There are bound to be some changes to your bowel pattern after weight loss surgery. With a smaller intake of foods and fluids, which may move more quickly or more slowly through your digestive system, you’ll have to find a new normal for your body. Although you may have periods of constipation or diarrhea, you shouldn’t accept that as normal. Making a few alterations in your diet can help you become regular.

As with any medical condition, consult with your doctor before beginning any treatment.

Diarrhea

Your post-bariatric-surgery body may tolerate foods and beverages very differently than before. If diarrhea is severe or lasts more than two days, contact your surgeon’s office. Dehydration can develop quickly.

What causes diarrhea and what can you do about it? 

• Lactose, the sugar found in milk and to a lesser degree in other dairy products, is a common cause of diarrhea after weight loss surgery. If you suspect lactose intolerance, avoid dairy for 3 days. If your symptoms (gas, bloating, and/or diarrhea) resolve, lactose may be the cause. Slowly add dairy products with a lower lactose content back into your diet (yogurt, cottage cheese, cheese, and some protein drinks) and switch to lactose-free milk.
• High-fat foods can rapidly move down your digestive system, not allowing time for fluids to be reabsorbed. If the stool is light in color, floats on the top of the water, and looks oily—look at the fat content of the foods you are eating.
• Added sugars can cause dumping syndrome, mostly for those who had gastric bypass surgery. The symptoms of dumping syndrome can vary, but basically, you feel like you have the flu. You may be light-headed, dizzy, very tired, nauseated, weak, have muscle aches, and may or may not have diarrhea. Keep your intake of added sugars to 2 grams or fewer per serving to prevent dumping syndrome.
• Sugar alcohols are used to sweeten no-added-sugar or sugar-free products. Sugar alcohols don’t impact your blood sugar or insulin levels like added sugars do. They are lower in calories and don’t cause tooth decay. The only downside is that if you consume too much, they can cause gas, bloating and diarrhea. Individual tolerance varies, but most people can tolerate about 7 grams of sugar alcohol per day without the downside. Sugar alcohol is listed separately on the Nutrition Facts label. You can also find them in the ingredient list: maltitol, hydrogenated starch hydrolysates, isomalt, lactitol, mannitol, sorbitol, xylitol, and erythritol. Erythritol is the exception and typically does not cause gastric side effects even if consumed in large amounts. It tastes good and works well in baked products. You can purchase it online in granulated and powdered form.
• Drastic changes in dietary fiber can lead to either constipation or diarrhea. Gradually make changes to your intake of fiber-rich foods or fiber supplements. 

Probiotics may help.

You may want to consider a probiotic supplement to help increase the number of “good” bacteria in your large intestine. This can reduce diarrhea and constipation.  Look for a product with 2 billion or more live cultures. Yogurt and kefir are good sources of dietary probiotics as well.

If you need some extra help:

It’s important to stop diarrhea before it leads to dehydration. Sometimes a medication will be needed to do that. You don’t want to rely on medications, which treat the symptoms, long-term, but make changes to your diet that will eliminate the cause of diarrhea. Imodium is a good medication to start with. Check with your surgeon’s office for alternatives if this is not effective. Note that Pepto-Bismol, a common anti-diarrhea medication contains an aspirin-like compound and should not be taken after weight loss surgery.

Stay in contact with your surgeon’s office.

Diarrhea or constipation can signal other non-food related issues. Keep in contact with your primary care physician and surgeon’s office if you are not able to achieve regularity on your own.

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Be Regular

There are bound to be some changes to your bowel pattern after weight loss surgery. With a smaller intake of foods and fluids, which may move more quickly or more slowly through your digestive system, you’ll have to find a new normal for your body. Although you may have periods of constipation or diarrhea, you shouldn’t accept that as normal. Making a few alterations in your diet can help you become regular.

As with any medical condition, consult with your doctor before beginning any treatment.

Constipation

Both the frequency and size of bowel movements may decrease after surgery—this is normal. Difficulty emptying the bowels, often combined with abdominal discomfort, or having fewer than 3 bowel movements a week indicates constipation.

Why is constipation common right after weight loss surgery?

Many factors work together for smooth digestion and elimination. Your body goes through many changes right after surgery, creating a situation where constipation is more likely. Here are a few factors that impact your ability to be regular.

