The clinical diagnosis of constipation is when a person has difficult bowel movements or passes less than three bowel movements a week.¹ As we discuss constipation further, it is important to remember this: pre-surgery, you might have had a bowel movement every day, but changes are occurring, and remembering the clinical diagnosis can be helpful to prevent stress about this common side effect. Constipation is a common side effect patients deal with after bariatric surgery. Constipation can occur in patients who have had any of the four major bariatric surgeries: sleeve gastrectomy, gastric banding, Roux-en-Y gastric bypass, and duodenal switch. The occurrence after bariatric procedures ranges between 7 and 39%.

What Causes Constipation

Constipation can occur as a result of a number of causes. After surgery, patients consume little solid food and small amounts of fluid; both can cause constipation. Additionally, iron supplementation is needed after surgery, and this and patients' post-op pain medication can contribute to constipation in some patients.

How to Treat Constipation

Nutritional treatment should focus on higher consumption of water or noncarbonated non-sugary drinks and dietary fibers found in fruits, vegetables, and whole-grain products². Patients should increase liquid consumption to at least 64 oz. per day (this can be hot or cold liquid). In fact, hot liquid can help stimulate the bowels and increase movement, helping relieve constipation. Patients should avoid carbonated or sugary beverages. An increase in consumption of foods rich in fiber, such as fruit, vegetables, and whole grains will help promote bowel regularity. If there is no improvement, supplements or medication should be considered. Please speak with your provider about adding fiber supplements or medications to your regimen, even ones that are found over the counter.

It’s worth pointing out that in certain surgeries, either a portion of the stomach is removed, or the digestive process is changed. With that comes disruptions to the gut microbiome. The disruptions can remove healthy bacteria from the stomach and increase issues such as constipation. Replenishing the stomach's healthy bacteria with probiotics may prevent these issues.

Resources:

1.  “Constipation.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 June 2019, www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253#:~:text=Overview,three%20bowel%20movements%20a%20week.
2. ASMBS Public/Professional Education Committee. Bariatric surgery: postoperative concerns [Internet]. May 23, 2007; revised February 7, 2008 [cited 2016 Sep 4]. Available from: http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Guidelines/asbs_bspc.pdf