Constipation after appendicitis: what to do, causes, prevention

Symptoms

Delayed bowel movements (inability to go to the toilet) – within 24 hours is the first sign of constipation. In the postoperative period, this time increases to three to five days. This is due to the fact that after the operation the most important thing is the person’s recovery from anesthesia. During this period, vomiting poses a danger, so for 24 hours after the procedure the patient is prohibited from eating, including drinking plenty of fluids. If attacks of vomiting do not recur after a day, the patient is allowed to eat.

If difficulties arise with defecation, the patient feels sharp pain and heaviness in the lower abdomen, and does not leave a feeling of fullness.

The inability to defecate leads to poisoning by toxic elements contained in feces. Intoxication of the body occurs - nausea and vomiting, appetite decreases. Sleep is disturbed, fatigue and a feeling of malaise appear.

The accumulation of gases causes belching and an unpleasant taste in the mouth. Feces harden over time and become the cause of mechanical damage - cuts, through which infection easily penetrates. A weakened body suffers complications in the form of an infectious disease.

Recommendations for patients after surgery

Inpatient rehabilitation phase During the first hours after surgery,
you will wake up in the intensive care unit.
The anesthesiologist and nurse will monitor your body temperature, pulse, blood pressure and other indicators. During surgery, you may have a catheter inserted into your bladder to monitor the amount of urine you produce. You will also have a chest tube connected to a drainage device. During the first hours/days after surgery, your voice may be slightly different from normal, this is normal. You may remain in the recovery room for one or several days, depending on your condition after surgery. Then you will be transferred to the ward in the surgical department where you were originally located. Frequently Asked Questions Will I experience pain after surgery?
You will experience pain after surgery, this is normal.
Your doctor and nurse will ask you frequently about your pain and give you pain medications as needed. If the pain does not go away, tell your doctor or nurse. Pain relief is essential so that you can clear your throat, breathe deeply, and get out of bed and walk. Remember that taking painkillers can lead to constipation (retention of stool for more than 2-3 days). If constipation occurs, consult your doctor. Upon discharge, your doctor will give you recommendations on taking pain medications. What is pleural drainage and why do I need it?
A chest tube is a flexible tube that drains blood, fluid, and air that accumulates in the chest cavity after surgery. This tube is placed between the ribs in the space between the chest and lungs (see Figure 1).

Picture 1

Chest drainage and pleural banking.

The timing of drainage of the pleural cavity is individual for each patient.
Removal of pleural drainage is carried out by the attending physician if 2 conditions are met: 1) the amount of fluid released does not exceed 200 ml/day 2) there is no air flow through the drainage . Why is it important to walk after surgery?
Walking helps prevent blood clots from forming in the legs.
It also reduces the risk of other complications, such as pneumonia. During your postoperative hospital stay, try to set yourself a goal of walking 1.5-2 km daily. Will I be able to eat after surgery?
You will gradually return to your normal diet when you are ready.
Your healthcare provider will provide you with more information. Can I shower?
You can shower 48 hours after your chest tube is removed.
A warm shower is relaxing and helps reduce muscle pain. Try to avoid contact of the wound with water until it is completely healed. If you do get the bandage wet, contact your doctor to change the bandage. When can visitors come to me?
Visitors can visit you as soon as you are transferred from the intensive care unit to the surgical unit.
You can find out the hours during which visits are allowed from your attending physician at the department. When will I be discharged from the hospital?
The length of your hospital stay depends on many factors, such as the type of surgery you had and how well your recovery was. You will remain in the hospital until your doctor thinks you are ready to go home. Your doctor will tell you what day and time you can expect to be discharged. Your doctor will tell you if you need to stay in the hospital longer than planned. The following are examples of reasons why you may need to stay in the hospital for a longer time:

prolonged release of air through pleural drainage;
problems with healing of postoperative wounds;
breathing problems;
increase in temperature in the postoperative period (38.0 °C) and higher.

