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

Question

I had my surgery 4 days ago and have had no bowel movement, granite I'm not regular anyways. I have taken a few laxatives as well. What should I do"

Richard H. Tholen, MD, FACS · Answer

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

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.If the constipation is severe, there are some 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.

Thomas Trevisani, MD · Answer

Unfortunately, in some patients general anesthesia may trigger constipation. Try prune juice, add more fiber in your diet- such as Citrucel, you can try Milk of Magnesia. In severe cases -- some patients use mineral oil anemas. Best to discuss with your doctor. Hope this helps

Rachel Streu, MD, FACS · Answer

Hi and thank you so much for your question! It is very common for narcotics, such as oxycodone or norco to cause constipation. I like to tell my patients in their pre-op appointment to take a stool softener or something that has worked in the past for them. Some examples are Miralax and Sennakot. For some people prune juice and coffee can help as well.Congratulations on your breast augmentation and thank you again for your question.Best,Dr. Rachel Streu

Steven M. Camp, MD · Answer

So I totally agree with Dr. Tholen.  That is the most comprehensive explanation on constipation after surgery I have seen.  Sticking to the basics, drink fluid, stop narcotic pain medicine, walk around, and use a home enema.  Hope this helps.Best Wishes

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