Constipation after gastric sleeve gastric bypass surgery

Unfortunately, constipation is not uncommon after gastric sleeve gastric bypass surgeries.  Although NO ONE likes to talk poop 💩  (except maybe GI dietitians lol!)

Here you are struggling!

Let’s face it, constipation isn’t just a bariatric problem.  As a matter of fact, more than 63 million people in North America struggle! WOW!!

However, you may have found the standard recommendations don’t always work…

• Increase fluids
• Eat more fiber
• Exercise more

Instead, you may be using prescription Amatiza or Linzess, stool softeners, laxatives, enemas, suppositories, mineral oil or smooth move tea regularly!

Anything to move the cement in your gut!!

Although I am for ALL of these strategies, taking a different approach to focus on the root cause of motility may serve you better. 

Understanding the “Why”

First off, let’s talk about “why”.   Understanding what’s causing your chronic constipation helps you find better solutions.  It’s like using the right tool in the toolbox for the job. 

We are going to dive into 6 different categories of what causes constipation.

6 categories that contribute to constipation

With this purpose in mind, we’ve broken down the different causes of motility issues into six different categories.

1. Structural
2. Surgical
3. Imbalance
4. Medications/Supplements
5. Malabsorption
6. Deficiencies

First, Structural

This is something that is inhibiting your body’s ability for the movement to flow naturally.  This could be your alignment. Your pelvic alignment is off.  You may benefit from a chiropractic adjustment.  In addition, this could be your posture used during a bowel movement.  You may benefit from a stool or Squatty potty.

This area also includes your pelvic floor.  Pelvic floor dysfunction is possible in males and females.  Therefore working with a physical therapist who specializes in pelvic floor dysfunction may help!

Last, you have to consider bowel obstruction or partial obstruction.  For most, this correlates with surgery or anything that’s created abdominal scar tissue.  This leads us into our surgical connection.

Second, Surgical

Surprisingly, vagus nerve damage can occur during surgery.  As a result, motility becomes an issue.  Additionally, Scar tissue.  Anyone who’s had surgery has scar tissue.  To list endometriosis, gallbladder, appendix, gastric sleeve, gastric bypass, hysterectomy.  All create scar tissue and adhesions which impact motility.

Third, Imbalance

This covers imbalance in all areas of life.  This includes…

• Diet
• Hydration
• Gut Bacteria
• Stress
• Thyroid

Because fiber is the best solution sometimes, including soluble and insoluble fiber is important.  On the other hand, some feel worse increasing fiber.  This may be the result of food sensitivities.  In addition, certain individuals react to fermentable fibers naturally in food.

Although fibers are great for gut bacteria, they may cause constipation in those intolerant to FODMAPs.  To explain, FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.  Working with a Registered Dietitian who understands FODMAPs is key.  Lastly, you may want to consider fats.  Increasing healthy fats in your diet may provide the right balance for normal poops.

At no surprise, gut bacteria play a significant role in regular bowel movements.  Anyone experiencing dysbiosis, small intestinal bacterial overgrowth(SIBO) or low levels of good gut bacteria can experience constipation.

Next you may want to consider your thyroid.  Hypothyroid slows down motility, increasing constipation.  Working with a practitioner that will look at a full thyroid panel is important.

Lastly, Stress.  Whether we like to admit it, everyone experiences stress!  It’s learning to manage what you are given.  Anyone in fight or flight(sympathetic) daily can struggle with constipation or diarrhea.  When you don’t move into rest & digest(parasympathetic) throughout the day your digestion will be altered.

Fourth, Medications or Supplements

Of course, many of you are full aware of the constipating effects of iron.  Certain forms are more constipating than others. Working with a dietitian can help you choose a less constipating iron that won’t cause constipation.  Calcium supplements are also known to cause constipation in some individuals.  Increasing your dose slowly may help prevent this.

In the same way, certain medications can cause motility issues as well.  These include narcotic pain meds, antacids and some antidepressants.  Talk with your prescribing provider.  Switching a medication to one that isn’t constipating may do the trick.

Fifth, Malabsorption

Bile acid malabsorption is something we can’t dismiss as a potential cause.  Compelling evidence is showing bile acids shift after gastric sleeve and gastric bypass surgeries.   Bile acid malabsorption can be tricky.  It has only been recent that research is showing the connection with constipation.  Traditionally diarrhea was believed to be a symptom of bile acid malabsorption.  The key is focusing on bile flow.  There are several nutrition tricks that can improve bile flow.   At no surprise, working with a dietitian my help.

Sixth, Deficiencies

Finally, deficiencies are our last to consider as a contributor of constipation.   Deficiencies in nutrients such as…

• magnesium
• vitamin D
• vitamin B1, thiamin
• vitamin B12

In the same fashion, having a low level of vitamin A, iron or zinc will impact your thyroid level.  Given these points, your thyroid will not function optimally.  Therefore, impacting motility.

In conclusion, constipation is complex.  It’s unlikely that just one area will solve the issue.  Typically considering a few of these can help move you beyond fiber, fluids and movement.

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