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Constipation and stool softeners

Discussion in 'Post Surgery Information' started by Josephine, Nov 15, 2009.

  1. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator
    Thread Starter

    Member Since:
    Jun 8, 2007
    The North
    United Kingdom United Kingdom
    A lot of people suffer from constipation after surgery. This is one of my 'mini' lectures on the subject!

    Activity of the bowel is dependent upon two things
    1. muscular activity called peristalsis
    2. bulk in the bowel

    This rhythmic muscular activity, like ripples along the bowel wall, happening from the stomach all the way along the gut - duodenum, small bowel and large bowel - to the beginning of the rectum. Peristalsis only starts up in the rectum when a quantity of stool begins to enter it and causes the urge that tells us we need to go to the bathroom. Unlike the rest of the gut which we are unaware of, this part is under our conscious control and can be delayed until it is convenient for us to cooperate with a little pushing!

    Peristalsis depends to a very great degree on the right quantity and condition of bulk in the bowel which should be bulky and soft but not fluid.

    If a body gets constipated, more fluid is absorbed from the bowel contents and the stool becomes harder and smaller and then extremely hard to expel.

    Now when we have surgery, several unusual things happen to our gut.
    1. we are starved before and after surgery
    2. we have lots of drugs that make our entire bodies, including the gut, go into deep relaxation - this is true in both general and spinal anaesthesia
    3. we start taking pain killers which have the side effect of inhibiting bowel movements
    4. our appetite and dietary intake for the first few days will be very low

    All these things result in a period of subdued peristalsis and little or no bulk in the bowel.

    Medications for constipations are:
    Laxatives - these stimulate the peristalsis.
    Bulking agents or stool softeners - these are taken as pills or granules which swell up as they pass along the gut, thus providing the necessary stimulus to create peristalsis.

    A properly filled bowel will rarely become constipated.

    People with a full bowel are unlikely to be constipated purely because of muscular inactivity, although pain killers like Percocet, Tramadol, codeine and paracetamol can certainly contribute. Even then the inactivity is mostly caused by lack of bulk which is easily remedied by taking bulking agents.

    Never ever take laxatives for this type of constipation - it will not achieve the desired ends and may cause gut ache and discomfort.

    Bulking agents should be taken daily whilst taking those medications known to be a problem, though other natural products could be taken instead like prunes or prune juice, fruit and vegetables or bran. Some people also find things like nuts and licorice help as well. It's very much a personal choice and what suits one person probably won't suit another.

    One other important thing is to drink lots of fluids. Can't emphasise that enough.

    Prolonged constipation can result in the following symptoms
    ~ headache
    ~ excess gas
    ~ lassitude
    ~ poor appetite
    ~ abdominal aches and pains
    ~ feacal impaction


    Constipation is when you are not passing stool as often or as easily as is normal for you. Your stool becomes hard and dry, and it is difficult to pass. This can result in a faecal impaction is a large lump of dry, hard stool that stays stuck in the rectum. It is most often seen in people who are constipated for a long time.

    Faecal impaction often occurs in people who have had constipation for a long time and have been using laxatives. The problem is even more likely when the laxatives are stopped suddenly. The muscles of the intestines forget how to move stool or faeces on their own.

    Common symptoms include:
    • Abdominal cramping and bloating
    • Leakage of liquid or sudden episodes of watery diarrhoea in someone who has chronic constipation
    • Rectal bleeding
    • Small, semi-formed stools
    • Straining when trying to pass stools

    Other possible symptoms include:
    • Bladder pressure or loss of bladder control
    • Lower back pain
    • Rapid heartbeat or light-headedness from straining to pass stool

    Haemorrhoids (piles):
    Another point of interest: it is a well documented fact that constipation and straining at stool are the primary cause of haemorrhoids. Therefore, it's essential that good bowel management is seen as a priority during the post op period.