• Anesthesia stops the contractions in your intestine that keeps things moving along. It may take a day or two for those contractions to start back up.
• Pain medications slow the transit through the digestive system and can reduce the urge to go.
• Fluid intake is typically decreased after surgery, resulting in a smaller, harder stool that is more difficult to pass.
• Food volume is limited after surgery and with the focus on protein; fewer fiber-rich foods are consumed, resulting in a smaller stool.
• Activity is typically limited, slowing the movement through your digestive system.
• Iron supplements, if needed, commonly constipate. Calcium supplements can cause constipation in some individuals.

What can you do?

It seems that the odds are stacked against your bowels in the beginning. Here’s what you can do to get things back to normal as soon as possible:

• Drink as much fluid as you are able. Remember to sip slowly all throughout the day. Keep a drink with you at all times. Try different temperatures to see what goes down easiest for you. Sometimes popsicles, fudgesicles and slushies work well. You can let them melt in your mouth. You may be able to drink more room temperature or warm liquids. Be sure to monitor your fluid intake so you know if you’re shorting yourself or not—you’re shooting for at least 64 oz of any type of fluid a day.
• A cup of hot water with lemon, no-added-sugar hot cocoa, decaf coffee (caffeine is fine once you’re drinking 64 oz of fluid a day), or herbal tea may help stimulate your system.
• Try a probiotic. A good one to start with is Nature’s Bounty Advanced or Ultra Strength Probiotic 10.
• Slowly increase the amount of fiber in your diet.
  • Eat beans—think black beans, chickpeas, pinto beans, navy beans, kidney beans and white beans. Just ¼ cup provides 4 grams of fiber and 4 grams of protein (mash or blend for the pureed stage).
  • Add 1 Tbsp of flaxseed to your yogurt or smoothie for 3.3 grams of fiber.
  • Mix together ¼ cup applesauce with 1 Tbsp of wheat bran (look in the baking aisle), and 2 Tbsp prune juice—really, it works.
  • Starting with the soft food stage, you can add in cooked veggies and soft canned fruits (packed in water or juice—not syrup). Once on regular foods, fresh veggies should be right behind high-protein foods on your priority list—then add in a little fresh fruit and whole grain.
  • Add veggies and fruits to your protein smoothies.
• Add small amounts of healthy fat to your diet. The initial diet is almost fat-free. You don’t want to overdo it, but small amounts of fat may help. Think:
  • Avocado–mash it for the pureed stage.
  • Coconut oil—add a teaspoon to your protein smoothie.
  • Olive oil—use when preparing foods.
  • Peanut butter and other nut butters.
• Position yourself properly. Place your feet on a small footstool in front of the toilet so your body is in a squatting position instead of in a seated position. This position aligns your body for an easier go. If you’d like to purchase a stool designed just for this purpose, look for the Squatty Potty.
• Don’t put it off. If you feel the need to go, give yourself adequate time in a private location so you don’t feel rushed or embarrassed.
• Walk, walk, and then walk some more. Short frequent walks often work best right after surgery, but you’ll want to build your endurance and increase the amount of time you can walk at one time.
• Unless otherwise instructed, wait to take iron and calcium supplements until 6 weeks post-op.

If all else fails and you need a little extra help:

After 3 days without a bowel movement, take:

• 2 Senokot and 2 Colace tablets at bedtime. This should produce a bowel movement the following morning.
• If not and if there is no bowel movement in the next 3 days, take 2 Senokot and 2 Colace tablets in the morning and also at bedtime. You can add 1 ounce of Milk of Magnesia at bedtime.
• Consider a Dulcolax or glycerin suppository, or fleets enema after 5-6 days without a bowel movement.

Be sure to contact your surgeon’s office if you are not successful with these efforts. You do not want to take laxatives on a regular basis; your body will come to depend on them. Other things to consider:

• Many patients swear by a cup of Smooth Move tea in the evening.
• Avoid adding fiber supplements in the first 4 weeks after surgery unless you are able to consistently drink 64 ounces of fluid. Taking fiber supplements without adequate fluid can result in greater constipation, not less. Be sure to slowly add in fiber.

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