Four days post op and still can't move my bowels. Is this normal?

Question

I just had a breast augmentation on February 17 have been drinking plenty of fluids, eating vegetables high in fiber, and after speaking with my PS's nurse, have taken a dose of milk of magnesium last night. I am still not able to "go" and am getting very bloated and uncomfortable. I have a 1 week check up with my PS on Tuesday, but that seems so far when feeling this way Should I be concerned enough to go to a doctor before Tuesday? Or should I just be patient and wait for things to move along?

Nagi T. Ayoub, MD, FACS · Answer

Great question!
Constipation can be very common after any surgery, not just plastic surgery.  The narcotic pain medicine you receive in your IV from surgery as well as the narcotic pain pills you may or may not take after surgery have the side effect of making you constipated.

Most importantly: drink plenty of fluids!! This will help keep you hydrated and help move your bowels along.  But since you are already POD4 and constipated, some over the counter medications could work well for you, Colace to Metamucil.  You may require an at-home enema or gentle laxative but these can irritate the bowel as well if used too frequently.
If you have additional concerns, give your plastic surgeon a call.  They are there to HELP you along your journey.  Don't necessarily 'wait it out' until your appointment.  I would give the office a call.

Thank you!

Brian C. Reuben, MD · Answer

Thank you for your question.  Constipation is common after any surgery.  The narcotic pain medicine you receive in your IV from surgery as well as the narcotic pain pills you may or may not take after surgery have the side effect of making you constipated.  It is important to drink plenty of fluids to stay hydrated but you may also need additional medications to help combat the constipation that the pain medicine can cause.  Typically most over the counter medications work well.  Anything from sennakot to metamucil is fine.  There are no major medication interactions that you need to worry about.  If you have additional concerns, give your plastic surgeon a call.  They will be happy to hear from you and provide you with assistance.  Don't necessarily wait until your appointment.  Your surgeon is there to help you along the way.

Richard J. Brown, MD · Answer

It is normal to be stopped up. If you are still taking any narcotics at all for pain that will make it worse. In the worst of cases you may need enemas or a little bit of laxative to help jump start your guts. It is common for patients to become constipated because of all the pain medications.

Benjamin Chu, MD, FACS · Answer

This is a serious problem after breast surgery.  The breast augmentation procedure can be quite painful and naturally patients will take a lot of narcotics to control the pain.  The problem with narcotics is that it paralizes the bowels so it can not propel the bowel contents.  Narcotics may also cause nausea and vomiting which may lead to bleeding after surgery.  I usually use a numbing medicine dispensing pump called a pain pump to control post-operative pain thus reducing or eliminating the need to take narcotics.  If you are constipated you will need to take a bowel stimulant such as Dulcolax (which is over the counter) to stimulate the peristalsis of the bowels.  However if you are really constipated you may also have to use a lubricant such as a Mineral oil enema to allow you to go.

Margaret Skiles, MD (retired) · Answer

This is quite common and usually a side effect of taking pain medication. If you can, decreasing the number of pain pills should help but call your surgeon and let him or her know your problem; there are any number of ways to relieve your constipation that he or she can prescribe. Good luck to you.

William A. Terranova, MD (retired) · Answer

Constipation following breast augmentation is not at all uncommon.  Most often due to the narcotic pain medications.  Every surgeon has his/her own routine for handling this.  Do not wait until your next appointment.  Call the doctor's office today and tell them that the Milk of Magnesia has not worked and ask them for the next recommended step.

Four days post op and still can't move my bowels. Is this normal?

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