Constipation after joint replacement surgery can be a common occurrence. It is something we strive to avoid.

What actually is constipation?

There are many definitions of constipation. Constipation is the inability to pass faeces or having difficulty passing faeces, because it is dry or hardened. We all have our own “normal” pattern for bowel movements- for some that may be 2-3 times a day, for others 2-3 times a week.  Alterations to this normal pattern can be classed as constipation to the individual. So if you use your bowels three times a week prior to surgery, then there is no reason for concern. However for those that use their bowels daily, a change to 2-3 times a week is classed as constipation.
As the time frame of constipation increases so to does its severity. As the length of time between bowel movements increases, more water is absorbed back into the bloodstream, causing the stool to harden in the colon. The discomfort increases, along with the damage that can be done by straining to have a bowel movement. As a result there can be symptoms of reduced frequency of bowel motions, difficulty and straining when passing bowel motions, passing small, hard, lumpy stools; and a feeling of incomplete/inability to empty the rectum. Additionally some people experience abdominal bloating, generalised feeling of being unwell and loss of appetite. Occasionally, some people complaining of diarrhoea may in fact have ‘overflow’ diarrhoea as a result of constipation.

What causes constipation after surgery

Post-operative patients are prone to constipation for a variety of reasons:

  • Pain Medications prescribed
  • Change in eating and drinking habits
  • Change in activity levels
  • The anaesthetic
  • Change in daily routine-
    • different bathroom/toilet
    • sharing bathroom/room with others
    • different surroundings

Preventing and Treating Constipation

If you are prone to constipation please mention this to your surgeon.  A stool softener (Movicol) is often prescribed in hospital and you may also be discharged home with Movicol.

  • Drink plenty of fluids- water and fruit juices.
  • Eat plenty of fruit/vegetables
  • Ensure that you get adequate walking/exercise.

Why is Constipation a Big Deal After Surgery?

Constipation can progress to impaction. Impaction is when the stool is so hard and dry that you cannot have a bowel movement. The hardened stool must be removed by enemas, manual disimpaction or (in advanced cases) surgery.

If your bowels have not worked within three days of surgery please seek advice from your local Pharmacy.  If they still haven’t worked the next day – contact you surgeon.  It is more advisable to act promptly rather than to wait until the situations escalates and hospitalisation is required.