These Narcotics are making me Constipated

You betcha! Here is the problem. Even the most stoic patient will need some narcotics post-op, either taken orally or by injection. All narcotics cause the bowel movements (peristalsis) to slow down and this is what causes constipation and bloating. Even if you took only Tylenol post-op, completely avoiding narcotics, you still are relatively sedentary and your diet is not back to normal. All these factors can make your bowels go into low gear.

After pain control, post-operative patients’ second biggest problem is constipation. My advice is first “know thy bowels.” If you are routinely constipated for whatever reason pre-op, it is imperative that you have an efficient bowel prep several days before you enter the OR. If you are taking lots of narcotics to control your painful joint, then you likely have constipation. Your family doctor can advise you, however, I have found that the use of an over-the-counter product called Miralax, taken several days and the day before the surgery, can be helpful to get you ready for your operation. Colace twice daily for 5 days is another great over-the-counter medication to help soften your stools. Also, you should drinks lots of water. At the Hospital for Special Surgery, where I had my hip replacement surgery, I was told to use a Fleets enema the night before my big day. I just couldn’t do it! If you have regular bowel habits, this pre-op bowel prep with Miralax is not for you. Using the Colace and drinking lots of water is still a good idea for all patients. You should not take Metamucil.

Eat lightly the day before your surgery. You should NOT gorge yourself. Drink lots of water. Do not eat anything after midnight. You may drink some water with your meds the morning of surgery. Do not drink anything when you arrive at the hospital. The night of surgery, you will get Colace and a gentle laxative, Senna. Unless you have loose stools, the Senna tablets will continue throughout your admission. If you have difficulty with constipation post-op, Miralax can always be added to your regimen of care. Adding bran and prunes to your post-op diet will also help.

Although this issue of constipation may appear less important (and less glamorous) to you as you prepare for your surgery, please allow me to suggest that it is of the upmost importance in making your admission comfortable. Another piece of advice: take only the narcotics you need to make you comfortable. Fewer narcotics, less constipation! Consider this point: a large ice pack may help with your pain and will not cause constipation!


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