as medically cleared
- Consuming fiber-rich foods gradually
- Taking stool softeners like docusate sodium (100mg twice daily) preventatively
- Using mild laxatives such as Miralax (polyethylene glycol 17g daily) if needed For more severe constipation, stimulant laxatives like bisacodyl (5-10mg) or senna (8.6-17.2mg) may be necessary, as suggested by the study published in Clinical Nutrition in 2012 1. It is essential for patients to inform their healthcare provider if they haven't had a bowel movement within 3-4 days after surgery or experience severe abdominal pain, as these could indicate complications requiring medical attention.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Post-Surgical Constipation
- Opioid use is a significant contributor to post-surgical constipation, as it can slow down bowel movements and cause constipation 2, 3.
- Patient-related factors such as age, gender, and pre-existing medical conditions can also increase the risk of post-surgical constipation 4.
- Surgical procedures, particularly those involving the lower extremities, can also contribute to constipation due to reduced mobility and increased pain 4.
- The use of certain medications, such as opioids and other analgesics, can also increase the risk of constipation in the post-surgical period 5.
Prevention and Management of Post-Surgical Constipation
- Increasing fluid and fiber intake can help prevent constipation in patients undergoing surgery 6.
- Early mobilization and encouragement of physical activity can also help reduce the risk of constipation 6.
- The use of laxatives, such as stimulant bowel products, may be effective in preventing constipation in patients receiving opioids after surgery 2.
- Individualized nursing care plans and daily dialogues with patients can also help identify and address constipation risk factors 6.
Risk Factors for Post-Surgical Constipation
- Female gender, advanced age, and unemployment are associated with a higher risk of constipation after surgery 4.
- Patients with pre-existing constipation, chronic diseases, and those taking regular medications are also at increased risk of post-surgical constipation 4.
- Opioid use, high pain severity, and prolonged hospital stay are also significant risk factors for constipation after surgery 4.