Recovery after returning home Will I feel pain when I return home?
The duration of the presence of pain and discomfort in the area of surgical access is different for each person and depends on a large number of factors.
Thus, pain after open operations will be stronger and longer lasting than after video-assisted thoracoscopic and robotic operations. For some people, pain in the area of the surgical wound or a feeling of tightness or aching muscles may continue for 6 months or longer. This doesn't mean there's anything wrong with you. Follow the guidelines below. Take pain medications as directed by your doctor and as needed. Call your doctor if the prescribed medicine does not relieve your pain. Do not drive or drink alcohol if you are taking prescription pain medication. As your surgical wounds heal, the pain will become less painful and you will need less pain medication. To relieve pain and discomfort, mild painkillers and non-steroidal anti-inflammatory drugs are suitable: ketanov, ibuprofen (Nurofen-express), Nise (imisulide), xefocam (lornaxicam), diclofenac, as well as other drugs in this group. Pain medications should help you as you return to your normal routine. Take enough medication so that you can exercise comfortably. Remember that it is normal for a slight increase in pain as your activity level increases. Keep track of when you take pain medications. Pain medications are most effective 30 to 45 minutes after you take them. It is better to take the medicine at the first appearance of pain and not wait for it to intensify. How should I care for surgical wounds?
After surgery, you will have several incisions. The location of the incisions will depend on the type of surgery performed. They will be performed at the site of the operation and at the site of the chest tube. You may experience some numbness below and above the incision, as well as along the intercostal space where the incision was made. You may also experience tingling and tenderness in the area around your incisions as they heal. By the time you leave the hospital, your surgical wounds will begin to heal.

Change the wound dressing daily and clean the wound with skin antiseptic/diamond green/betadine (check with your healthcare provider for instructions on how to care for surgical wounds).

Upon discharge, your attending physician will give recommendations on when to remove sutures from post-operative wounds. To do this, you will need to contact a surgeon at the clinic at your place of residence.

If, after discharge from the hospital, discharge appears in your postoperative wounds, contact your doctor.
What should I eat at home?
Eating a balanced, high-protein diet will help you recover faster after surgery.
Your diet should include a source of healthy protein at every meal, as well as fruits, vegetables and whole grains. How can I prevent constipation?
After surgery, your bowel movements will change.
There may be problems with bowel movements (stool excretion). If you can, drink 8 glasses (250-300 ml each, 2 liters total) of fluid daily. Drink water, juices, soups, milkshakes and other caffeine-free drinks. Caffeinated drinks, such as coffee and soda, remove fluid from the body. Both prescription and over-the-counter medications are used to treat constipation. If constipation occurs, start with 1 of the following over-the-counter medications: Docusate sodium (Norgalax) 100 mg. Take 3 capsules once daily. This remedy softens the stool and causes only minor side effects. Senna 2 tablets before bed. It is a stimulant laxative that may cause cramping. How can I speed up the recovery process?
Exercise for at least 30 minutes a day. This will make you stronger, improve your well-being and promote recovery. Incorporate a daily walk into your daily schedule. Just walking down the street or walking on a gym will do. If the weather is not very suitable for walking, you can spend time in the shopping center. Climbing stairs is also suitable as a workout. When you return home, continue to do deep breathing exercises and exercises that stimulate coughing. Drink fluids so that the mucus is not thick and can be easily coughed up. Ask your doctor how much fluid you should drink daily. For most people, this will be at least 8-10 glasses (250-300 ml) of water or other liquids (such as juices) per day. During the winter months, run a humidifier in your bedroom. Follow the instructions for cleaning this device. Change the water in it frequently. Avoid contact with people who have a sore throat or cold or flu symptoms. All this can cause an infection to develop.

Do not drink alcohol, especially if you are taking pain medication.

