Patient and Family Education
Bowel Problems After Orthopedic Surgery After major surgery, many people have a hard time having a normal bowel movement for a few days or even longer. The two most Most people use the term “constipation” for this. Constipation is a important things you condition of the bowels in which the feces are dry and hardened, and having a can do are: bowel movement is difficult and infrequent. • Cut back the amount But, for most people having a hard time the first few days after surgery, the of opiate pain actual cause may be bowel hypo-motility, which is the lack of the normal medicines your child bowel muscle activity that moves the stool through the bowels. takes What causes bowel hypo-motility? • Have your child be more active • Surgery • Anesthesia • Opiate pain medications (e.g., morphine, Dilaudid, oxycodone, codeine and hydrocodone) • Anti-nausea medications Tylenol and anti- • inflammatories are OK Not being physically active, being in bed to use because they do not cause constipation. What is the difference between constipation and bowel hypo-motility? Think of a tube of toothpaste that you squeeze out with your hand. Your hand is the muscle of the intestines. The toothpaste is the stool. Constipation is a condition where the toothpaste becomes dry and hard, making it hard to push out. Bowel hypo-motility is more like your hand becoming so weak that you can’t even push the normal toothpaste out. No matter how watery you make the toothpaste, you can’t squeeze any out. This is what is happening in your child’s intestines during the first few days after surgery. Often after spine surgery, it will be 5 or more days until your child has a fairly normal bowel movement. At some point, your child will have a normal bowel movement, but if their belly gets too full before then, it can cause vomiting and belly pain.
How do I know if my child has constipation or bowel hypo-motility? • If your child is constipated, they will feel full, but when there is an urge to have a bowel movement (BM) and they push, it won’t come out or it is really hard to get out. If a suppository is placed in the rectum, the person placing the suppository will feel stool that is firm and formed. In later stages, you can get cramping and belly pain. People usually hear their stomach making noises and pass some gas out of their bottom.
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Bowel Problems After Orthopedic Surgery
• If your child has bowel hypo-motility, they will not feel or hear their stomach gurgling, they will pass very little or no gas from the bottom, and they will not have an urge to have a BM. They may start feeling bloated. The symptoms will get worse and your child will feel more uncomfortable as time goes on. Unlike constipation, if a suppository is put in the rectum, the person placing the suppository will usually not feel any stool at all.
What are our options? There are two main ways to deal with bowel movement problems after surgery: 1. Make the intestines pump again (directly affecting the bowel hypo-motility) 2. Make the stool softer (this doesn’t work well if the bowel can’t pump)
What can we do to stimulate muscle activity for a bowel movement? • Cut back on your child’s opiate pain medications as much as possible (oxycodone, Dilaudid, codeine or Vicodin). These medications usually cause nausea, and so anti-nausea medications that also cause bowel hypo- motility may be cut back or completely stopped. • Walk more. When your child rests in bed too much, their intestines tend to rest, too. • Warm, caffeinated, sugary or fatty drinks in the morning such as cocoa, coffee or mochas can help start a BM.
What medications can my child take? There are a few options for medications you can give your child to help with their bowel problems. Check with your child’s healthcare provider first before giving any type of medicine to your child. • Senna-S helps soften stool but also stimulates the bowel to move. • Ducosate/Colace are stool softeners that make the stool softer but not watery. • Bisacodyl tablets taken by mouth help get the intestines pumping but may cause cramping. They are 5 mg over-the-counter pills and are also available in liquid form. 5 or 10 mg for teenagers or adults is usually effective. • A Bisacodyl suppository stimulates the colon and rectum to have a BM. They work “from the bottom” so they cause less cramping in the intestine above. • Enema (Fleet’s Enema is sold over the counter) will stimulate the rectum to have a BM (it also loosens and lubricates hard stool). • Miralax or Glycolax are available in liquid or pill form and are taken by mouth. They fill the bowel with more water. This makes the stool looser so it is easier to have a BM, but it does not really stimulate the muscles that make the bowel move. If the bowels are not moving yet, it causes swelling of the bowel and can make your child more uncomfortable.
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Bowel Problems After Orthopedic Surgery
What can be done to make my child’s stool softer? To Learn More • Senna, Senna S, Ducosate or Colace should be used to keep your child’s • Orthopedics Clinic stool from getting too firm, and until they have somewhat normal bowel 206-987-2109 movements (sometimes it may take up to 2 weeks). • Ask your child’s • Drink plenty of fluids to avoid dryness of the stool. healthcare provider • Fruits and vegetables have fiber that helps soften stool. • www.seattlechildrens.org • Citracel or Metamucil also help soften the stool. They are mixed with water and simulate the fiber in fruits and vegetables. • Miralax makes the stool more watery and loose.
Free Interpreter Where should I start? Services • Give your child Senna or Ducosate tablets or in liquid form, 1 or 2 doses a • In the hospital, ask day as needed. your child’s nurse. • Encourage your child to become more physically active by going for a walk • From outside the a few times a day or more. hospital, call the • Have your child drink plenty of fluids. toll-free Family • Cut back on your child’s opiate pain medicine as fast as possible. Interpreting Line • Have your child drink a warm, caffeinated, sweet or fatty drink in the 1-866-583-1527. Tell morning, like cocoa, mocha, or coffee. the interpreter the name or extension What should I do if my child still has not had a BM? you need. If this is not working, you can add things progressively including: • Bisacodyl suppository • Bisacodyl tablets • Miralax • Enema
When should I call the doctor? Call the Orthopedics Clinic at 206-987-2109 (ext. 4) if you need more help getting your child’s bowel moving again. This can almost always be done at home without having to come back to the hospital.
Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the Family Resource Center at 206-987-2201. 7/18 This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s needs are unique. Before you act PE2857 or rely upon this information, please talk with your child’s healthcare provider. © 2018 Seattle Children’s, Seattle, Washington. All rights reserved. Orthopedics 3 of 3