Empty My Bowel but Not My Tum
December 3, 2008 1:33 PM   Subscribe

I'm having abdominal surgery on Tuesday of next week. And you are not my doctor or, in fact a doctor at all. Although it's not bowel surgery, my bowel is notoriously difficult and always seizes up for a few days after anyone has been in there having a fiddle. What can I eat in advance to reduce the "residue" so I enter surgery with a pretty empty bowel?

Extremely important is that I have diet controlled diabetes and have asked my doctor and he just said to eat normally till the morning of the surgery, fast before the surgery and then take it slow eating at the other end (so to speak).

I have done it his way in the past, and it has still resulted in a sluggish bowel with extreme pain and discomfort. So I'd like to help myself as much as possible and eat a low residue, low glycaemic index diet in the next few days.

Anecdotal advice welcome, doctors feel free to gnash your teeth and ignore, or contribute and any other advice or warnings are also welcome.

I've had enemas in the past, and they haven't really helped in case you were going to suggest that. Sorry if this is gross and far too much information.

If you've got any more questions, I'll email jessamyn.
posted by anonymous to Health & Fitness (9 answers total)
I know of what you speak, after my c-section I was almost forced to stay in the hospital an extra day because I'd not yet farted.
They have the salty drink that will *empty* you out that is used before colonoscopy. That might be extreme - but you wouldn't just be pretty empty - you'd be absolutely empty. I would check with a doctor about this first - I am not one and have no idea if this is a good thing to do before someone cuts you open or if it's something you should do as a diabetic.
I'm sluggish on a good day - I've found miralax to be very helpful without being extreme in getting things going again. Eat lightly/fast before hand and have some miralax on hand if things are still bad on the other side of surgery.
Good luck in surgery.
posted by Wolfie at 1:53 PM on December 3, 2008

In simple terms, when your abdominal cavity is opened up and explored surgically people commonly develop what is referred to as postoperative ileus -- which means that the normal squeezing of "stuff" through your intestinal track slows or even becomes transiently paralyzed. As far as I know with perhaps one exception, this has not been shown to be in any way related to what you've been eating previously or how empty the bowel is, and there's no reason to believe that clearing you out prior to surgery is going to make any difference with respect to these unfortunate but all too common symptoms. There is a very small amount of observational data that suggests preoperative high bran/fiber diets might speed post-operative ileus along. While by no means concrete evidence, it's probably one relatively harmless thing you might consider trying.

A few other routine things that may help after surgery are judicious use of the right type and amount of analgesics prescribed by someone experienced in this issue, and possibly trying to get up and about as soon as you are comfortable and capable of doing so under the appropriate medical monitoring. The latter is conventional wisdom not well proven by the science out there with respect to postop ileus, but it does definitely help prevent a variety of other complications associated with surgery as well and is generally a good idea.

Remember that surgery is a scenario that is often associated with lots of fluid shifts, which could lead to falling blood pressure and potentially serious complications, so stay well hydrated, especially if you choose to do something drastic like using laxatives (which is something I would also strongly recommend against).

Good luck! Hope it's not as bad this time as the others.
posted by drpynchon at 1:58 PM on December 3, 2008

iAlot of what seizes the bowel is all the meds during a procedure and esp pain pills. If you tell the doctor this they will prescribe something. If you just want to try food, fiber is the way to go. Try fiber cereal... it tastes like twigs but should work quick.
posted by femmme at 2:57 PM on December 3, 2008

Make sure you have stool softener pills (post-op)--they will help things get moving after the surgery, otherwise you can have a wicked case of constipation.

The one time I had abdominal surgery, I ate clear-broth soup (chicken and rice) the day before--nothing really heavy.
posted by pushing paper and bottoming chairs at 3:07 PM on December 3, 2008

Don't think there's anything you can eat pre-op. The more your bowel is manipulated (handled) by the surgeon, the more irritable it's going to be and the slower it'll be to return to passing gas (flatus).

There's some data out of Japan that suggests that chewing gum post-op helps get the bowel back to normal motility faster, but I would not recommend doing ANYTHING without the knowledge and consent of your surgeon.
posted by gramcracker at 3:43 PM on December 3, 2008

What you are describing doesn't sound so much like strict paralytic ileus (in which case, any food or drink would be withheld) so much as it sounds like regular old post-operative constipation.

Post-operative constipation is exacerbated by dehydration, immobility, and pain medicine. Generally, the better your pain is treated, the more mobile you are. Because of that, I would recommend being extremely careful with femmme's advice. Too often, post-op patients think, "Well, it doesn't hurt if I lie absolutely, perfectly still, and decline pain medication that would otherwise allow them to begin ambulation earlier. If you're choosing between Percocet and reduced mobility, just take the Percocet already.

I suppose it's possible that existing crap in your bowels could lead to exacerbated constipation, but any attempt to clean that crap out would leave you dehydrated-- which would be worse for your constipation than pre-existing feces. If you insist on trying it, colon prep solutions like Golytely are available over-the-counter-- but I wouldn't recommend it, and if you do decide to try anything like that, please please PLEASE tell your doctor before you do it.

You should speak to your surgeon about these problems before your surgery. Ask him about using stool softeners following the surgery. I can't imagine that there'd be any contraindications to an over-the-counter stool softener like Colace.

And drink tons of water as soon as you are able. And walk around as much as possible, even if it hurts.

(IANAD. I am a nurse who has cared for a fair share of post-op abdominal patients.)
posted by nathan v at 3:50 PM on December 3, 2008

I've had the same issue ranging from two days up to almost a week after (spinal) surgery. The quicker I'm up and about, the quicker everything starts moving.

Having hospital food you actually want to eat seems to make a lot of difference as well.
posted by HFSH at 6:27 PM on December 3, 2008

yeah, lots of liquid after the surgery, and take a stool softener. general anaesthesia and heavy pain meds put the brakes on my bowel as well. generally, taking a stool softener or some kind of milk of magnesia type product before bed the first night out of the hospital has had me pooping reasonably the next day.
posted by rmd1023 at 8:16 PM on December 3, 2008

a low residue, low glycaemic index diet

This might be hard to achieve, since most low GI foods have fibre in them, and fibre is the residue you're trying to avoid.

I'm actually not sure low-residue is what you want prior to the surgery -- because low-residue means your intestinal transit time is increased, and the food will stay in there longer, making it more likely you'll have "extras" left in the gut for the day of your surgery (though not likely if you fast a full 24 hours prior. Just saying.) Like Dr. Pynchon said, you might even want to try a higher-fibre diet before the surgery of you're concerned about sweeping the ole tract.

When the surgery is over, you want to give yourself time before you progress to full solids. Start on clear fluids and work your way up.

Low residue diets, in my experience, are used when you don't want to the patient to poop (e.g. when a patient is receiving gynecological brachytherapy and must not move from bed for a couple days), or where there's some kind of obstruction in the bowel. I'm not sure either of these apply to your situation.
posted by peggynature at 9:03 AM on December 4, 2008

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