Do not smoke.
Smoking cigarettes will always be harmful to your health. It is especially dangerous during the recovery period after surgery. Smoking causes blood vessels to narrow. This reduces the amount of oxygen supplied to wounds during their healing process, which significantly slows down the regeneration process. Remember, if you are not able to quit smoking on your own, you can contact the “Smoking Quit Assistance Center” located on the territory of the St. Petersburg NIIF by contacting them on the hotline (+7). Can I return to normal activities?
It is very important that you return to your normal activities after surgery. Distribute their implementation throughout the day. Walking and climbing stairs are excellent exercise. Gradually increase the distance you walk. Climb the stairs slowly, resting and stopping as needed. Do light housework. To the best of your ability, try to dust, wash dishes, cook simple meals, and do other tasks. When going about your business, use the arm and shoulder on which the operation was performed. For example, wash yourself, comb your hair, take things out of the closet shelf with this hand. This will help restore full function of the arm and shoulder.

You can return to your normal sex life as soon as the post-operative wounds have healed, without experiencing any pain or weakness.

Your body will tell you when you are overtired.
As you increase the intensity of your exercise, monitor your body’s reaction. You may notice that you have more energy in the morning or afternoon. Schedule your activities for the time of day when you feel more energetic. Is it normal to feel tired after surgery?
Typically, a person has less strength than usual after surgery.
Recovery time is different for everyone. Increase your activity every day to the best of your ability. Always maintain a balance between periods of activity and periods of rest. Rest is an important factor in your recovery. It may take some time for you to return to your normal sleep pattern. Try not to sleep during the day. Showering before bed and taking prescribed pain medications will also help. When will I be able to drive?
You will be able to drive again after: the range of motion of the arm and shoulder on which the operation was performed is restored to full extent;
you will not take narcotic pain medications (which make you drowsy) for 24 hours. Can I travel by plane?
Do not fly by plane until your doctor allows it; in the first months after surgery, try to use other means of transport or completely avoid long-distance travel.
When can I return to work?
The time frame for returning to work depends on what type of job you have, what type of surgery you had, and how quickly your body recovers.
If you need a certificate to return to work, contact your doctor. When can I lift weights?
Check with your doctor before lifting weights.
It is generally not recommended to lift anything heavier than a normal grocery bag (5kg) for at least 1 month after surgery. Ask your doctor how long you should avoid lifting heavy objects. This depends on the type of surgery you had. Which doctors should I see after surgery?
Upon discharge from the hospital, your attending physician will give you a discharge summary with further recommendations.
If it is necessary to consult any specialists, this will be indicated in the epicrisis. What questions should you contact your doctor about?
Sometimes in the postoperative period the patient may be bothered by the following conditions:

shortness of breath appeared or worsened;
swelling of the chest, neck, or face;
the voice changed dramatically;
temperature increased (38.0 °C) or higher;
the pain has sharply increased and does not go away after taking painkillers;
redness or swelling appears around the postoperative wound;
there is discharge from the postoperative wound that has an unpleasant odor, thick consistency or yellow color (similar to pus);
no bowel movements for 3 days or longer;
new symptoms or physical changes appear;

And if you have any questions or concerns regarding your health, please contact your healthcare provider.

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Causes

Removal of appendicitis disrupts the normal functioning of internal organs, which causes difficulty with bowel movements. Constipation after appendicitis removal is caused by the following reasons:

The effect of anesthesia and other painkillers. Removing appendicitis is a surgical operation that requires the use of narcotics and painkillers. They are the main cause of bowel problems. Anesthesia is administered during the surgical procedure, causing relaxation of all muscles of the body; painkillers reduce tension in the abdominal muscles. Therefore, immediately after the surgical procedure, problems arise in restoring the tone of all muscle tissues; the evacuation function does not occur at once.
Limited human mobility after appendectomy. Due to bed rest, the patient is inactive, which helps to reduce the tone of all muscles.
Adhesive processes. Connective tissue compaction can cause obstruction.
Stressful state of a person. Nervous tension caused by illness and surgery disrupts the normal functioning of the digestive system.

What is appendicitis

5% of the total population is familiar with acute appendicitis, regardless of gender, age and other factors. This disease is an inflammation of the vermiform appendix of the cecum - the appendix. The exact causes of acute appendicitis are unknown. Experts suggest that the source of inflammation may be chronic constipation, helminthiasis or other conditions leading to blockage and expansion of the cavity of the appendix.

