Constipation after sleeve gastrectomy

Constipation is not a fun topic but it’s a common issue after sleeve gastrectomy, so let’s chat about how to move past it (#punalert!). Bowel movements commonly change after a sleeve, and even if you weren’t prone to constipation beforehand you may be after. However, it’s important to prevent constipation, not only for comfort, but also to reduce the risk of things like hemorrhoids, hernias and diverticulosis that can occur with straining.

Before we go any further… Are you actually constipated?

Bowel habits vary between people, whether they have had weight loss surgery or not. For some, going three times a day is normal while for others having three bowel movements per week is normal. Because surgery permanently changes part of your digestive tract and you can eat a lot less after surgery than you could before, your bowel habits may change too. So, it may be some time before you know what your “new” normal is going to be.

Also, “not going” is not the same as being constipated. If you move your bowels at least once every three days and are not suffering any abdominal discomfort, you are probably not constipated and do not need to take any action. However, if you experience pain or difficulty when going to the loo and your stools are hard, then you need to take action.

So why is constipation so common after surgery?

There are a few reasons why constipation is more of an issue after a sleeve. Changes to what you can eat and drink, as well as pain medication prescribed initially after surgery are biggies, but longer-term after surgery it’s likely to be one of three things (of a combination of all):

1. Fluid
2. Fibre
3. Movement

Fluid

Fluid is important for bowel movements as it softens your stool and helps things move through. Often after sleeve gastrectomy, you will be drinking less than you did before, or not enough to be properly hydrated, especially in the early stages.

The fix? Try to sip sip sip throughout the day and get your fluids up to a minimum of 1L but ideally 1.5-2L if you can. If you’re not sure how to do this, check out this post.

Fibre

There are three types of fibre in the food we eat: soluble, insoluble and resistant starch. All are important for bowel health. Soluble fibre helps keep us fuller for longer as it slows gastric emptying, insoluble fibre absorbs water in the large intestine and forms the bulk of our stools, and resistant starch helps to feed our good gut bacteria (see this great article from Nutrition Australia for more info).

When you can, make sure you are eating a wide variety of foods, and including fruit once a day and veggies or beans twice a day to increase the amount of fibre you have in your diet. Including a fibre supplement daily also helps to keep you moving and should be part of your daily routine. However, taking too much without drinking enough fluid can make things worse. So, if you’re not taking a supplement at all, add one to your daily routine, but start slowly by adding one teaspoon then building to two teaspoons once you’re comfortable. And, most importantly, make sure you increase the amount you’re drinking at the same time!

Movement

This one is kinda simple – if you move, your gut will move too! So get out there as soon as you can. You don’t need to run a marathon, but just getting up and walking regularly throughout the day will stimulate your bowel to get moving too.

And if none of this is working?

As always, please call your team. They can advise you on medications like stool softeners or laxatives you might take to get you started, without becoming too reliant on them in the long run. You dietitian can also help by looking at your diet and making suggestions specifically for you.