A Patient's Guide to Management of Constipation Following Surgery

After your surgery, you may be taking certain pain killers which may cause constipation. You may also be less mobile and may be eating and drinking less which can also lead to constipation.

Constipation is when there is a decrease in frequency from your normal bowel habit or the faeces (stools or motions) become hard, and difficult or painful to pass. (Note: there is a large range of normal bowel habit. Some people normally go to the toilet to pass faeces 2-3 times per day. For others, 2-3 times per week is normal.)

Drink plenty of fluid (6-8 cups per day) and eat a diet rich in fibre. Fruit, vegetables, wholegrain breads and cereals are foods that are high in fibre. Prunes are especially high in fibre and contain sorbitol, a stoolloosening sugar that naturally helps relieve constipation. If you don't like the wrinkly texture or unique taste of prunes, prune juice may be a more palatable alternative. Chewing sugar free gum (containing sorbitol), taking hot fluids (tea, coffee, water) or abdominal massage in a clockwise direction (the same direction as movement in the colon) may also help to ease constipation.

Changing position - sitting out of bed, standing or light exercise such as walking is also good for easing constipation but this will depend on the type of surgery you have had and your mobility after surgery. Ask your physiotherapist or doctor looking after you if there are any special restrictions on exercise after your surgery. However, if this is not successful (or unsuitable) then medicines called laxatives may be taken.

Laxatives are a group of medicines that are used to treat constipation. They can be taken by mouth as liquids, tablets, or capsules or they can be given via the rectum (back passage) as suppositories.

There are different groups of laxatives which work in different ways.

You will usually be prescribed a combination of laxatives.

Stimulant laxatives e.g. senna

Stimulant laxatives speed up the movement of your bowel by stimulating the muscles that line your digestive tract. They usually take 6-12 hours to work, and come in many different forms, including tablets, liquids and suppositories or enemas (which are introduced through the anus).

Senna

The usual dose of senna is one to two tablets taken either once daily at night or twice a day (each tablet is usually 7.5mg). It usually takes about 8-12 hours for senna to work therefore it is best taken at night to produce a bowel motion in the morning.

Stimulant laxatives can cause abdominal (tummy) pain. Using them for a long time can lead to a weakened (lazy) bowel.

Osmotic laxatives - e.g. Macrogols (Movicol®), lactulose

Osmotic laxatives make your stools softer by increasing the amount of water in your bowels. They usually take a few days to work and come in several different forms, including powders, liquids and enemas. It is essential that you keep up your intake of water for these laxatives to work effectively.

Macrogols (Movicol®)

The usual dose of macrogols is one or two sachets once or twice a day according your individual needs. Each sachet needs to be dissolved in 125ml of water.

Osmotic laxatives can make you feel sick (this can be reduced by taking with water, fruit juice or with meals), abdominal pain, bloating and flatulence (wind).

Lactulose

Your GP may have prescribed this for you, however this medicine is not available for use at the RNOH.

Stool Softener laxatives – e.g. docusate sodium

Stool softener laxatives add water to your stools to lubricate them, making them more slippery and easier to pass. They are taken as capsules or enemas, and usually take one to two days to work.

Docusate sodium

The usual dose of docusate sodium is one or two 100mg capsules twice a day.

Stool softener laxatives can cause abdominal cramps and nausea

In most cases, you should only take laxatives occasionally and on a shortterm basis whilst you are on your pain medication. Using laxatives frequently, over a long period of time can make your body dependent on them so that your bowel no longer functions properly without the medication.

Over-using laxatives can also cause:

• diarrhoea

• dehydration

• unbalanced levels of salts and minerals in your body

If you find that you need to use laxatives more regularly, or if you have been taking them for more than two weeks, see your GP for advice.

If you are worried about the laxatives you have been given or any other medicines you have been asked to take, please contact your GP or community pharmacist. You can also phone the hospital pharmacy on 020 3947 0037.