In any case, this condition requires urgent medical attention and the only treatment method is surgery. The operation is performed under anesthesia and therefore requires some preparation.

In conditions of emergency assistance, preparation is not carried out as thoroughly as for planned interventions. For example, instead of using laxatives, a doctor may prescribe a cleansing enema to a patient.

Consequences of stool retention

Accumulated dense feces delay the removal of gases, which causes bloating. Due to bloating, the diaphragm is compressed, cardiac activity and lung function are disrupted. The symptoms of stool retention cannot be ignored; the consequences of the disorder have a bad effect on the patient’s health.

This provokes problems with postoperative sutures and injures the intestines. There is a reason for surgeons to perform repeated surgical interventions and prescribe additional medications that will further weaken the body and make it susceptible to other infections. As soon as the operation is completed, prevention begins from the first days.

Causes of bowel dysfunction

Constipation after surgical treatment of acute appendicitis can be caused by various factors:

taking medications - surgical interventions are always associated with a risk of infection, so patients are prescribed antibiotics, the side effects of which include inhibition of intestinal microflora;
anesthesia - with local or general anesthesia, all the muscles of the body are weakened, peristalsis is disrupted, which makes it difficult for food to pass through the intestines and excrete feces;
stressful state - experiences and emotional overstrain do not pass without leaving a mark on the body, they negatively affect the functioning of the autonomic system, which leads to disruptions in intestinal motility;
restraining bowel movements - after surgery, many patients suppress the urge to defecate, as they are afraid of the sutures coming apart, as a result of which feces accumulate and a dense, dry lump forms in the rectum.

Features of treatment

After studying the patient’s complaints and personal examination, the doctor recommends treatment. The main directions are drug treatment, gymnastics, diet.

Drug treatment

The patient is prescribed laxatives and glycerin suppositories. Enemas and microenemas are used - oil or based on herbal decoctions. The purpose of these drugs is cleansing; they help perform the evacuation function, but do not improve intestinal motility.

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Their constant use will allow a person to get used to the auxiliary substances; without their use, defecation disorders become chronic. As you get used to it, a constant increase in the dose of the laxative is required, and the drug soon becomes useless. Therefore, a laxative is not a panacea for this problem, but only an element in the fight against it.

If problems with stool are caused by a stressful condition, sedatives are prescribed - tincture of motherwort or valerian. Tinctures of chamomile, mint, caraway fruits and dill seeds enhance the muscle activity of the intestines. Oil preparations in combination with herbal ones have a healing effect.

Physiotherapy

To restore intestinal functionality, a course of therapeutic exercises is prescribed, aimed at strengthening the pelvic floor muscles. The main condition for the appearance of a positive shift is the regularity of the exercises. Walking and light jogging are helpful if your doctor allows it. Physical activity is allowed only on the recommendations of a specialist.

Diet

Principles of normalizing the functioning of the gastrointestinal tract:

Food is taken in portions five or six times a day.
Food is heated to a comfortable temperature, hot and cold are excluded.
Maintaining water balance.

Products that cause gas formation are excluded.

Immediately after appendectomy, the diet includes jelly, juice, weak tea and low-fat chicken broth. After a few days, mashed potatoes, zucchini and pumpkin are added. Then the menu includes light vegetable soups and steamed chicken cutlets, fruits and low-fat yogurt. It is forbidden to eat fixative foods: semolina or rice porridge, astringent fruits, fatty broths from fish and meat.

Beetroot, dried apricots and prunes provide a relaxing effect. Products containing fiber, oatmeal, honey, and natural juices have a beneficial effect. Smoked meats, spices, chocolate and pickles are prohibited. Solid food, fast food, coffee, soda, alcohol and cigarettes are prohibited.

Constipation after appendicitis removal: treatment methods

What to do to restore normal stool after appendicitis? In this situation, a comprehensive program of postoperative therapy is necessary.

Drug treatment

If you do not have stool after any operation, the most obvious solution is laxatives (senna, regulax, etc.). Doctors also recommend glycerin rectal suppositories after appendicitis. It is better to use candles, because... Laxative tablets increase intestinal motility and can cause pain.

