Breast Reconstruction Specialist & Plastic Surgeon Dr. Constance Chen Provides Tips for Minimizing Post-operative Discomfort

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Preventing Constipation After Surgery.

Dr. Constance Chen

Several factors are responsible for constipation after surgery, chief among them anesthesia, which paralyzes the muscles and prevents food from moving along the intestinal tract.

When patients think about healing after surgery, many worry about pain and sometimes nausea. For some patients, however, there is an additional issue that they may be embarrassed to bring up: constipation. Not everyone suffers from constipation after surgery, but general anesthesia and postoperative narcotics slow down the gastrointestinal (GI) system. Lack of movement in the intestines can cause nausea, and it can also cause constipation. Not only is constipation uncomfortable, leading to a feeling of generalized abdominal pains and bloating, but for some people it can even make them feel dizzy.

“For the overwhelming majority of people, post-operative constipation resolves on its own after a few days,” says plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen, “but it is uncomfortable and distressing for the patient who is trying to direct all her energies to healing. For most people, minimizing narcotics will reduce the likelihood of postoperative nausea and constipation. For some people, however, more drastic measures may be necessary.”

Several factors are responsible for constipation after surgery, chief among them anesthesia, which paralyzes the muscles and prevents food from moving along the intestinal tract. Opioids, often given during and after surgery to control pain, also slow the movement of food and may increase the amount of water absorbed from food, making the stool drier and harder. Not eating before and after surgery exacerbates the problem since without food going in, there can be no stool coming out. Similarly, if the surgeon has recommended pre-operative bowel preparation that completely cleans out the colon, there's no digestive activity until the intake of food and water gets things moving again. Lastly, the lack of physical activity following surgery contributes further to the slowdown of the digestive system.

Dr. Chen offers these suggestions for preventing post-surgical constipation or minimizing its effects:
●    Ask your surgeon if it's possible to avoid or reduce the use of opioids for pain control, substituting acetaminophen, nonsteroidal anti-inflammatories (NSAIDs), gabapentin, and other non-opioid medications.
●    Follow your doctor's instructions about what and when to eat but when possible, eat a high-fiber diet before and after surgery, emphasizing whole grains, fruits and vegetables, beans, nuts, and seeds.
●    Snacking or eating small, frequent means may promote digestive activity.
●    Avoid foods that promote constipation like dairy products, processed foods, bananas, and refined grains such as white bread, white rice, and white pasta.
●    Drink lots of fluids. It's essential to be well hydrated to promote bowel movements that aren't dry and hard.
●    Start moving around as soon as your doctor gives you the okay, even moving arms and legs as much as possible while still in bed.
●    With your doctor's approval, take a stool softener, usually one that includes docusate sodium, to draw water from the intestines and moisten the stool, making it easier to pass. Do not take or use over-the-counter laxatives, probiotics, enemas, or suppositories without discussing them first with your doctor.

“There's no timetable or formula for determining when your bowel habits have returned to normal,” says Dr. Chen. “Normal is different for everyone, but most people know when they feel better. If you have a history of constipation, it’s a good idea to bring it up with your doctor to discuss strategies to minimize the effects. That way, you can be proactive about taking the necessary steps to make your recovery from surgery as comfortable as possible.”

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She operates at Lenox Hill Hospital and Park Avenue Medical Suite, and is also Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

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