Constipation After Gallbladder Removal (Acute and chronic): causes and treatment.

A- Acute constipation after gallbladder removal.

Constipation for days after surgery is common. Abdominal operations (such as gallbladder removal surgery) are even more likely to cause constipation.

Constipation after gallbladder removal surgery occurs when you pass lumpy (hard) stool or pass fewer than 3 stools in a week.

Some people may feel as if their poop is too big to come out. In severe cases, stool impaction can develop.

It is important to determine the severity of your constipation and to learn how to differentiate constipation from stool impaction. Learn more HERE.

Common causes of ACUTE constipation after surgery include:

1- Anaesthesia.

Anesthetic medications lead to temporary paralysis of your gut motility. The type, dose, and duration of the anesthetic medication play a role in the development of constipation. (ref)

Treatment:

Once happened after your gallbladder surgery, no specific treatment can be given. This is because the condition is self-limiting.

Try to stick to the standard tips to relieve constipation such as a high fiber diet, physical activity, and trying a fiber or a stimulant laxative.

If the condition is severe, Ask your surgeon or doctor about prescription medications to relieve anesthesia-induced constipation.

2- Opioid analgesics.

Narcotic pain relievers are commonly used either before gallbladder removal (to relieve biliary colics) or after surgery to relieve pain.

Opioid pain analgesics are known to cause constipation. Opioid-induced constipation (OIC) is estimated to affect up to 60% of patients receiving it (ref).

The risk of developing opioid-induced constipation after gallbladder removal is particularly high with higher doses and older ages (ref).

Commonly used opioid analgesics in the USA: (ref)

• Hydrocodone (Vicodin).
• Oxycodone (Oxycontin, Percocet).
• Nalbuphine (NUBAIN).
• Morphine (Kadian, Avinza).
• Codeine.
• Fentanyl.

Treatment: 

Work with your doctor to either stop or decrease the dose of opioids after the surgery. 

But take care that “untreated pain” is also a major cause of constipation after gallbladder removal. So, a balance between analgesics dose and pain relief has to be achieved.

Also, a trial to switch to other pain relievers such as ibuprofen or acetaminophen is a good choice. 

3- Lack of physical activity after the gallbladder surgery.

Prolonged bed recumbency increases the risk of constipation after gallbladder removal.

Even a simple physical activity such as walking inside your home will decrease the risk of constipation.

Treatment:

• Walking (slowly, at your pace, and after permission from your surgeon).
• A 10-minute walk 3 to 5 times or as described by your doctor will do the job.
• Avoid any vigorous physical activity to avoid surgical complications. 

This slight physical activity also helps the healing and reduces the risk of blood clots. It also improves appetite, which, in return, will help regular bowel movements. 

4- Post-operative pain.

Painful abdominal conditions, in general, can induce constipation. The abdominal pain after gallbladder surgery alone can induce constipation. (ref).

The inflammatory process of the surgical wound will make the bowel movements more painful. Both pain and certain pain relievers (especially opioids) can cause constipation after gallbladder removal.

Treatment:

Work with your doctor to help reduce post-operative pain while limiting the use of opioid narcotics.

Using alternative pain relievers such as Ibuprofen and acetaminophen carries less risk of constipation after gall bladder surgery.

Don’t withhold analgesics or switch the type without permission from your surgeon.

5- Lack of fiber-rich diet after the gallbladder surgery.

Fibers are vital for a healthy gut with normal motility. Lack of sufficient eating or lack of a diet rich in fibers can lead to constipation after gallbladder surgery.

Treatment:

• Eat whole grains.
• Eat fresh fruits.
• Drink plenty of water.
• Eat lots of vegetables.
• Eat beans.
• Eat prunes and drink prune juice (a powerful anti-constipation remedy).

Also, try to avoid a low fiber diet that may aggravate constipation such as:

• meat and processed foods.
• Refined grains such as bread and white rice.
• Dairy products.

Complications of acute constipation after gallbladder surgery:

• Abdominal colics and bloating.
• Nausea, and maybe vomiting.
• Anali fissures.
• Hemorrhoids.
• Stool impaction. 
• Straining may impact the surgical wound. 
• Rectaliprolapse. 

Should you use a laxative for constipation after gallbladder removal?

If the above lifestyle and dietary modifications fail, your doctor may prescribe a laxative to treat constipation after gallbladder removal.

Some laxatives (especially fiber laxatives and stool softeners) are available over-the-counter. However, we prefer to ask your doctor about the best laxative that fits your condition.

Common laxatives that can be used:

• Start with a fiber laxative such as Psyllium (Metamucil). Always drink plenty of water to get the benefits of fiber laxatives. Methylcellulose (Citrucel) is a reasonable alternative.
• A stool softener such as docusate sodium can also help.
• Stronger osmotic laxatives such as Polyethylene glycol (MiraLAX) can be used in severe cases.
• Also, a stimulant suppository such as glycerin suppository can help temporarily relieve acute constipation after gallbladder surgery.

B- Chronic constipation (for months or years) after gallbladder surgery. 

Acute constipation after gallbladder surgery is relatively common. It usually resolves within days, especially with proper management.

However, a smaller subset of the patient may continue to suffer from constipation for months or years.

Possible theories explaining the cause of chronic constipation after gallbladder surgery:

• Alternation of the gut beneficial microbes due to the use of antibiotics during and after the gallbladder surgery.
• Change the food behavior after the gallbladder surgery (eating small amounts, less fiber in diet).
• Associated Irritable bowel syndrome with constipation.
• Associated Chronic Idiopathic constipation.

MORE: Do gallstones Cause constipation?

Also, chronic constipation that develops months after the surgery is not necessarily due to the surgery. It can develop due to its unique causes. 

Anyway, you have to consult your doctor. Any cause of chronic constipation has to be evaluated by a gastroenterologist to define its cause. 

Chronic constipation after gallbladder surgery will respond to classical anti-constipation remedies. Ask your doctor about the best treatment that fits your condition. Learn more.

MORE:

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