Breast augmentation constipation, 4 days post-op. What should I do?

Thanks for asking this sometimes embarrassing question at 4 days post-op. I have had patients wait 7, 8, and even 10 days, when I then wonder which brand of TNT we will need to blast out the fecal plug that has been caused by that length of wasted time! Sorry, this is a crappy subject!But here is what I recommend, based on the physiology of what got you in this predicament. Anesthesia and narcotic pain medications slowed your gut peristalsis, and reduced activity (just normal body movement that stimulates the intestines) further aggravated the lack of propulsion through your gut. The fecal material (bowel movement) in your sigmoid colon and rectum just sat there without much urge for you to go (the rectal valves that "signal" the need to go are sluggish as well, and even more so if you are normally somewhat constipated without anesthesia or narcotics), and all this while your body is absorbing fluid from the bowel movement, and what peristalsis you are able to generate only further compresses or impacts the fecal plug.This fecal plug acts like a "cork" that gets bigger and more solid. Now we have a problem Houston!So the first step is NOT laxatives that stimulate peristalsis--this only causes no result and often cramps (and terrible diarrhea when you get your "cork" out). The first step is to moisten and dislodge the fecal plug, You can start with a glycerine suppository that can act like a mild lubricant, but at 4 days with no BM and this probably won't work. But it won't hurt either (and no cramps), so give this a go, so to speak.But you'll probably need to start with one or two Fleets enemas (small pre-filled enemas available at your drugstore or Costco--get the twin-pack). If this doesn't work, a (bigger-volume) water bottle enema may be necessary. Remember, getting the plug of hard fecal material out of the rectum is the problem to be addressed, not stool softeners, laxatives, or fiber bulk agents by mouth. The problem is at the other end!Once the fecal plug is evacuated (nurses and medical students had to do this with the gloved digit in nursing home patients unable to do this themselves--called disimpaction), then everything should be back to normal--unless your activity is still limited, or you are still taking narcotics. Then a stool softener, fiber bulk agent, prunes or juice, Miralax, etc. will be necessary until your gut is returned to its baseline state.Fortunately this is temporary. But don't waste time doing the easy oral laxative route--that's not the problem, as I hope I have detailed. Sorry for the detail, but not being able to, er, do your business really IS a crappy problem to have. (Twice in one answer is enough, don't you think?) Best wishes for a speedy return to regularity! Dr. Tholen

This unpleasant complication can be experienced in varying degrees following anesthesia and from taking narcotic pain medications following surgery. It is not uncommon. I'm active in taking preventive steps to avoid this sometimes painful condition, and have a supplement I give my patients which is designed specifically for post-operative patients that help immensely during my patients recovery. In addition, we give my patients specific instructions if they should develop constipation following their procedures and prefer home remedys or over-the-counter products such as bulk laxatives (Metamucil, Fiberall, etc), stimulants (such as Dulcolax and Senokot), lubricants (mineral oil, Fleet, etc), or saline laxatives like Milk of Magnesia. Enemas or suppositories can also help stimulant a movement. Women who are prone to constipation should let their surgeon know ahead of time so that they can get specific instructions on what they can do. 

Weaning  off of narcotics as soon as possible will help with your constipation. Staying hydrated also helps so drink plenty of water. Sometimes in difficult cases milk of magnesia or Dulcolax helps as well. Hope this helps.