Post-Surgery Probiotic Use for Constipation Relief in Seniors

Issues with taking probiotics after colon surgery?

Hello Doctor,
I would like to explain my grandfather's situation.
He is 83 years old.
In early July, he experienced difficulty with bowel movements.
After seeing a doctor, he was diagnosed with "C187 malignant tumor of the sigmoid colon." He later underwent surgery for tumor removal and did not require chemotherapy.
After returning home to recover, he experienced constipation several times.
During a follow-up visit, he informed the doctor, who then prescribed additional laxatives (magnesium oxide tablets and Bisacodyl) and stool softeners (Docusate sodium).

Regarding his diet, initially, he had three meals of plain rice porridge with vegetables, meat, and eggs, and he would eat papaya in the afternoon.
He took stool softeners (4 magnesium oxide tablets and 2 Bisacodyl tablets) after breakfast and dinner, as well as before bedtime.
The doctor mentioned that my grandfather's intestines were dry and advised him to drink more water, which he has been doing regularly.
However, despite this diet, medication, and hydration, he still faced irregular bowel movements, sometimes experiencing constipation every other day, requiring laxatives for relief.

After taking the laxatives, his initial bowel movements were hard and pellet-like (requiring effort to pass), followed by softer, tubular stools, and finally, more formed stools.
I then attempted to improve his diet by having him eat savory porridge (with cabbage, carrots, sweet potatoes, minced meat, and small fish) for all three meals, while continuing with the stool softeners (4 magnesium oxide tablets and 2 Bisacodyl tablets), along with papaya and water.
As a result, he began to have the urge to defecate around 4 or 5 AM the next day, with minimal effort required, and his stools were of normal shape.
Currently, my grandfather has follow-up appointments every three months.

In the past week, he has also been having bowel movements in the early morning, with infrequent constipation.
However, he mentioned that sometimes while sleeping, he suddenly feels a strong urge to go, almost not making it to the bathroom.
Additionally, he has experienced multiple bowel movements between 6 and 7 AM, even after having already gone around 4 or 5 AM (mostly soft tubular stools that do not break apart in water, followed by thicker stools that do break apart).
To note, my grandfather does not experience abdominal pain, nor does he have any pain during bowel movements, and he is otherwise pain-free.
I believe that his current regularity in bowel movements is due to the "medications," and I am concerned that his intestines may become too reliant on them.
I worry that stopping the stool softeners suddenly could lead to constipation again, and I am unsure how to proceed.
(I have researched Bisacodyl and found that it contains "Sennosides," which are similar to stimulant laxatives and are not recommended for long-term use.) I am considering introducing probiotics to enhance gut flora and potentially reduce the need for stool softeners.

I have a few questions for you, Doctor:
1.
When starting probiotics, how should he take the stool softeners? Should the dosage remain the same or be reduced? (Currently, he takes 2 magnesium oxide tablets after breakfast and dinner, and 2 Bisacodyl tablets before bedtime.) I am concerned that if he continues with the same dosage of stool softeners while starting probiotics, it might lead to more urgent bowel movements resembling diarrhea.
Conversely, if the probiotics do not work and he stops the stool softeners, could he become constipated again?
2.
Do stool softeners or laxatives reduce the beneficial bacteria in the gut?
3.
The doctor mentioned that my grandfather's intestines are dry and lacking moisture.
Besides drinking more water and eating fruits and vegetables, can probiotics also help improve intestinal dryness?
4.
I found a probiotic product called "Taiwan Sugar Oligosaccharide Lactic Acid Bacteria" that I would like to try.
However, I am unsure if it is suitable for someone like my grandfather who has had intestinal surgery.
(Here are the ingredient details: "Taiwan Sugar Oligosaccharide Lactic Acid Bacteria" - Ingredients: Oligofructose powder, active lactic acid bacteria powder (maltodextrin, anhydrous glucose, Bacillus coagulans (Lactobacillus sporogenes), Lactobacillus acidophilus), indigestible maltodextrin (water-soluble cellulose), DL-malic acid, kumquat flavor powder (flavor, lactose, silicon dioxide).
Health benefit ingredient content: Oligofructose (1-Kestose + Nystose total): 36±5% (w/w), active lactic acid bacteria: ≥2×10^8 cfu/g.
Recommended intake: 2 packets (6 grams) daily, which can be taken in 1 or 2 doses after meals with warm water.)
Thank you, Doctor!

N, 20~29 year old female. Ask Date: 2020/11/11

Dr. Ke Fangxu reply Surgery

1.
Theoretically, probiotics and laxatives should not have an impact on each other, and adjustments can be made based on bowel movement status.

2.
Products that contain chicory may even enhance the effects of intestinal probiotics.

3.

4.
It should be possible.

Reply Date: 2020/11/11

More Info

Post-surgery constipation is a common issue, especially in seniors like your grandfather, who is 83 years old and has undergone surgery for a malignant tumor in the sigmoid colon. After surgery, many patients experience changes in bowel habits due to factors such as reduced mobility, changes in diet, and the use of medications like opioids or laxatives. In your grandfather's case, it seems that he has been managing his constipation with a combination of softeners and laxatives, but you are right to be concerned about the long-term reliance on these medications.

1. Probiotic Use and Softener Dosage: When introducing probiotics, it is generally advisable to maintain the current dosage of softeners initially. Probiotics can take time to establish a beneficial effect in the gut, and during this period, your grandfather may still need the softeners to ensure regular bowel movements. You could consider gradually reducing the softener dosage once you observe consistent improvements in his bowel habits. However, it is crucial to monitor his response closely. If he experiences increased urgency or loose stools, it may be wise to revert to the previous dosage until his gut flora stabilizes.

2. Impact of Laxatives on Gut Flora: Long-term use of laxatives, particularly stimulant laxatives, can potentially alter the gut microbiome. While osmotic laxatives like magnesium oxide are generally considered gentler on the gut flora, any laxative use can lead to dependency, where the bowel becomes less responsive without the stimulant. This is why it is essential to use these medications judiciously and explore alternatives like dietary changes and probiotics.

3. Improving Dryness in the Gut: Your grandfather's doctor has indicated that he has a "dry" gut, which can be exacerbated by insufficient fluid intake and dietary fiber. In addition to increasing water and fiber intake through fruits and vegetables, probiotics can help improve gut health by enhancing the gut microbiome, which may, in turn, improve bowel regularity and hydration in the intestines. Probiotics can help in fermenting dietary fibers, producing short-chain fatty acids that can improve gut motility and hydration.

4. Safety of Probiotics Post-Surgery: The probiotic you mentioned, "台糖寡糖乳酸菌," appears to contain beneficial strains like Lactobacillus acidophilus and Bacillus coagulans, which are generally safe for most individuals, including those who have undergone gastrointestinal surgery. However, it is always best to consult with your grandfather's healthcare provider before starting any new supplement, especially given his recent surgery and current medications. They can provide personalized advice based on his overall health status and any potential interactions with his current treatment regimen.

In summary, while probiotics may offer a beneficial addition to your grandfather's regimen to help manage constipation, it is essential to approach this change thoughtfully. Maintain the current softener dosage initially, monitor his response, and consult with his healthcare provider for tailored advice. Additionally, continue to encourage a diet rich in fiber and adequate hydration to support his digestive health.

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