Constipation & bacterial overgrowth after gastric sleeve & bypass

Having constipation after gastric sleeve & bypass surgery? Do you wonder why? 

In this episode, we discuss small intestinal bacterial overgrowth(SIBO) the main reason behind constipation after gastric bypass and gastric sleeve surgeries. 

Is SIBO the main reason behind constipation? Sounds like something new? Let’s uncover SIBO and how gastric sleeve & bypass constipation sufferers relate to SIBO.

First, What is bacterial overgrowth or SIBO?

SIBO is small intestinal bacterial overgrowth, and it’s where the bacteria is in the wrong location.  In fact, the majority of our bacteria should be in our colon.

Second, Risk factors for SIBO

Sometimes, based on certain things that happen in life such as 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.

Third, 3 types of SIBO

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

• Hydrogen
• Hydrogen-sulfide
• Methane

Fourth, Intestinal methanogen overgrowth 

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.   Actually, Intestinal Methanogen Overgrowth(IMO) was more fitting 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, labeling it as a methanogen overgrowth instead of bacterial overgrowth is more accurate. 

 Fifth, What % of bariatric patients get bacterial overgrowth

Bariatric surgery is a risk factor for bacterial overgrowth.  In fact, having multiple abdominal surgeries like hysterectomies, gallbladder removal, appendectomy. Would put you at a higher risk of developing SIBO.

In addition, PPIs are commonly used after bariatric surgery.  In one study, SIBO was detected in 50% of PPIs patients. So, long-term use of PPIs increases your risk of having bacterial overgrowth as well. 

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 86 and 87%. But I would say, in clinical experience, somewhere between 40 and 80% of you experience SIBO. So I think it’s just digging into what you are experiencing and 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. 

Sixth, Symptoms of bacterial overgrowth

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

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

As mentioned, many will experience two or three symptoms.  It’s rare to not experience any. But in my experience, most of you will have at lease one symptom. Some pretty extreme, while others pretty mild. Typically as you already know, constipation is one of the symptoms you will have with this intestinal methanogen overgrowth (IMO). 

Seventh, Consider IMO 

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 dominant constipation type of scenario. 

To sum up, if you are experiencing constipation after gastric bypass or sleeve surgery, SIBO may be the main reason.

Finally, are you struggling with constipation?

There is no reason to suffer with chronic constipation after gastric sleeve & bypass surgery.  Ruling out SIBO is a great place to start.

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