Constipation & bacterial overgrowth after Gastric Sleeve & bypass

Do you ever wonder why someone is having constipation chronically after gastric bypass and gastric sleeve surgeries? Typically people say it’s due to pain medications, dietary changes including insufficient fiber intake, and not drinking enough water after surgery.

But even when you drink more fluids, eat more fiber, and exercise, sometimes nothing seems to work. In that case, you require prescription medications or supplements like Amatiza, Linzess, stool softeners, and magnesium to have kind of occasional bowel movements. But even after taking stool softeners, constipation persists. The potential reason behind constipation after surgery is SIBO, which is a situation where there are too many bacteria in the small intestine.

This article covers the ideal bowel movement, constipation, and bacterial overgrowth after gastric sleeve and bypass surgeries.  The symptoms, tests, and risk factors of having SIBO, and more! Please read on.

Ideal Bowel movements

Most people will feel better physically and mentally if they have bowel movements daily. The standard is every one to three times a day to three times a week, but we know the importance of doing it every day in the functional world. And that’s what you should strive for, having a bowel movement no less than once a day. That’s an ideal one!

Now, you may be wondering what’s driving someone not to have regular bowel movements or for things not to flow naturally?

The goal of this article is to help you to have daily bowel movements. So that’s what we’re digging into.

Bacterial overgrowth and risk factors

SIBO is a small intestinal bacterial overgrowth, and it’s just where the bacteria is in the wrong location. We’re supposed to have the majority of our bacteria in our colon. Sometimes, based on certain things that happen in life because of surgeries, medications, and different disease states, bacteria flow more into the small intestines where we don’t want them. However, it’s normal to have some. SIBO is just the higher levels that are supposed to be in the colon.

In a study, SIBO was detected in 50% of patients using PPIs. So, being on PPIs increases your risk of having multiple abdominal surgeries. Bariatric surgery is one of these risk factors. Think about hysterectomies having your gallbladder removed, and appendectomy. Those abdominal surgeries would put you at a higher risk of developing SIBO.

Gut gases: 

Different types of gut gases are linked to SIBO, and they usually present with other symptoms. These gut gases include:

• Hydrogen
• Hydrogen-sulfide
• Methane

The SIBO can be hydrogen-dominated, methane-dominated, or mixed. The hydrogen and Hydrogen-sulfide are usually associated with diarrhea, and the methane is associated with constipation. Some people will have both constipation and diarrhea. So don’t rule that out if you have both.

In 2020, experts provided a better description of methane SIBO, as they are actually intestinal methanogen overgrowth because they’re really focused on those methanogens.

In 2021, the Journal of Clinical Gastroenterology and Hepatology further explained that 30% of patients with SIBO are colonized with Archaea. And archaea are just anaerobic organisms that produce methane. In other words, it’s not bacteria but archaea. Therefore, they felt that we were dealing with something different and wanted to acknowledge that a little bit more in line with what they were dealing with.

So, if constipation is your main or one of the symptoms you’re regularly experiencing, in that case, it could be the methanogens, and just really that overgrowth is driving that constipation dominant type of scenario.

Test for constipation driven bacterial overgrowth

For the SIBO test, there are some stool tests from that you can evaluate it. However, the best test for SIBO is a breath test that gives us a glimpse into methanogens. A breath test is usually used to identify people with SIBO. But they are not always available in every community at your local labs or hospitals.

In my experience, sometimes just treating empirically actually works too. So you need to find a doctor who understands SIBO and can explain the symptoms, the causes, and how to treat it. That’s the key piece, so find someone who has experience with it and work with them to help you resolve the issue.

Obese patients and bacterial overgrowth

In 2016 a study on “The consequences of SIBO in obese patients before and after bariatric surgery.” said that about 15% of obese patients have SIBO before they even have bariatric surgery and are probably unaware of it. However, this number rises to about 40% after surgery.

Further studies even go as high as like 86 and 87%. But in clinical experience, somewhere between 40 and 80% of you experience SIBO. So, it’s just digging into what you are experiencing and what you are dealing with and focusing on fixing that problem.

This study also found that the positive people for SIBO after bariatric surgery had lower weight loss. You may be thinking, just roux-en-y gastric bypass has higher SIBO, or is that sleeve gastrectomy, or both?

According to experts, sleeve gastrectomy holds the same numbers as SIBO, perhaps a little less, but you still have the same potential for SIBO after gastric sleeve surgery.

Bacterial overgrowth symptoms

When you have SIBO, most people face some symptoms. These are as follows:

• Gas
• Bloating
• Belly distension(looks pregnant)
• Diarrhea
• Abdominal pain
• Nausea
• Belching
• Cramping

It is observed that some people maybe face three or fewer symptoms, as mentioned above. There may be someone who does not face any of them. But most of you will have a minimum of one sign. Some will be pretty extreme, and others will be pretty mild. Typically, constipation is one of the symptoms of this intestinal methanogen overgrowth (IMO).

Constipation driven bacterial overgrowth needs an expert to diagnose and treat

While the symptoms listed above are for SIBO, they are also present in many other digestive problems. We’ve already talked about bile acid malabsorption. You can read this blog. It carries similar symptoms to this EPI, exocrine pancreatic insufficiency. All of those have a potential after weight loss surgery.

Working with someone who understands the differences and can help you get the right testing to diagnose what you are dealing with is important.

If you are having problems with constipation chronically and fiber fluids and exercise have not helped or even made it worse, you should have to consider SIBO or IMO as a reason.

Final words

If you’re struggling with constipation and you want solutions, reach out. Let’s work together. Don’t be afraid to ask for a free 15-minute conversation where we can chat about your symptoms and see if we’re a good fit and see if we can help and guide you maybe to what you need first and get you going to healing. Hopefully, you found this information useful.

If you prefer video, check out our YouTube channel, where I discuss this topic in detail!