I'm 6 days post op and I haven't had a bowel movement yet. Is this normal?

Thanks for asking this sometimes embarrassing question. It's too bad you waited till 6 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 6 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!

Please call your surgeon to notify him/her.  Your plastic surgeon will most likely recommend a suppository or enema on top of stool softeners to get things going.  Pain medication causes constipation and it's better to treat before the problem gets too bad.  I typically tell my patients to be sure they don't go longer than 2 days with out a BM.  Best of luck to you!

Hi,

You should have a bowel movement by now. I'd suggest letting your doctor know and he/she will likely recommend a stool softener and possibly a suppository to get things moving. Be sure to stay hydrated as dehydration can lead to constipation. Taking narcotics will contribute to constipation, as well. 

All the best,

Dr. Blagg

Austin, TX

Hello,I recommend that you talk to your Plastic Surgeon about medication and activity which can help alleviate your constipation.All the best

First of all, thank you for the question.  Between the General Anesthesia and the narcotics, it slows the bowels down.  I have my patients start with Senokot S right after surgery to help get the bowels moving.  I would recommend at this point to do a suppository.   If you still need something after this, I would suggest a fleets enema.  As always, I would check with your surgeon and follow his or her advice.  Best of Luck.