Preventing Constipation After Back Surgery

Constipation is a common problem for many people recovering from back surgery, and frequently causes considerable discomfort and/or pain. While it is often not mentioned to patients as part of the recovery process, constipation, and its adverse side effects can be a significant challenge following back surgery.

There are many aspects of having back surgery that can contribute to constipation, including anesthesia, stress, dietary changes, use of pain medications and decreased activity.

Symptoms of constipation may include some combination of the following:

• Abdominal pain and bloating
• Nausea and/or vomiting
• Hard stools or inability to have a bowel movement

Recovering from the actual surgery is enough to focus on without having to deal with the negative side effects of constipation. Here are a number of actions that one can take to prevent the unpleasant and often painful side effects of constipation after back surgery.

Actions to Prevent or Minimize Constipation

There are a few simple measures that one can take to help prevent and/or minimize the possible pain and discomfort from constipation following back surgery.

• Increase activity as soon as possible after surgery. Walking is an excellent way to help bodily functions return to normal, and also helps with healing from the surgery.

• Limit use of narcotic medications (e.g. Vicodin, Tylenol #3, Darvocet, Percocet, Oxycontin) to just what is necessary for adequate pain control. Narcotics slow down bowel motility, leading to constipation. Consider switching to a non-narcotic pain reliever (such as regular Tylenol or extra strength Tylenol) for pain control shortly after surgery to reduce the risk of constipation.

• Begin using a fiber laxative, stool softener, or combination product after surgery to reduce the risk of constipation, particularly if one has experienced constipation in the past.
• Drink plenty of water and other non-caffeinated fluids (at least 40 oz per day), provided that the physician has not restricted fluid intake for another reason. Prune juice and apple cider (not apple juice) are also excellent natural laxatives.
• Eat foods that are naturally high in fiber to stimulate the intestines. High-fiber foods include beans, whole grains and bran cereals, fresh fruits (such as watermelon, grapes), and vegetables (such as lettuce, carrots). Limiting foods that contribute to constipation is also a good idea, such as cheese, meat, and processed foods.
• Eat small, frequent meals throughout the day, rather than large meals to aid in the digestive process.

See After ACDF: How to Prevent or Manage Constipation

Constipation Medications

In addition to the above actions, it is also worth considering taking non-prescription constipation remedies prophylactically after surgery. These are readily available at most grocery stores, convenience stores and pharmacies. When taking any form of medication, it is important to read the directions carefully and/or consult a pharmacist or primary care provider if there are any questions.

• Bulk fiber laxatives (e.g. Citrucel, FiberCon, Metamucil). This type of laxative works by adding bulk to the stool, which encourages water to remain in the colon. These products may take 12 hours to 3 days to take effect, so it is a good idea to begin right after surgery to prevent constipation.
• Stool softeners (e.g. Colace, Dialose, DSS, Surfak). Stool softeners - also called emollient laxactives - help fluids mix with stool to soften it, as stool that is too hard may not be able to pass despite normal bowel contractions. Stool softeners usually take one to three days to take effect, so are a good option to begin right after surgery to prevent hard stools, which can be painful.
• Stimulant laxatives (e.g. Dulcolax, Ex-Lax, Milk of Magnesia). This type of laxative works by stimulating bowel contractions to move the stool out. They often work within a few hours, so may be a good option to take if constipation has set in (e.g. a few days after surgery).
• Combination laxative-stool softener (e.g. Senokot-S, Peri-Colace). Combination products can offer the benefits of both the laxative and the stool softener. They generally take effect within 6 to 12 hours, so it is possible to wait until the day after surgery to take them.
• Suppositories (e.g. Dulcolax). This works as both a laxative and stool softener. Suppositories work by causing the colon to contract and push the stool out, while also softening it so it passes more easily. Suppositories are inserted into the rectum and usually work quickly.
• Enemas. These work as a bowel stimulant and involve injecting liquids (usually water or saline) into the rectum and up into the colon to stimulate the colon to pass stools. An enema may usually be tried once, and if there is no response it is advisable to seek medical attention for constipation treatment.

The above suggestions include a variety of ways patients can prevent or manage constipation following back surgery. However, if these actions do not produce results, or if discomfort or prolonged constipation is experienced, it is advisable to seek medical care. Usually a primary care physician is best suited to treat constipation.