Jacqui Lewis - August 2021

Regulate Your Bowels: Constipation After Weight Loss Surgery

Protein-rich food like brocolli

Changes in bowel habits can occur for various reasons: ageing, dietary intolerances, bacterial imbalance and after bariatric procedures.
The changes made to your digestive tract by sleeve gastrectomy and gastric bypass surgery impact several vital digestive process components leading to constipation, hard stools or incomplete digestion of food.

The most severe constipation symptoms are rectal bleeding or blood in your stool.
These can require emergency medical attention.
Other hard stool symptoms include:

  • Abdominal pain
  • Difficulty passing gas
  • Pain passing stools
  • Straining when passing stools

Many of these symptoms can make you afraid to pass any other stools.
This fear can worsen constipation.

 Directly following your weight loss surgery, the combination of the pre-op diet, fasting for surgery, and the drugs administered during and after your procedure can lead to constipation. Stool softeners are given during your hospital stay.

A lack of bowel movement is expected due to a low fibre diet leading to surgery, bed rest and pain medications. You can help yourself by sipping water as directed in the hospital to rehydrate, keeping your stools soft enough to pass.

After the initial phases of your recovery pass, common causes of constipation or diarrhoea can persist in weight loss surgery patients and may be linked to:

  • Dehydration/inadequate water intake
  • Iron supplements
  • Lack of dietary fibre
  • Inadequate food intake
  • Sensitivity to certain foods
  • Pain medication
  • Inadequate gut flora
  • Low levels of digestive enzymes and gastric acids/secretions
  • Lack of physical exercise
  • Lack of fresh food/overuse of processed food
  • Intolerances to foods such as gluten and dairy can also arise after WLS

Firstly, consider that heavily decreased input of food will also equal a decrease in 'output'. You will find that some of the changes in your bowel habits will be linked purely to the reduction of food your body is managing after gastric sleeve or bypass.

Before experimenting with home remedies or searching on social media for quick fixes - contact your bariatric surgeon or dietitian if you are experiencing extreme constipation or diarrhoea. It's imperative to rule out any complications. Once this is achieved, work on finding your solutions to these common but often intrusive complaints.

What can be done to re-establish Healthy Bowels and
why does it matter?

The digestive process serves a wide range of purposes, from extracting nutrients - from food passing through the intricate system to eliminating toxins and byproducts of varying metabolic processes.

This handy system also plays a role in maintaining our mental health and immunity. So you can see why healthy digestion is your "scorecard" on your overall health in many ways. It's essential to use it as a good measure of your health and vitality.

When this whole system is impacted, a range of problems can arise—constipation results in recycling waste products such as cholesterol and hormones. The constant flow of food in and out helps reduce cholesterol and the build-up of toxins in the body. 

So what helps and what doesn't help? 

Once you are experiencing a total bank of waste, to the point where things simply won't budge - the last thing you want to do is add too much bulk to your food to move things along.

At this stage, you would be looking to draw water into the bowel to soften the mass and help to liquify things to help with elimination. Osmolax, Magnesium Citrate, High Doses of Sodium Ascorbate, bowel preparations like Movicol - have a place here, and most of these can be found in the pharmacy.

Suppose you know you can become constipated. In that case, you might look for preventative methods rather than reactive treatments, like the ones suggested above.

Home Remedies

Abdominal massage:

  • Start at the right lower side of your abdomen.
  • Slowly make circles in a clockwise direction using gentle pressure.
  • Use the palm of your right hand to apply gentle pressure to the inside of your hip bone.
  • Release and apply pressure to the right side, underneath the centre of your ribs, and the left side.

Drink more water:

Increasing water in the digestive tract can make stool softer and easier to pass.

A promising sign that you're drinking enough water is if your urine is pale yellow.

Eat more fibre to boost your microbiome:

Fibre can add bulk to the stool, which can stimulate the bowels and help move stools through the digestive tract.

However, try not to introduce too much fibre at once.

It can have the opposite effect and cause discomfort.

Include a non-bulking fibre supplement daily:

try our BN Fibre; instantised corn fibre is flavourless and with total mixability.
You can add it to any food or drink, hot or cold, with ease.

Avoid empty-calorie, low-fibre foods:

Many low-fibre foods don't add much nutritional value to your diet.

Avoid fast food, processed meats and other foods, and chips.

Remove foods you feel might be problematic: 

Foods such as dairy can be linked to digestive issues such as constipation, bloating, and diarrhoea.

Once eliminated for two weeks, monitor for changes, then reintroduce one at a time - watching for the result on your digestion each time.

Exercise:

physical activity can have a bowel-stimulating effect on the body.

Explore digestive enzymes:

Gastric sleeve and gastric bypass surgery can interfere with the levels of stomach acid and digestive enzymes needed to break down your food well.
Talk to your health food shop about digestive enzymes that can support the digestive process after WLS.

Key takeaways:

  • Rule out complications
  • Look at dietary changes to improve your bowel habits
  • Encourage healthy elimination of toxins and metabolites
  • Improve your weight loss efforts

Jacqui Lewis
BHsc Nutritional And Dietetic Medicine

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