How to prevent constipation after BMX surgery?
Hi, I'm having a bilateral mastectomy in a couple of weeks. I had two lumpectomies already, and the antibiotics and anesthesia drugs used during surgeries were really hard on my colon . I suffer from IBS and very painful hemorrhoids. I'm on veggie diet with addition of some cooked meat and probiotics (no sugars, cannot eat sweet fruit (yeast infection) , no grains). It's hard for me to sustain any balance even without surgeries. I'm dreading the upcoming one. I'm absolutely terrified of the prospect of possible chemo should they find some invasive cancer after pathology. No imaging technique predicted the extensive DCIS, and MRI did not rule out the invasive cancer in my case. Proctologist suggested stool softeners after the surgery and milk of magnesia or miralax. He communicated through the nurse, who mixed up what stimulant I should use, and, I suspect, just made up certain recommendations. My surgeon prescribed bisacodyl after lumpectomies, which I did not use, because my problem is the impaction (I think). Sorry for such an unpleasant topic, but I would really appreciate a suggestion on what to do before the surgery so I can prevent what will happen after it .
Comments
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senokot with stool softener is amazing stuff. Maybe take it the morning of surgery but then make sure it's added afterward, should help a lot... Also try to stay as hydrated as possible
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Hi dragonsnake:
I would not take anything like senokot the morning of surgery, unless you have already taken it before and know exactly how you will react to it, because it does not agree with some people. In addition, it goes without saying, please be sure to clear any and all drugs (over the counter or prescription) to be used or taken prior to surgery with your surgical team, to ensure no contraindication or drug interaction.
For post-surgical use, Colace (a stool-softener only) was prescribed to me (although it is sold over-the-counter). Hydration is very important. Members here recommended taking such meds after surgery, but in a preventative manner (after surgery, but before a problem develops), which I did once I got home the next day. I have since found that prune juice (6 oz) is quite effective.
BarredOwl
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Thank you. Do you think some specific diet or bowel prep will work? Sometimes I have 2 bowel movements a day, and still have hard rocks plugging the exit. Sorry for these disgusting details, but my proctologist just says "take care of your bowels" and my GI - "just take fiber". I did not go to GI after he called me in just to yell at me saying that I should not bother him with my hemorrhoids, and just should take fiber.
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I took colace and senakot prescribed by my doc after BMX, but I also ate foods with baked beets and eggplant and drank prune juice. Also drank plenty of water. All of these help with constipation. In fact, I did not take drugs very long because the diet helped. I also ate mostly vegetable soups and sautéed veggies, which I believe helped. And moving around as best as you can helps too
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I bought all kinds of natural and otc stuff and found in the end, prunes worked the best. GL
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Coconut oil seems to help some people.
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I ate all-vegetable diet and three servings of beets with prunes a day before surgery, but it did not help much. The suffering next day was comparable to childbirth, and I do not have good memories of my kid being born: I was torn so badly, that a doctor could not figure out how to anatomically correctly repair all the damage (all organ that you can think of down there were torn, too gruesome to describe). I did not want any kids after that experience, and never had them. What also contributed to this decision is my horrific experience of breast feeding: milk got stuck in the breasts. I was running high fever for the first half year. Doctors said to drink less fluids so I would produce less milk, massage breasts, and manually pump milk, otherwise they threatened to cut my breasts open to remove hard lumps. Actually, I think my BC is partially caused by the injury to my milk ducts caused by these vigorous massages that I had to do two times a day for more than half a year. This was more than 25 years ago (in a country that ceased to exist), but I avoided touching my breasts afterwards, they were very painful for 2 weeks each monthly cycle. I'm sorry for venting, I'm just scared of what future hold for me, and I have no confidence in medical community after what they did to me then and over the next decades. I understand that to treat BC I have to go to them, there is no choice, but more often than not I just want to quit.
