There are bound to be some changes to your bowel pattern after weight loss surgery. With a smaller intake of foods and fluids, which may move more quickly or more slowly through your digestive system, you’ll have to find a new normal for your body. Although you may have periods of constipation or diarrhea, you shouldn’t accept that as normal. Making a few alterations in your diet can help you become regular.
As with any medical condition, consult with your doctor before beginning any treatment.
Both the frequency and size of bowel movements may decrease after surgery—this is normal. Difficulty emptying the bowels, often combined with abdominal discomfort, or having fewer than 3 bowel movements a week indicates constipation.
Why is constipation common right after weight loss surgery?
Many factors work together for smooth digestion and elimination. Your body goes through many changes right after surgery, creating a situation where constipation is more likely. Here are a few factors that impact your ability to be regular.
- Anesthesia stops the contractions in your intestine that keeps things moving along. It may take a day or two for those contractions to start back up.
- Pain medications slow the transit through the digestive system and can reduce the urge to go.
- Fluid intake is typically decreased after surgery, resulting in a smaller, harder stool that is more difficult to pass.
- Food volume is limited after surgery and with the focus on protein; fewer fiber-rich foods are consumed, resulting in a smaller stool.
- Activity is typically limited, slowing the movement through your digestive system.
- Iron supplements, if needed, commonly constipate. Calcium supplements can cause constipation in some individuals.
What can you do?
It seems that the odds are stacked against your bowels in the beginning. Here’s what you can do to get things back to normal as soon as possible:
- Drink as much fluid as you are able. Remember to sip slowly all throughout the day. Keep a drink with you at all times. Try different temperatures to see what goes down easiest for you. Sometimes popsicles, fudgesicles and slushies work well. You can let them melt in your mouth. You may be able to drink more room temperature or warm liquids. Be sure to monitor your fluid intake so you know if you’re shorting yourself or not—you’re shooting for at least 64 oz of any type of fluid a day.
- A cup of hot water with lemon, no-added-sugar hot cocoa, decaf coffee (caffeine is fine once you’re drinking 64 oz of fluid a day), or herbal tea may help stimulate your system.
- Try a probiotic. A good one to start with is Nature’s Bounty Advanced or Ultra Strength Probiotic 10.
- Slowly increase the amount of fiber in your diet.
- Eat beans—think black beans, chickpeas, pinto beans, navy beans, kidney beans and white beans. Just ¼ cup provides 4 grams of fiber and 4 grams of protein (mash or blend for the pureed stage).
- Add 1 Tbsp of flaxseed to your yogurt or smoothie for 3.3 grams of fiber.
- Mix together ¼ cup applesauce with 1 Tbsp of wheat bran (look in the baking aisle), and 2 Tbsp prune juice—really, it works.
- Starting with the soft food stage, you can add in cooked veggies and soft canned fruits (packed in water or juice—not syrup). Once on regular foods, fresh veggies should be right behind high-protein foods on your priority list—then add in a little fresh fruit and whole grain.
- Add veggies and fruits to your protein smoothies.
- Add small amounts of healthy fat to your diet. The initial diet is almost fat-free. You don’t want to overdo it, but small amounts of fat may help. Think:
- Avocado–mash it for the pureed stage.
- Coconut oil—add a teaspoon to your protein smoothie.
- Olive oil—use when preparing foods.
- Peanut butter and other nut butters.
- Position yourself properly. Place your feet on a small footstool in front of the toilet so your body is in a squatting position instead of in a seated position. This position aligns your body for an easier go. If you’d like to purchase a stool designed just for this purpose, look for the Squatty Potty.
- Don’t put it off. If you feel the need to go, give yourself adequate time in a private location so you don’t feel rushed or embarrassed.
- Walk, walk, and then walk some more. Short frequent walks often work best right after surgery, but you’ll want to build your endurance and increase the amount of time you can walk at one time.
- Unless otherwise instructed, wait to take iron and calcium supplements until 6 weeks post-op.
If all else fails and you need a little extra help:
After 3 days without a bowel movement, take:
- 2 Senokot and 2 Colace tablets at bedtime. This should produce a bowel movement the following morning.
- If not and if there is no bowel movement in the next 3 days, take 2 Senokot and 2 Colace tablets in the morning and also at bedtime. You can add 1 ounce of Milk of Magnesia at bedtime.
- Consider a Dulcolax or glycerin suppository, or fleets enema after 5-6 days without a bowel movement.
Be sure to contact your surgeon’s office if you are not successful with these efforts. You do not want to take laxatives on a regular basis; your body will come to depend on them. Other things to consider:
- Many patients swear by a cup of Smooth Move tea in the evening.
- Avoid adding fiber supplements in the first 4 weeks after surgery unless you are able to consistently drink 64 ounces of fluid. Taking fiber supplements without adequate fluid can result in greater constipation, not less. Be sure to slowly add in fiber.