Constipation After Sleeve Gastrectomy

There are reports that have associated gastric bypass and duodenal switch with diarrhea, while gastric band and sleeve gastrectomy have been associated with increased cases of constipation. There are numerous factors contributing to individual bowel habits.

Constipation after sleeve gastrectomy is a common bariatric surgery side effect.

Bariatric surgery changes part of the digestive tract permanently affecting dietary intake, nutrient absorption, and bowel habits.

While you will have to adjust to a new normal, it’s essential to recognize the side effects of bariatric surgery, including constipation.

What This Article Covers:

What is Constipation?

Constipation is described as having fewer than three bowel movements per week. It is usually associated with hardened stool and is often accompanied by stomach cramps and gas. Other symptoms of constipation include:

  • Straining during bowel movements
  • Bloating or increased gas
  • Having abdominal or rectal pain
  • Hard stools 
  • Incomplete emptying after bowel movements 

Causes of Constipation After Sleeve Gastrectomy

Many factors contribute to developing constipation. Some studies have shown that a quarter of bariatric patients present with constipation at the 6 month follow-up.

Obesity itself can actually be associated with constipation due to dietary habits and sedentary lifestyles before undergoing surgery.

Gut health should be a topic of discussion and education should be provided before a patient experiences constipation after bariatric surgery.

Smaller Stomach Capacity

Your stomach capacity is severely decreased, which translates into a substantial reduction in food and liquid intake.

For some time after surgery, you will be on liquid bariatric meal replacements and progress to soft food after that. This does not create much bulk in your intestine and significantly reduces the need to eliminate waste.

Fiber

Constipation and sleeve gastrectomy

Inadequate fiber intake can be extremely common when consuming smaller meals after bariatric surgery. In addition, if fiber is being consumed, but with inadequate water intake, constipation can worsen. 

Fiber adds bulk to the stool. If the movement of your intestine has slowed down and you are battling to stay hydrated, adding fiber is like pulling more traffic into a traffic jam.

meta-analysis of studies demonstrated that although dietary fiber can increase the number of bowel movements in patients with constipation, it did not decrease stool consistency or any other symptoms of constipation. 

Fiber is a very important factor in the diet that can have more benefits than just improving bowel movements. It is important for dietitians and healthcare providers to educate patients on the proper ratio of fiber to water intake. 

Dehydration

The capacity of the stomach limits how much fluid you can drink at any one time. This is why dehydration after bariatric surgery can be a long-term complication.

When dehydration occurs, more water is drawn out of the colon, leading to harder stools.

Anesthetics

A common cause of constipation in the days immediately following weight loss surgery is the anesthetic itself.

Anesthesia causes a paralysis of the intestines during surgery. This will stop muscle contractions that push food along the intestinal tract for a short period of time. 

Medication

Pain medication, in particular narcotics, are notorious for causing constipation. Certain classes of drugs slow down intestinal movement, which results in excess water being reabsorbed through the gut lining.

Iron supplements can be a further contributor to constipation. When high dosages of iron are required daily, it is recommended to work with your healthcare provider in breaking up the regimen throughout the day to avoid bowel issues. 

Lack of Exercise and Weak Abdominal Muscles

Getting up and about as soon as possible after surgery is essential for preventing constipation and other risks of bariatric surgery. The colon responds to physical activity and muscle tone.

Many individuals who qualify for bariatric surgery are predisposed to constipation due to a sedentary lifestyle, weak abdominal muscles, and dietary intake.

Lactose Intolerance and Food Sensitivity

Adding to the list of potential bariatric surgery problems is food intolerance. Enzyme and hormonal changes after bariatric surgery may result in toleration issues specific to some food groups.

Intolerance to lactose or sensitivity to the protein in dairy may disrupt regular bowel habits.

Complications of Constipation

Any kind of straining after bariatric surgery should be avoided. Hernias and bowel obstruction after bariatric surgery are already risk factors, so it is not advised to put additional pressure on the gut.

Constipation can also lead to painful hemorrhoids and fecal impaction. 

It is important to keep track of your bowel movements. Any concerns should be taken to your bariatric team immediately. 

Treatment for Constipation

  • Light physical activity, such as walking
  • Adequate hydration
  • Stool softeners
  • Fiber
  • Laxatives only when necessary

Stool softeners may be recommended directly following bariatric surgery for preventative measures. When they are stopped, the focus should be on consuming enough fiber and water daily.

Going forward, laxatives should only be taken when necessary as frequent intake can be detrimental to proper bowel function. Your bowels could become dependent on these medications, and regular bowel movements may not resume.

Prevention of Constipation

Keep track of your fluid consumption and make sure you are drinking enough water.

Caffeine is recommended to be avoided after bariatric surgery. If caffeine is consumed, keep in mind that excessive amounts can have a diuretic effect increasing urine output. If you drink tea or coffee, increase your water intake accordingly.

Daily physical activity is essential. Walking stimulates bowel activity, as well as increasing the tone of abdominal muscles. Just 10-15 minutes once or twice each day can significantly improve symptoms of constipation and help normalize bowel movement. 

A stool softener may be necessary short-term while you settle into your new bowel habits. This product should be taken under the direction of your healthcare provider. 

Maintain a sufficient gut microbiome. It is essential to have a balance in gut bacteria. When there is an imbalance, you can see diarrhea and constipation as a result. Good gut bacteria may help prevent constipation. Eating probiotic-rich foods may not be sufficient in correcting gut flora post-surgery, so consult with your doctor to ensure a probiotic is suitable for you.

Work with your dietitian on healthy dietary intake. Fiber and water should be consumed in a proper ratio in order to promote proper bowel movements. Fiber-rich foods are essential in the diet and fiber supplements may be added when needed. 

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**This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your physician or another qualified health provider with any questions in regards to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs.