Is it normal to have a sluggish bowel after surgery?

Question

Hi doctor,

I had CABG three weeks ago. At that time, I had Ileus and did not have a bowel movement for two days. I was incredibly distended, and now, three weeks later, I am having multiple bowel movements a day using Exlax (Sennosides). But I am still very bloated and only passing gas a few times a day. My stomach is making sounds, though. As well I failed a Sitz marker study a few months ago, showing that I have a motility disorder, but before the surgery, it was manageable. Still, after the surgery, it was very uncomfortable. It improves after a bowel movement and worsens after I eat. My gastro had prescribed Linzess, which I will start next morning. Should I be worried? Is it normal to have a very sluggish bowel after surgery? I am still retaining fluids in my lower legs to a slight degree.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

It would be tough for you to have undergone such major surgery and now have gas and abdomen issues. After close evaluation, it seems that you are taking at least four medicines for your heart problem, which tend to cause constipation. Namely, metoprolol, amlodipine, and isosorbide mononitrate. They are all cardiac muscles and smooth muscle relaxants. The later action causes a slowing of the large bowel and possibly worsens your constipation. Since you already have slow bowel transit, as you said (on the site marker test), it is not uncommon to have worsening constipation following the use of the above medications. The gas bloating is secondary to constipation. I could not suggest stopping or modifying the regimen of your current medicines since your cardiologist prescribes and they must be essential. Please discuss the medication and the worsening of your constipation issues. Secondly, I am going to give you some drugs that would improve your gut motility and improve your gas issues. I suggest taking a tablet of Motilium (Domperidone) 10 mg twice daily before meals, Miralax (Polyethylene Glycol) sachet, two sachets twice daily with a glass of water, Ispagula, two tablespoons full with water or commercially available as a sachet, and Rifaximin 200 mg thrice daily for two weeks.

I hope this information will help you.

Thanks.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes, they all seem to be drug side effects, post-op recovery phase from major surgery, and due to compromise of mobility in the perioperative area. Linzess (Linaclotide) is a suitable medication for slow transit constipation, which will also improve your bowel movements and, secondarily, help improve your gas. If you have diarrhea, then you can skip taking Linzess. Otherwise, Miralax (Polyethylene Glycol) and Linzess can continue together.

I hope this information will help you.

Thanks.