It is quite common for patients who underwent surgery to have bouts of constipation—an inability to pass stool, or difficulty passing stool because it’s dry or hardened—than the average person which causes discomfort or pain. There are several aspects of back surgery which may lead to constipation. They include anesthesia, changes in diet, stress and the use of some pain-relieving medicines.
When it comes to defining constipation, there’s no hard-and-fast rule for bowel movement frequency. Stool tends to become harder and harder as the length of time between bowel movements increases. This is because more water is absorbed back into the bloodstream, causing the stool to dry out in the colon.
Spine injury and constipation :
Spinal cord injuries may cause tightness (spasticity) or looseness (flaccidity) in the muscles of the rectum, sphincters, and pelvic floor. The degree of tightness or looseness may be related to the severity or completeness and level of the injury. If the injury is above level T11/T12, then the muscles of the sphincters and pelvic floor may be tight, which leads to constipation. If the injury is level T11/T12 or lower, then these muscles may be loose, which leads to stool incontinence. People with incomplete spinal cord injuries tend to have more muscle strength and sensation and therefore have fewer bowel problems than people with complete injuries.
A spinal cord injury can lead to bowel problems which can cause pain in the abdomen. Bowel problems can also contribute to depression or anxiety. Symptoms associated with constipation are:
- Pain and bloating in the abdomen
- Nausea and vomiting
- Hard stools and the inability of bowel movement.
Common causes of constipation after spine surgery :
Spine surgery patients are prone to constipation for multiple reasons, the primary reason being the prescription drugs given for pain relief.
1). Pain medication:
Opioids are a powerful type of pain medication and are frequently given after surgery to control the pain. Unfortunately, all opioids have a well-known side effect of causing constipation. One way in which opioids promote constipation is that they decrease the movement of food through the intestinal tract, which gives the body more time to remove water. This can lead to a drier than typical stool. It’s also believed that opioids may actually increase the amount of water that is absorbed from the GI tract. Finally, opioids may decrease the urge to have a bowel movement, which again allows more time for the body to remove water.
2). Food and drink after surgery:
As a part of the preparation for surgery, patients are usually advised not to eat or drink. After surgery, patients may be advised to eat or drink minimally and perhaps not eat at all for a day or two. The combination of too little fluid and no food intake can work against your body’s normal routine of elimination. Too little fluid in the body means less fluid in your stools, resulting in hard, dry bowel movements. Food works to stimulate the digestive system and keep things moving along. With no food being eaten, the “food in, food out” mechanism doesn’t work as well.
Dietary choices along with intake level also may have changed after surgery. Even the food provided in the hospital may be a significant change from the normal diet and can cause constipation.
Inactivity: Getting up and walking or being active is one of the triggers for a bowel movement. So suddenly spending most of the time in bed resting after surgery does not assist the bowels in moving stool along.
Preventing constipation after spine surgery
It is ideal to prevent constipation after surgery, rather than develop it and have to treat it. Following are some tips to optimize bowel health and avoid as much discomfort as possible.
Reduce the use of narcotic medicines and use only what is needed for controlling pain. Narcotic medicines slow bowel movement and cause constipation. Use non-narcotic pain relieving medicines to prevent constipation. Use fiber laxatives, stool softeners or combination products after back surgery to prevent constipation.
2). Increase fluid intake:
Drinking more fluids, avoiding caffeinated beverages and focusing on beverages (water and juice) can help keep well-hydrated and decrease the risk of constipation. Fluids will also help the body to recover after developing constipation. Apple cider juice and prune juice are effective natural laxatives.
3). Eat more fiber:
Increase fiber intake by eating fruits and vegetables, preferably as close to their natural state as possible. A whole orange will do a better job of providing fiber for diet than orange juice with the pulp removed. Avoid foods known to cause constipation. It is best to avoid cheese, meat and processed food. Instead of large meals, have frequent, small meals throughout the day.
4). Physical activity:
Physical activity, such as walking, has also been shown to decrease the risk of constipation. Follow the doctor’s instructions regarding the limits on exercise.
Medicines for constipation :
Non-prescription medicines can be taken for preventing or treating constipation after back surgery. Here is a list of some effective medicines that relieve constipation:
- Bulk fiber laxatives, which add bulk to stool and encourage water to stay in the colon. These medicines need up to three days to show effect.
- Stool softeners or emollient laxatives help in softening stool by making fluids mix with them.
- Stimulant laxatives take action by stimulation of bowel contractions for moving stool out. They are effective and start working very quickly.
- Suppositories also perform the dual function of stool softening and acting as laxatives. The colon gets contracted, and stool is pushed out and as the stool gets softer, it can pass easily.
- Enemas perform the function of bowel movement stimulation. Liquids are injected into the rectum, up into the colon. This stimulates the colon, and stool is passed.
Importance of maintaining bowel function :
Worsening and untreated bowel function can lead to many additional health problems:
- Partial paralysis of the stomach
- Chronic heartburn
- Gas pain
- Stomach or intestinal ulcers
- Abdominal discomfort, pain or distension
- Bloating or fullness
- Change in weight (related to a poor diet or a decrease in appetite)
- Autonomic dysreflexia – This is a serious condition where a dangerous elevation in blood pressure is associated with a drop in heart rate in people with spinal cord injury at levels T6 and above. It may cause heavy sweating, flushing, headaches, and blurry vision. If left untreated, it may lead to stroke, bleeding in the eyes, swelling of the heart or lungs, and other severe health problems.
- Worsening pain and/or spasticity
- Decreased sense of well being
These health problems can reduce your quality of life. Constipation should not be ignored, especially after a stressful experience like surgery. But you may be able to avoid these problems by taking proper precaution and remedies.