Patients undergoing back surgery might find that they suffer from constipation after their operation. Constipation after back surgery is quite common and often a result of the pain medication patients are prescribed as well as the possibility of dehydration and the lack of physical exercise to promote bowel movements. Pain medications are the prime suspects however, especially where a patient is on a high dose of an opioid analgesic. Straining to go to the bathroom can also put extra pressure on the back and cause post-surgery problems for some patients, making it important to address constipation as soon as possible. Patients awaiting back surgery and on lots of pain medication also suffer from constipation and the straining they experience can be quite hazardous to bulging discs or herniated discs in the back.
UPDATE: In recent trials of an experimental drug, CB-5945, constipation associated with opioid use in chronic back pain was found to respond well to this new medication. FDA approval has not been given for this new drug, however, and its use as a treatment for constipation after back surgery requires further investigation.
Fiber and Water for Constipation
Staying hydrated is extremely important after back surgery as dehydration prevents the body from healing properly, can make the blood stickier and more likely to experience clotting problems, and also contributes to dry and brittle intervertebral discs where the dehydration continues. Patients will also often find it beneficial to increase their intake of fiber from fresh fruits and vegetables as this can help bulk out the stool and make it easier to pass through the colon. Eating wholegrains can also be helpful but some patients, particularly those with Irritable Bowel Syndrome, may find the insoluble fiber in these foods too abrasive and troublesome. Talking to your doctor or getting a referral to a dietitian may be necessary for patients suffering from severe constipation or symptoms that do not respond to simple measures such as drinking sufficient water.
Bulk fiber laxatives such as FiberCon, Metamucil, and Citrucel add bulk to the stool and draw water into the colon. They should be used alongside adequate water intake to ensure that the body stays properly hydrated. Taking twelve hours to three days to have an effect, such bulk laxatives may be helpful as an immediate prophylactic against constipation in those who are aware that they are prone to this symptom.
Laxatives Not Recommended for Most
Many patients with constipation after back surgery will automatically assume that laxatives are the only remedy. Unfortunately many laxatives, even natural laxatives such as senna, can cause the bowel to become lazy and actually make the problem worse in the long run. Occasional use may be necessary for some patients but laxatives are generally to be avoided where possible. Stool softeners may be helpful for some patients as this can make peristalsis and bowel movements easier. Colace, Dialose, DSS, and Surfak are examples of stool softeners available to make bowel movements easier. These take one to three days to take effect in most cases and your doctor should be able to recommend a product and dosage appropriate for the amount of pain medication you are on after back surgery.Natural laxatives include prunes and figs, and these can be quite powerful for some patients although they do not take over bowel function so can usually be used every day in small amounts. Even a simple drink of warm water with a squeeze of lemon can help get the bowel moving in the morning. Gentle exercise is also good and is usually part of post-surgical rehabilitation, but patients will normally need to avoid squats and lunges after back surgery even if they do help with constipation.
Consult Your Physician
Healthcare providers and pharmacists can be helpful in recommending products to help prevent constipation after back surgery or relieve it if it does occur. Narcotic medications used in the first week or so after back surgery are a primary culprit when constipation strikes but these pain medications are usually only used temporarily as they can be habit-forming. Following medication guidelines may help avoid the side-effects of narcotic drugs but for many patients constipation, nausea, and excessive sleepiness are inevitable effects of the drugs. Unfortunately, the effect of constipation can be an increase in pain leading patients to take higher doses of the analgesics and creating a vicious cycle. Medications such as Vicodin, Tylenol no.3, Darvocet, Percocet, and Oxycontin are all possible causes of constipation as they slow down bowel motility, switching to regular Tylenol or non-narcotic medications after back surgery can help lower the risk of constipation.
Stress, Diet, and Constipation
Stress after back surgery is also a contributor to constipation as are the changes in diet that can follow back surgery as patients’ appetites change or the diet is restricted in some way. Avoiding cheese, meat, and processed foods may help some patients prevent or relieve constipation and those on antibiotic medications or having just finished a course of antibiotics might wish to supplement their diet with a friendly bacteria product (probiotic) as this can help bowel function. Eating smaller, regular meals can aid digestion and ease constipation. Constipation often goes hand in hand with stomach pain and bloating, nausea, vomiting, headaches, and a feeling of heaviness and sluggishness. Nobody wants to experience these symptoms of constipation after back surgery and taking preventative action is advised so as to make the recovery period as easy as possible.