#38 Blocked Up? 3 Tips to Deal with Constipation after Bariatric Surgery

Are you feeling blocked up? You know, constipation. Last week we had a discussion in the new private facebook group about what a pain constipation can be after surgery or any time. Let’s talk about some tips to help relieve it.

Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 38. This is the first podcast under the new name but you shouldn’t have any trouble locating it. The feed to your favorite podcatcher remains the same and it will continue on where Beyond Bariatric Surgery left off. It’s been a frantic few weeks so if you’re having an issue with anything, let me know. You can contact me easily thru the website. You’ll see the contact us link at the top of the page.

Website: Breaking Down Nutrition 

Don’t forget to join the NEW private FB group, the Bariatric Surgery Success community. You can join right now from the website as well. You’ll see the JOIN button on the homepage. 

Last week in the new private Facebook group, there was a lot of dialogue on constipation. You’re probably thinking…really…you sit around and talk about pooping. If you’ve had trouble pooping since surgery, you know why we’re talking about it. It’s one of the most common complaints after surgery especially sleeve gastrectomy and lap band according to my bariatric dietitian colleagues who work with bariatric surgical centers. Depending on your surgery and your body, your bowel movements may or may not be the same as before surgery which is typically a normal side effect. Before surgery, maybe you had a poop daily but after you may be going only every other day. Remember, you are your own unique person so if you’ve not had a bowel movement in several days or if having a movement becomes painful or uncomfortable get back in touch with your surgical center and physician. Most have their own protocol for constipation depending on how far out from surgery you are and what type of surgery you had. It’s not unusual to need to take a stool softener for the first month or so after surgery but again ask what the suggested protocol is for your specific situation. 

Do you feel like you’re on a roller coaster you can’t get off and go back and forth between dumping syndrome and constipation? Dumping syndrome is related to the type and amount of carbs that you eat. Remember you can listen anytime to podcast number #32 on 4 ways to prevent dumping syndrome from dumping on your day. There’s also a freebie with some great tips just waiting for you…download it on the homepage.

Podcast: #32 4 Ways to Prevent Dumping Syndrome from Dumping on Your Day

Website: Breaking Down Nutrition 

But if constipation makes you feel like a cement block is in your gut, let’s talk about how to help relieve it from a nutrition perspective.  Constipation can occur for a number of reasons. Run thru this checklist with me and ask yourself how many of these speak to you. Any or all of these items can increase the chance that you’re constipated.

Here we go…

Are you eating less food? 

Are you taking an iron supplement?

Are you abdominal muscles weak? 

Are you taking pain medications?

Are you drinking less water and other fluids than perhaps your body needs? 

Is your exercise or activity level down?

Is your diet missing foods high in fiber? 

How many of these did you answer yes to? 

Looking at constipation from the nutrition perspective, typically about one month after bariatric surgery you can start to increase your consumption of higher fiber vegetables, beans and lentils which help prevent constipation and work to help with regular bowel movements. Typical fiber intake goals range from 25-30 grams daily or about 15 grams for every 800-1000 calories you eat. A gastric band, sleeve gastrectomy or gastric bypass greatly reduces the ability to consume large amounts of fiber-containing foods so you know that it can be challenging to get enough fiber day to day. It becomes really important to choose as many high fiber vegetables and fruit along with lentils and beans as you can when you start adding them your diet. By the way, lentils and beans have an added bonus of containing protein. An overall bonus of fiber is that it makes you feel more full and is helpful in combating weight regain. Nuts are also a nice source of fiber but portion size is super important since they’re so high in calories. 

Ok a little science 101. I know it’s temping to add a fiber supplement or a laxative when you feel blocked but don’t rush into it. There are two types of fiber, soluble and insoluble, and both play a role in promoting regular poops. However, many fiber supplements contain just one type. Plus fiber supplements can make constipation more of a problem if your intake of fluid is not adequate. When it comes to fiber supplements and laxatives more fiber or numerous laxatives can make constipation worse not better. Remember that concrete block feeling? More is not better. Here’s why dietitians love food sources for fiber. Most food sources contain both types of fiber, soluble and insoluble, and are less likely to worsen constipation and more likely to help you be regular. 

Bonus:  Adding fiber from food sources is a big win for you. Why? Have you heard the word microbiome? Or health of your gut? These soluble and insoluble fibers go into your gut, into the large intestine and break down and thrive to make a health microbiome. This is a major reason that variety in your diet from all of these food fiber sources is so important to your long term success and health. 

Tip: start by adding high fiber foods slowly to avoid gas and bloating. As you add foods with fiber, increase your fluids…they are team mates. Spread fiber sources throughout the day versus loading up at one meal.

Try soft-cooked lentils, split peas and beans which are all terrific sources of fiber. Non-starchy vegetables, nuts and seeds all are good choices too… remembering portion control for nuts. Beans, oatmeal, fruits with skin, vegetables and whole grains all contain fiber. 

Should your physician or dietitian suggest a fiber supplement, add it slowly and increase the amount slowly to minimize gas and bloating just like you do when adding more fiber from food sources. And don’t forget your fluid. As we just talked about, these are teammates working hand in hand to help you prevent constipation and relieve it when it happens.

Drinking water is not doubt one of the most important thing you can do for constipation. Aim for at least eight, 8-oz glasses of water each day or around 64 ounces total which is close to 2000 milliliters.  To get this much fluid will require that you sip frequently from a water bottle throughout the day so set timers on your watch or phone, put a water bottle or other beverage right beside you, find one of those bottles that blinks or beeps to remind you to drink, whatever it takes to get the job done.

Constipation is something you want to prevent if possible because of potential problems with hemorrhoids, hernias and intestinal blockages. So if you’re taking an iron supplement which tends to increase the likelihood of constipation, it may be necessary to take a stool softener for the first month or so until you can drink more fluids and eat more fiber. Stool softeners such as Colace are available over–the-counter. Again this is a question for your health care provider. Your physician may put you on some type of laxative if a problem continues but your goal is to not take laxatives on a regular basis. Your bowels could become dependent on these medications and this makes it hard for normal bowel movements to occur.

Walking and daily activity and exercise help with regularity as well so discuss with your medical team how quickly you can be moving around.

Before I wrap up let’s talk a little about protein. It’s the one macro nutrient you need every day and a lot of it. This never changes. Sometimes it’s constipating, especially some of the shakes and supplements. Protein sources typically contain little to no fiber. What to do: look for products such as a shake or supplement with added fiber of about 5-7 grams per serving.

Constipation doesn’t have to be a pain for you. It’s knowing what to do to prevent it and relieve it when it happens. The two biggest steps that should become a daily part of life from now on are 64 ounces or 2000 milliliters of fluid every day and fiber from as many food sources as possible. Remember that certain medications, supplements and even lack of physical movement all play a part. Don’t hesitate to have this conversation with your dietitian or physician if you need to. 

Have a good week and I’ll talk to you soon.