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Hi dragonsnake:
Paradoxically, sharp increases in fiber intake can cause constipation. Thus, when increased fiber is indicated, it is recommended to slowly increase fiber intake. If you already have good fiber intake now, with only two weeks to go to surgery, (unless advised otherwise by your providers) I would not try to make any big changes in diet, but carefully maintain current good intake, avoid constipating foods (e.g., cheese, bread), hydrate, and avoid salty food.
BarredOwl
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I was trying to strike a balance within the last three years. I thought I did, but the surgeries knocked me out of it big time. I can feel the big shift in digestion patterns practically overnight, after the second one: I could not eat too much raw vegetables before, and, suddenly, I can, without major gas or discomfort. I did a test for gut flora before, and it showed some overgrows of not very pathogenic bacteria. It seems like antibiotics killed this species, and some more, and now I cannot manage . I calculated that I eat the average of 40 g of fiber from veggies and flax seed per day. I also drink more than a gallon of water in a hope to help. I'm running out of ideas.
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Check out this long running thread on constipation. There's bound to be suggestions to help you through it.
https://community.breastcancer.org/forum/6/topics/...
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Thank you all. I guess I have to accept yeast infection as a lesser evil, and load up on beets, fruit, and prunes with some stool softener (?). I guess a stimulant laxative (like senna or bisacodyl ) can be taken as needed. What is your experience with milk of magnesia (magnesium hydroxide) and miralax (polyethylene glycol)? I think these laxative draws water into intestines and colon, respectively, but I may be wrong. I never tried them, I also never tried stool softeners either. What about mineral oil? Thank you again for helping me out.
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dragonsnake, I would definitely recommend stool softeners like Colace. Start with 1 cap twice a day and see if that helps. Eating prunes tend to keep me regular, and after surgery, I found prune juice really got things moving for me. Yes, you could use a stimulant laxative but if you have hard, difficult to pass stools, then it may hurt, so that's why I think a stool softener should be added to your regimen.
Do check out the thread linked above about constipation. Lots of input there.
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My brother-in-law is a gastroenterologist and he recommends Miralax for surgically induced constipation. I tend to have the opposite problem, so can't advise other than to say there is a bunch of good advice on the linked thread in exbrnxgrl's post.
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I am 11 days out of my surgery (PBX) and in the end it was a combo that worked. I religiously took the colace they gave me but by day 5, still nothing. I added Miralax and did have a BM but it was really uncomfortable- so I also added in "Calm" this sort of fizzy drink that you mix from a powder. It's magnesium and I drank it right before bed, woke up and had a much easier BM. I'm drinking prune juice now, still on the colace and miralax with occasional Calm powder also. It's been a hard time getting things moving again but it seems to be resolving a bit. I am still taking pain meds though so I intend to keep on the extras until I'm certain I won't back up again. Good luck to you!! :
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I'm responding now to my own question. I'm 6 days post-op BMX now. This is what I did to prevent post-op constipation. I started taking stool softener 4 days before surgery: first one dose, then two. I went on a diet consisting of boiled chicken, chicken broth, and boiled vegetables (cabbage soup ) two days before surgery. One day before surgery I was on a liquid diet (fresh apple+carrot juice, broth, vegetable broth, water) and one dose of stool softener. No food or drinks 12 hours before surgery. Vegetable soup, pureed apples and carrots at the end of the day after the surgery + stool softener with food. Resumed my diet of fresh vegetable salads, vegetable soups, chicken soups and broth afterwards, took two doses of stool softener a day and Jarrow's Gentle fiber.. Had a bowel movement the day after the surgery, and then every day so far, but I still take one dose of stool softener a day. A cup of freshly brewed diluted warm coffee helped to initiate a bowel movement for me. Magnesium citrate (the "Calm" drink) also worked once, but not as good. I also have taken two doses of probiotics every day, had some fruit, seeds, coconut butter, boiled and shredded beets every day after the surgery. I did not take any opioids after the surgery, only extra strength Tylenol, so far.
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