Constipation After Abdominal Surgery
As I have written about here before, I don't just have IBS. I also have endometriosis and adenomyosis (when endometrial cell penetrates the muscle of the uterus – it's as painful as it sounds). Well, I finally decided to bite the bullet at the end of last year and have a hysterectomy (which is the surgical removal of the uterus), along with radical endo excision.
As I wrote for Endometriosis.net, my surgery was overall pretty successful and I am so glad I was fortunate enough to have it and have enough time to mostly recover before the pandemic hit. However, there was one main negative side effect of the surgery: constipation.
No stranger to constipation
Now, as someone with IBS, I am no stranger to experiencing constipation, though frankly, I have always veered more toward IBS-D symptoms than IBS-C. In my early twenties, I went through a period for a couple of years when I alternated pretty dramatically on and off between bouts of diarrhea and constipation.
Yet, after I had my first laparoscopy to diagnose and treat endometriosis at 23, the constipation issues mostly disappeared for a very long time. It's only been in the past few years, with the symptoms of my endo returning in full force and getting much worse that I also noticed some subtle symptoms of constipation gradually creeping back into my life.
Unlike in my 20s, when constipation I experienced mainly manifested as me not being able to go to the bathroom at all for a day or several at a time, this time it was more like when I went to the bathroom I felt like not everything inside me was coming out (sometimes called an "incomplete evacuation") and I'd go around feeling bloated and uncomfortable, even sluggish. This didn't happen often – maybe a few times a month. But I noticed it was starting to become more commonplace and it was bothersome. Then I had my hysterectomy.
Research on constipation after abdominal surgery
In general, it's not uncommon to experience some constipation in general after any surgery, as both anesthesia and painkillers like opioids that are often administered during and immediately after an operation, can slow things down digestion-wise. But this can even be more the case when the surgery in question is abdominal and impacts the GI system, especially when I had to fast for a day before the surgery. I had a lot of endo on my bowels.
The first bout of constipation I experienced after surgery didn't last long, and things seemed to go back to normal after a week or so. But a few weeks later, constipation started becoming a problem again and it seemed like some of what I had been experiencing before surgery – not feeling like I could get everything out of me – began to ramp up from something that happened to me a couple of times a month to several times a week. That was unpleasant (to say the least).
Is constipation more likely as a long-term consequence after a hysterectomy? It's hard to say. One peer-reviewed study published in 2017 that surveyed 300 women over a 4-year period both before and after having a hysterectomy found 1 in 6 developed either constipation or another urinary or bowel-related complication.1 But just because something may be correlated, doesn't mean it's the direct cause. Additionally, an earlier study from 2008 that evaluated over 400 patients concluded that "Hysterectomy does not seem to cause constipation." The study also found half of the participants who had constipation issues before the surgery, actually had improved symptoms afterward.2
Taking steps to improve my IBS
This past month I did take some steps to address my constipation with relative success. Namely, I started giving myself gentle abdominal massages in the evening before I go to sleep and again in the morning when I wake up; I bought and began using a Squatty Potty and finally, I have added some mild apple juice (the extra Vitamin C helps) and few other daily staples to my diet.
I've noticed constipation has improved and I will be writing about each of these solutions in greater detail in subsequent posts! On the other end of the spectrum, I have not had any incidences of diarrhea in the nearly 5 months since my surgery – the longest stretch I have ever gone without having diarrhea in decades. So that's been a big benefit of my hysterectomy.
Have you had a hysterectomy or any kind of other abdominal surgery? Did it benefit your IBS or causes more complications? Please feel free to share it in the comments below.
Do you think there is enough awareness of IBS?