Post-Surgery Bowel Issues: Managing Constipation and Diarrhea in Seniors

Q: Post-Surgery Bowel Issues: Managing Constipation and Diarrhea in Seniors

Hello： 1. Please ask the physician to prescribe a stool softener in advance. 2. It is not recommended to use a water jet directly; instead, it is advised to use a sitz bath or an enema bulb. 3. There may be side effects from the medication; however, be aware o

Postoperative bowel issues?

1.
After administering Irinotecan, it is common to experience constipation due to the preventive medications taken beforehand.
To manage this, consider increasing fluid intake, incorporating high-fiber foods, and using over-the-counter laxatives or stool softeners as needed.
If constipation persists for more than a few days, consult a healthcare provider for further evaluation and treatment options.
2.
If there is a sensation of hard stool being stuck in the rectum, it is important to avoid manual removal, as this can lead to injury or complications.
Instead, consider using a gentle enema or a stool softener to help facilitate bowel movements.
If the problem continues, seek medical advice for appropriate interventions.
3.
Experiencing normal stool consistency at the beginning of a bowel movement followed by diarrhea-like symptoms at the end may indicate a condition known as "overflow diarrhea," which can occur due to fecal impaction or changes in bowel habits from chemotherapy.
It is advisable to discuss these symptoms with a healthcare provider for proper assessment and management.
4.
During the transitional phase of a low-residue diet post-surgery, it is beneficial to focus on hydration, consume easily digestible foods, and gradually introduce fiber as tolerated.
Consulting a dietitian can provide personalized recommendations to alleviate bowel issues.
5.
Regarding the administration of probiotics, it is generally safe to consider them if hemoglobin levels are above 10 g/dL and white blood cell counts are within normal limits.
However, it is best to consult with a healthcare provider before starting any new supplements, especially in the context of ongoing chemotherapy.

MDD, 70~79 year old female. Ask Date: 2020/07/03

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
Please ask the physician to prescribe a stool softener in advance.
2.
It is not recommended to use a water jet directly; instead, it is advised to use a sitz bath or an enema bulb.
3.
There may be side effects from the medication; however, be aware of signs of a Clostridium difficile infection (such as fever, severe diarrhea, blood in stool, etc.).
4.
If the physician only recommends a low-residue diet, you can inform the physician that medication treatment (such as stool softeners and probiotics) can be initiated, along with abdominal massage or light physical activity as permitted by the physician.
5.
White blood cell counts should not be too low; a neutrophil count above 1000 is necessary for basic immune function.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2020/07/03

More Info

Post-surgery bowel issues, particularly in seniors undergoing chemotherapy, can be quite challenging to manage. The situation you described involves a senior who has undergone a rectal resection without a stoma and is currently receiving chemotherapy with Irinotecan and Xeloda. Here’s a comprehensive approach to address the concerns raised:
1. Constipation Management: It is common for patients receiving chemotherapy, particularly with agents like Irinotecan, to experience constipation. This can be exacerbated by preemptive medications given to mitigate side effects. To manage this, it is essential to increase fluid intake, encourage a diet rich in fiber (if appropriate for the low-residue diet), and consider the use of stool softeners or mild laxatives. Over-the-counter options like polyethylene glycol (MiraLAX) or docusate sodium (Colace) can be effective. If constipation persists for more than a few days, it may be necessary to consult with a healthcare provider for further evaluation and possibly prescription medications.

2. Impaction and Manual Removal: The sensation of hard stool being stuck in the rectum can be distressing. While it may be tempting to use water or manual methods to relieve this, these approaches can lead to injury or worsen the situation. Instead, gentle abdominal massage, warm baths, and the use of a glycerin suppository may help soften the stool and facilitate passage. If the situation does not improve, a healthcare professional should be consulted for safe manual disimpaction.

3. Diarrhea and Stool Consistency: The presence of diarrhea at the end of a bowel movement, despite initially normal stool, can indicate a few things. It may suggest that the rectum is not emptying completely, leading to residual liquid stool. This can also be a side effect of chemotherapy. Keeping a diary of bowel movements can help identify patterns and triggers. If diarrhea persists, it may be necessary to adjust the chemotherapy regimen or add medications like loperamide (Imodium) to manage symptoms.

4. Dietary Considerations: During the low-residue diet phase, it is crucial to focus on easily digestible foods that can help regulate bowel movements. Foods like bananas, white rice, applesauce, and toast (the BRAT diet) can be beneficial. Additionally, incorporating soluble fiber sources, such as oatmeal or psyllium husk, can help form stool and ease constipation. Always consult with a dietitian or healthcare provider to tailor dietary recommendations to the individual’s needs and treatment plan.

5. Probiotics and Blood Values: Probiotics can be beneficial for gut health, especially after surgery and during chemotherapy. However, it is essential to ensure that the patient’s hemoglobin and white blood cell (WBC) counts are within safe limits before introducing probiotics. Generally, a hemoglobin level above 10 g/dL and a WBC count above 3,000 cells/mm³ are considered safe thresholds, but these values can vary based on individual health status and treatment protocols. Always consult with the healthcare provider before starting any new supplements.

In summary, managing bowel issues post-surgery in seniors, especially those undergoing chemotherapy, requires a multifaceted approach that includes dietary modifications, appropriate use of medications, and close monitoring of symptoms. Regular follow-ups with healthcare providers are crucial to adjust treatment plans as needed and ensure the patient’s comfort and health.

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