    Moral of this story: "Be kind to your bowel and your bowel will be kind to you"
    (Michael J Fox, "The Hard Way")
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    Last edited: Nov 15, 2014
  2. Jamie

    Jamie Administrator

    Member Since:
    Mar 24, 2008
    United States United States
    Wow, Jo....THIS is a subject that people so often shy away from discussing and I'm so glad you posted all this great information. I just love your no-nonsense explanations that tell how things really work! This now makes perfect sense to me why we need the stool softeners after surgery. Thanks!!
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  3. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator
    Thread Starter

    Member Since:
    Jun 8, 2007
    The North
    United Kingdom United Kingdom
    Blood in the stool may have different appearances or no appearance at all.

    1. Gross obvious red blood...usually caused by haemorrhoids or small anal fissures (splits in the skin in or around the anus). Many times you will see this with constipation.

    2. Blood mixed with mucous on the stool is sometimes indicative of some issues higher in the colon. Something to talk to the doctor about.

    3. Obvious diarrhoea lasting longer than two days with lots of mucous and blood is often associated with certain kinds of infections.

    4. If the diarrhoea is gross smelling it is usually viral, if not bad smelling it could be associated with a bacterial infection and probably requires a doctor's attention.

    5. Stools that are grey looking, with lots of flatulence (gas) can sometimes be associated with a common parasite called Giardia lamblia (usually seen after travel or camping where you might have had raw river water to drink)

    6. Stool that appears black and tarry is a symptom that needs to be brought immediately to the doctors attention. This can be indicative of bleeding high up in the large bowel.

    Note two major exceptions here.

    a) if you are taking something like peptobismol this contains bismuth which will turn the stool black
    b) high dosages of iron will also cause a dark stool.

    5. Small amounts will not show any change and
    are called occult (hidden).
    It is a good idea to be starting routine screening at age 50. The card tests for blood in stool is a screen for early detection of colon cancer and other problems.
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  4. crazycatlady 6-20-2011

    crazycatlady 6-20-2011 Member

    Member Since:
    Jul 22, 2011
    Springbrook, WI USA
    Re: tramadol

    In the group home I work at, we make a thing called "Power Pudding" The recipe isn't exact as it comes out different each time, so sometimes we add a little more or a little less, but here is the recipe.

    Take a
    18oz container of prunes
    1 good cup of water

    simmer together till almost all the water is absorbed.

    add 12oz apple sauce
    1 cup of prune juice

    bring back to a simmer for a few minutes.

    Remove from heat and add 1 cup all bran cereal.
    Let cool and then blend in a blender and you will have Power Pudding, which should give you some good results!!!
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  5. Retsel

    Retsel Member

    Member Since:
    Jul 4, 2011
    United States
    Re: New Left Knee . . . Check!!

    Here is a recipe that is used for people who are on medications that cause constipation. It is used in nursing homes, etc. It may not be your cure all but it wouldn't hurt to try it and see if it works. It can be taken a couple of times a day if needed. Good Luck constipation can be so miserable.

    Serving Size. Start with 1 TBSP and work up to 4 TBSP per day if needed.
    4 C Raisins
    1/3 to ½ # Prunes-canned and pitted
    2 T Honey
    2T Vanilla
    46 0z apple juice

    Soak raisins in water overnight
    Puree all together in blender or food processor
    Store in refrigerator up to one month
    May be used on toast, on cereal, on waffles, pancakes, etc
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  6. welshjane

    welshjane Senior

    Member Since:
    Nov 23, 2011
    Re: NEW Cooking and Recipe Forum

    Being a nutritional therapist, I tend to think in terms of 'food as medicine'. To that end, I've been working at some healthy flapjacks that may assist with constipation in hospital - a problem most of us suffer from because of the pain meds.

