Constipation After Gastric Sleeve

Written by Sherry Vickers and medically reviewed by Dr. Stephen Boyce, MD

When ya gotta go, ya gotta go. Except for when you can’t! Constipation is one of the not so pleasant side effects of weight loss surgery.

As a bariatric patient, I would argue that it is by far one of the crappiest situations we can find ourselves in – pun intended. Fortunately, there are steps we can take to combat this issue as well as ways to prevent it from happening.

Why does weight loss surgery cause constipation?

Constipation post-op can happen for several reasons:

Constipation After Gastric Sleeve Bari Life

Lack of physical movement. After surgery, you won’t be able to exercise right away. The first few weeks of recovery require you to be pretty calm. You will be encouraged to get up and take frequent walks – and it helps!

Iron and calcium in your supplements. I know, I know. Taking your vitamins every day is a new healthy habit you are forming. But now, I’m tellin’ ya that they can clog the pipe! Don’t fret; we will get through this.

Narcotic painkillers. They put the brakes on gastric emptying – the time it takes for food to move from your stomach into your small intestine. Narcotics also cause your small intestine to absorb more fluid which causes your stool to dry out.

Lack of water and fiber. As soon as you start pursuing weight loss surgery, drinking water becomes a top priority. And for good reason! You need to stay hydrated because you have all of the above working against you. Also, you will be eating far less fiber than a normal person. Fiber adds bulk to your stool and softens it, making it easier to pass.

How do I know if I am constipated?

Before surgery, you may have been very regular. Maybe you visited the pot several times a day, or maybe you were an every-other-day kinda person. Either way, you knew you were gonna go and life was good. But here you are after surgery, feeling like you’ll never go again.

Chances are, lack of food intake is causing your infrequent bowel movements. But if you are having less than two per week, are passing hard or lumpy stool, or have the sensation that you need to go but are unable to, you are probably constipated.

Constipation After Gastric Sleeve Bari Life

Constipation after bariatric surgery is common and easily treatable by following the tips in the next section. However, if you are going less than twice in a week and experiencing any of these symptoms, it’s time to call your doctor.

  • Cramps or stomach pain
  • Not passing gas
  • Nausea
  • Bloating
  • Feeling like you need to go, but can’t

What to do if you are already suffering from constipation post-op

First, check your water consumption

Water is a natural constipation remedy and is always the initial go-to. There is a reason why it is drilled into us to drink so much water! A lot of our post-op hassles are brought on by dehydration.

We can easily fix this by making sure we hit the water goals outlined by our surgeons. Nutrients and water are absorbed from your food during the digestive process.

If there isn’t already enough water in your system, your body will draw it from what you eat, resulting in hard stools. The ASMBS recommends increasing your water intake as a first-line treatment for constipation post-op.

Second, consider adding fiber supplements, stool softeners, or mild laxatives to your regimen

Fiber supplements are a great natural remedy for those who simply aren’t getting enough from their diet. Fiber absorbs water to plump up your stool and helps keep it soft. Most fiber supplements are taken by mixing the recommended dosage with water and can be taken a few times each day. It is very important to make sure you drink enough water to prevent fiber from making constipation worse.

Stimulant laxatives trigger contractions in your intestinal wall which helps move stool along. These types of laxatives can cause painful cramping and the sudden need to find a bathroom, stat.

Stool softeners are often recommended after bariatric surgery because they reduce straining. They pull water into your stool to help keep it soft.

Saline laxatives such as Milk of Magnesia work by drawing water into your intestines and often work pretty quickly. As with other constipation remedies, drinking enough fluids while using saline laxatives is crucial.

Constipation After Gastric Sleeve Bari Life

Most bariatric surgeons know that constipation is a post op issue, so they will prep you ahead of time by recommending you take laxative tablets (such as Senakot), magnesium hydroxide (Milk of Magnesia), or a stool softener (such as Dulcolax).

For the first six months after surgery, my doctor had me take each of these regularly. But because post-operative instructions can differ, always check with your medical team before taking any new medications!

How to prevent constipation

Constipation After Gastric Sleeve Bari Life
  1. Make sure you hit your fluid goals every day. Water really is the magic ticket to many of our post-op woes! It is generally recommended that we drink at least 64oz per day post-op. Start sipping in the morning – a few sips every 15 minutes or so will easily help you reach that water goal!
  2. Incorporate high fiber foods into your diet (this is easier during the later food stages by increasing fruits, vegetables, whole grains, and legumes).
  3. Exercise regularly! Once you get clearance from your surgeon to resume exercise, make sure you do it consistently. Mild to moderate exercise has been proven to help speed up digestion and stimulate bowel function.

In conclusion

Constipation is a nasty problem with a relatively easy solution. As bariatric patients, we have to remember that our way of eating has to change forever. Most of the negative conditions we experience can be prevented if we are intentional with our post-op lifestyle.

  • Carry a water bottle with you everywhere you go. We are more likely to sip all day if we have our fluids handy.
  • Always eat your protein first and then follow it up with produce. Not only do fruits and vegetables have lots of fiber, but they also contain essential vitamins and nutrients that your body needs.
  • Take your supplements! The reason we take our bariatric supplements is to help make up for malabsorption and the inability to eat enough of certain foods.

Doing these things will help keep your entire body functioning properly which is your number one defense against constipation. The first few months after surgery can be challenging.

You are adjusting to a new way of life and you have to learn what works for you. Although constipation isn’t fun, it also isn’t everlasting.

Last but not least, remember that the benefit of having surgery is overall well worth learning how to deal with pesky side effects 🙂 Be intentional about your diet and your body will thank you!


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