How can I prevent constipation after a tummy tuck?

Question

I am scheduled for a tummy tuck next month and feel prepared for the surgery and the recovery. The only worry I have is that I have a difficult time with constipation under the best of circumstances and often have to strain to move my bowels. My primary care doctor has suggested I start Miralax a few days before the surgery, which I will do. Do you think this will be enough? What other measures could I take? Thank you.

Robert F. Centeno, MD, FACS · Answer

Thank you for your question. This is a common complaint after tummy tucks due to the use of narcotics.  Miralax is a good suggestion.  You may also want to begin an over the counter stool softener like Colace 2-3 times per day.  Increasing your fluid intake would also be helpful.  Finally stopping your narcotics at the earliest possible time would help.  Supplementing with dietary fiber with vegetables and prunes can be beneficial.  Best wishes.

Larry S. Nichter, MD, MS, FACS · Answer

Take stool softeners day prior after surgery, keep hidrated, use bulk agents like metamucil, and walk. I also recommend avoiding narcotics which are all very constipating.All narcotics like Percocet, Vicondin, Noco, Codeine have significant side effects of nause, vomiting and constipation. I recommend the use of Celebrex and Acetominophen (does not make you drowsy and less chance of nausea) plus intraoperative use of Exparel. Exparel is a very long-acting local anesthetic that lasts approximately 3 or more days following injection and great for Tummy Tucks and other surgeries. Not only does it prevent pain but also most muscle spasms. It lasts the same length of time that a pain pump lasts and will therefore take the place of a pain pump. This means patients can enjoy the same effect of a pain pump, but without any catheters and no pain pump to carry around.Exparel will be available for those concerned about minimizing discomfort after surgeries such as tummy tuck and breast augmentation.Exparel costs the same as a pain pump and produces the same result but with less hassle and works great.Narcotics are used only as needed (as cause nausea, vomiting and constipation as frequent sided effects).

Tom J. Pousti, MD · Answer

Thank you for your question.It is quite common to be constipated after surgery, especially while taking narcotics. I tell my patients to try to ween off of the narcotics as soon as possible and to push foods that help with constipation such as high fiber foods, prune juice, staying hydrated, etc. Frequent ambulation, over the counter medications and prescription medications that can be taken as well.Best to communicate with your surgeon and see what he/she suggests.Best wishes.

Jeremy Pyle, MD · Answer

The constipation after tummy tuck is caused by narcotic pain medications and, to some degree, anesthesia.  In addition to what you describe, it may be worth making certain that your plastic surgeon uses something at the time of surgery to decrease your pain and decrease your need for narcotics. This is usually either a three day anesthetic called Exparel or a pain pump. I prefer Exparel because I can inject it exactly where I want it whereas the pain pump can move around somewhat and is not as effective in drainless abdominoplasty.Best,Dr. Pyle

Jaime Campos Leon, MD · Answer

Thank you for the question.Constipation happens frequently to post op patients, there's natural ways to prevent that after surgery like drinking prune juice etc. I agree with you PS, that should help you relieve the constipation.Dr. Campos

Jeffrey Zwiren, MD · Answer

Constipation after surgery is due dehydration and narcotic medications.  To help avoid this problem you should stay well hydrated and try to ween yourself off of the narcotic meds as soon as possible.   Also two tablespoons of milk of magnesia prior to bed time will help.

Jeffrey K. Scott, MD · Answer

Constipation is common and expected after tummy tuck. Your chronic constipation should not be much of an issue. Good hydration is important. Other measures such as stool softeners, fiber products (such as Metamucil) etc will all work well to prevent discomfort. I would let your surgeon know about this aspect of your history before your surgery. Also keep in mind that the post op constipation is due to the narcotic pain medications, so certainly stop these as soon as your pain subsides.

Robert L. Kraft, MD, FACS · Answer

I would not take any medication, whether OTC or by prescription, without discussing with your plastic surgeon.  Postop, Colace, suppositories and good old prune juice would be beneficial.  Remember not to strain and to keep hydrated.

Arun Rao, MD · Answer

lookahead-That is a great question. Pain medications will typically worsen your constipation. I would follow your PCPs advice about starting miralax.  I would ask your plastic surgeon for advice on a bowel regimen. I would recommend you drink 8 eight oz glasses of water every day. Another option is to take colace which is a stool softener. Good luck.

Bruce K. Barach, MD (retired) · Answer

the culprits are inactivtity and narcotics. colace and miralax are good suggestions. Try to get by with as little narcotic pain meds as possible. the sooner you stop them completely the better. try to be up and around a liitle bit every hour if you can. staying well hydrated is also wise for a number of reasons. good that you are thinking ahead....an ounce of prevention is worth a pound of cure!!!

How can I prevent constipation after a tummy tuck?

Answers (12)

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