    Here is the recipe:

    100g/ 1/2 cup coconut oil
    90g / scant 1/2 cup blackstrap molasses
    40g / 1/4 cup dark muscovado sugar
    200g / 1.3 cups jumbo oats
    40g / 6 tbsp ground flax seed
    100g / 1/2 cup prunes, pitted and chopped
    45g / 1.5 ounces walnuts, roughly chopped

    Preheat the oven to 180C/350F/gas 5. Lightly grease a 20cm square tin (I haven't got one, so I use an oblong baking sheet and a rolled up piece of foil to reduce the size to a square.
    Over low heat, melt together the coconut oil, molasses and sugar, stirring, until the sugar is dissolved.
    Combine the oats, prunes, walnuts and liquid mixture. Spoon into the tin, press into the corners and flatten the top.
    Bake in the preheated oven for 20 minutes.
    Remove from the oven and cut into 16 squares while still warm. Leave to cool completely before removing from the tin.
    Store in an airtight container, or wrap individually in foil.

    Drink one or two glasses of water or other fluid with one or two of these, as that helps to bulk up the ground flaxseed.

    Substitute honey for molasses if you prefer, and pecans for walnuts.

    I take no responsibility for the US equivalent measures, which I got off a converter on the internet. When one of my cookbooks was published in the US, they had to employ a professional writer to 'Americanize' it! I couldn't do that myself, accurately.
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  7. rider1960

    rider1960 Post-Grad

    Member Since:
    Nov 2, 2011
    United States
    I found this recipe and fell in love with it. Little did I know they were also going to be my saving grace from pain med-induced constipation after surgery. Eating 2 or 3 regular sized muffins a day worked better for my constipation than the physician prescribed stool softener! They are also super convenient because the batter "keeps" for up to 6 weeks, covered bowl in your fridge. Mix the batter once and you can make a few at a time, or whatever, and have fresh-from-the-oven muffins without mixing any batter for quite a while. Great for after surgery, when I couldn't spend a lot of time preparing food.

    6 Week Bran Muffins

    5 cups flour (I found the best is 4 cups whole wheat and 1 cup regular)
    3 cups sugar
    3 tsp baking soda
    2 tsp salt
    1 15-20 oz box bran cereal (can be raisin bran) crushed

    1 cup cooking oil
    4 eggs
    1 quart buttermilk

    Optional other dried fruit, such as cranberries (my favorite)--chop up the larger fruits. I use two packages of dried cranberries for this recipe.

    1) mix dry ingredients in one bowl and wet ingredients in another bowl
    2) mix the two mixtures together in a very large, bowl with a cover
    3) refrigerate overnight in a covered bowl
    4) scoop batter into muffin tins to make as many muffins you want each time
    5) bake at at 380 F degrees for 15 minutes (approximate--they are done when they are no longer mushy on the top when you press lightly)
    6) remaining batter can be stored in the covered bowl in the fridge for up to 6 weeks!
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  8. Janet2012

    Janet2012 Don

    Member Since:
    Mar 31, 2012
    This subject comes up so often, I thought I would add this to the options. This is from my surgeons office, and is untried by me... yet.

    Mix together:
    1 cup applesause
    1 cup coarse unprocessed bran
    3/4 cup prune juice

    "This mixture will be like a thick paste. Refrigerate in a covered container between use. Take one-two tablespoons of mixture every day with a glass of water. Take in evening for a morning bowel movement. Increase the bran mixture by two tablespoons each week until your bowel habits are regular. Always take one large glass of water with the mixture.

    A diet high in fiber and drinking at least 6-8 cups of water daily can also help."


    another submission from Titianlady here. 8th September 2012

    Here is a cocktail that my health nurse( who works with post surgical and ICU long term patients) uses in the hospital to relieve that dreaded constipation we get after surgery.

    1 dose of Milk of Magnesia
    5 ounces of prune juice
    2 ounces of 7-up

    Now, they mix it all together in a glass and have the patient drink it right down, BUT, she said if you really can't do that, just take the ingredients one after the other. Drink the milk of magnesia, down the prune juice, and finish up with the 7-up to take the taste out of your mouth.

    I was constipated so badly when I came home from hospital, I thought I would have to go to the emergency room. I told my health nurse, and she gave me this recipe.

    I drank it, and IT WORKED!
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