GUEST POST: Constipation is a common complaint after bariatric surgery. The combination of a high protein diet lacking in fiber, poor water intake, and inactivity is a recipe to feel “backed-up”
Many practitioners recommend laxatives such as Miralax or fiber supplement such as Benefiber to help keep things moving. Others suggest stool softeners such as Dulcolax to help give you relief. Besides fiber supplements and laxatives recommended by your health professional, is there anything else you can do?
The best place to start is to look at what you are eating and drinking.
Fibers from fruits, vegetables, nuts, seeds and whole grains are known to help with bowel regularity. The general recommendation is to eat between 25-35 grams of fiber daily. But after bariatric surgery (especially in the beginning) it is almost impossible to get this much. What should you do?
With the help of a dietitian, look over the food that you typically eat in a day. Are there any areas that you can sneak in extra fiber?
Perhaps you could include chia seeds in your yogurt? Or a small piece of fruit with lunch? My Top 10 Dietitian-Approved Foods to Eat After Bariatric Surgery includes high fiber options to help you with ideas.
Some clients tell me their high fiber protein bars are “a must” to keep them regular. Others add spinach to their protein drinks. If your pouch permits, I suggest aiming for at least 5 g of fiber at each meal and 2-3 g during snacks.
Protein is very important after surgery, but if you are meeting your surgeon’s requirements, then more is not always better. Protein does not make you constipated but it takes up “room” in your stomach that could be used for high fiber foods such as vegetables. If you have a string cheese for a snack but have already met your protein goals for the day, then this is a missed opportunity to get your fiber in with carrot sticks and hummus.
If you are including fiber throughout the day but not drinking enough fluids then this is also a recipe for disaster. In fact, you could become even more constipated with a high fiber diet and not adequate fluids! Crazy, right?
During digestion water is drawn into your small intestines. If you have fiber in your diet then the fibers soak up this water like a sponge, which gives you softer stool. But if you do not have enough water then your stools become hard and pellet-like as your body tries to absorb the water back from your food in your large intestine.
After working with bariatric clients over the years, I know it is hard to drink enough water. Some people need to drink every 20 minutes to get their water in, while others use a large water bottle with ounces listed to keep them motivated to drink throughout the day. Work with your dietitian or talk to with others who have undergone weight loss surgery to discover what tricks will work for you.
Prior to surgery you may have used caffeine to help your bowels move in the morning (coffee, anyone?) but many programs advise against caffeine after surgery. Instead try a warm glass of water with lemon in it. A warm drink in the morning may be just the trick to stimulate your bowels.
Besides what you eat and drink, activity is important to help keep your bowels moving. When you engage in exercise, your intestines contract and relax more, which creates wave like movements and propels your food through your intestines faster. This faster rate gives your body less time to absorb the water from your undigested food and hence you have softer, more frequent stools.
Viola! Easy right?
Fiber. Water. Exercise.
Yeah right! I know these things are hard to get in right after bariatric surgery.
If the prescription of fiber, water and exercise are not working for you, consider the following options with your surgeon’s team approval.
Magnesium citrate has been shown to be helpful in relieving constipation. It helps to relax the bowels and pull water into your intestines. It is usually safe and effective but please consult your surgeon for dose recommendations.
Epsom Salt Bath
An epsom salt bath is an option for those who are having a difficult time eating or drinking and can’t imagine taking one more pill to help them with constipation. The magnesium in epsom salts is absorbed through your skin and may give you relief.
Senna is an herb and is often used as stool softener in a capsule form but you can also drink it as a tea. While it is effective it can interact with medications and not recommended to use long-term. Try drinking a cup at night before bed.
Certain strains of probiotics have been shown to be helpful in relieving constipation, but research is still limited. According to Consumer Labs, Lactobacillus reuteri DSM 17938 and Bifidobacterium animalis subsp. Lactis have been shown to be effective against constipation.
Constipation after bariatric surgery can be painful and frustrating. But give your body time to adjust to the surgery. Keep communication open with your surgeon team about what you are struggling with and what options will work best for you.
Feature courtesy of Kristin Willard. Kristin is a Registered Dietitian who teaches bariatric patients how to eat healthy and maintain their weight after surgery. Join her Free Facebook Group to get recipes ideas and nutrition info while she creates her website, BariatricWholeLiving.com.