Bowel Problems After Orthopedic Surgery

• Surgery
• Anesthesia
• Opiate pain medications (e.g., morphine, Dilaudid, oxycodone, codeine and hydrocodone)
• Anti-nausea medications
• Not being physically active, being in bed

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.

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.

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.

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)

• 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.

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.

• Senna, Senna S, Ducosate or Colace should be used to keep your child’s stool from getting too firm, and until they have somewhat normal bowel movements (sometimes it may take up to 2 weeks).
• Drink plenty of fluids to avoid dryness of the stool.
• Fruits and vegetables have fiber that helps soften stool.
• 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 watery and looser.

• Give your child Senna or Ducosate tablets or in liquid form, 1 or 2 doses a day as needed.
• Encourage your child to become more physically active by going for a walk a few times a day or more.
• Have your child drink plenty of fluids.
• Cut back on your child’s opiate pain medicine as fast as possible.
• Have your child drink a warm, caffeinated, sweet or fatty drink in the morning, like cocoa, mocha, or coffee.

If this is not working, you can add things progressively including:

• Bisacodyl suppository
• Bisacodyl tablets
• Miralax
• Enema

Call the Orthopedics Clinic at 206-987-2109 (extension 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.