Prevention

Normal functioning of internal organs is required not only after removal of the appendix. Simple preventive measures will help prevent bowel irregularities.

Diet

Set a routine and diet. Food is taken often, with breaks. Light snacks are allowed during breaks. The diet includes foods that stimulate the work of the intestinal muscles - dried fruits, fresh fruits, nuts, bran.

Reduce your consumption of protein foods - meat, eggs. Avoid foods that strengthen the stool - remove black tea, persimmon, red wine, cocoa. The delay is caused by the consumption of cheeses and ice cream. In addition to eating a balanced diet, adjust your fluid intake.

Reducing the level of fluid intake will lead to hardening of the stool. This is necessarily water, juices and soups. Strong tea, cocoa, soda and alcohol, on the contrary, lead to fluid loss.

Activity

An active lifestyle helps improve bowel function. The abdominal muscles are especially important.

Regular physical exercise on the abs for half an hour a day will keep the muscles of the internal organs toned. Swimming, jogging and walking reduce the likelihood of stagnation. In addition to the diet, set a defecation mode.

Bowel movement

Fecal ejection is carried out in the morning. This process is accelerated by drinking a glass of water on an empty stomach. At the first urge of the body, you need to empty your intestines. Suppression of natural reactions of needs will lead to disorders: fecal retention, stretching of the intestinal walls.

Taking medications

Reconsider your attitude towards taking medications; their uncontrolled use has a negative impact on your health. Do not overuse medications unless specifically directed by a doctor. Painkillers, laxatives and antibiotics negatively affect the functioning of internal organs. Use sorbents, iron supplements, antacids and contraceptives with caution. The doctor will help you choose analogues of drugs with minimal impact on the digestive system.

Diet after appendicitis as a means of relieving constipation

A special diet after surgery to remove the appendix is a prerequisite for recovery and return to a full life.

It is important to follow a diet after appendicitis for at least 14 days, regardless of whether there is stool retention or not, ideally up to 30-40 days.

Basic rules of a therapeutic diet:

Fractional principle of nutrition (5-6 times a day in modest portions).
All dishes are only served warm.
A special drinking regimen is at least 6-8 glasses of clean (not cold!) water per day.
Eliminate foods that stimulate gas formation - all legumes, white cabbage.

On the first day after removal of the appendix, any food is prohibited; you can only moisten your lips with mineral water without gas. Then you can have fruit jelly, a little chicken broth or rice water. Over the next 2-3 days, boiled rice, crushed potatoes, chicken broth, zucchini/pumpkin puree, and mashed boiled chicken are added to the menu.

Throughout the month, your diet should focus on high-fiber foods, cereals, lean meats, and fermented milk. Prohibited are salted and smoked foods, fatty meats, soda, store-bought sweets, fast food, and fatty cheeses.

Constipation after removal of appendicitis in a child - how to cure?

What should you do if your child is constipated after appendix surgery? Treatment in this case should be careful and gentle: the use of laxatives is highly discouraged, herbal remedies and enemas - only on the recommendation of a surgeon or pediatrician.

When treating constipation in a child, special emphasis should be placed on the postoperative diet. The basic principles of a therapeutic diet for children are the same as for adults. On the first day you will have to limit yourself to mineral still water; on the second or third day you can introduce potato and apple puree, steamed low-fat cutlets, and boiled rice into your diet.

During the recovery period, it is necessary to exclude peas and beans, cabbage, grapes (including juices based on them) and corn from the children's menu. You should not feed your child fruits and vegetables - everything should be in moderation.

If constipation after surgery in a child continues for more than two days, enemas with a hypertonic solution will help - 100-150 ml of a 10% salt solution (10 g of salt per 100 ml of clean water).

Retention of stool after removal of appendicitis is an extremely unpleasant phenomenon, but coping with this problem in a short time is quite possible. It is only important to follow a therapeutic diet, take regular walks and exercise therapy, and follow all the recommendations of your surgeon.