Post-Surgery Gas Issues After Diverticulitis: Seeking Solutions for Slow Bowel Movement

Q: Post-Surgery Gas Issues After Diverticulitis: Seeking Solutions for Slow Bowel Movement

Hello： Your father is likely still hospitalized. <br>It is advisable to consult with the attending physician or physician assistants/nursing staff during rounds. <br>Continuing physical activity is essential, as recovery can sometimes be slower for elderly patients. <br>Additiona

Postoperative gas expulsion after diverticulitis surgery?

Hello, doctor.
My father is 68 years old.
Last week, he underwent surgery for diverticulitis.
The surgery lasted two hours and went smoothly.
However, it has been about a week since the surgery, and he has not been able to pass gas.
During this time, he has experienced some abdominal bloating and pain.
X-rays and imaging show that his colon motility is very slow.
He has been diligent about walking, but it has not helped.
He also used a suppository, which resulted in dark green liquid stool.
From the stool, we know that his entire digestive system is functioning, but it’s as if a four-lane road has been reduced to a single lane.

What can be done to determine why his intestines (both small and large) are not functioning normally after surgery, and how can we improve this situation? He cannot eat or drink until he passes gas, so medication has been ruled out.
He has also tried folk remedies, including acupressure.

Additionally, my father mentioned that his stomach occasionally makes gurgling sounds, but he still has not felt the urge to pass gas.
About four days post-surgery, he experienced slight abdominal bloating and was subsequently scheduled for a nasogastric tube insertion.
Since then, he has been continuously expelling dark green liquid (which the doctor said is gastric fluid) and air.
However, the doctor mentioned that it is not normal for gastric fluid to come out through the nasogastric tube; he should be passing gas and stool through the rectum to stimulate bowel movement.
Thank you for your assistance.

Lin Xiansheng, 30~39 year old female. Ask Date: 2022/04/10

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Your father is likely still hospitalized.
It is advisable to consult with the attending physician or physician assistants/nursing staff during rounds.
Continuing physical activity is essential, as recovery can sometimes be slower for elderly patients.
Additionally, adhesions may not be localized to a single area, or there may be bowel wall edema, which requires time to resolve.
Suctioning the nasogastric tube for excess fluid or air can help relieve pressure and increase the space within the abdomen for the intestines.
There have been cases where a second or third surgery was necessary to fully resolve the issue, as adhesions can occur in multiple locations.
There is no need to worry too much at this stage; please continue to consult with the clinical physicians.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun

Reply Date: 2022/04/10

More Info

Post-surgery gas issues, particularly after a procedure for diverticulitis, can be quite challenging and distressing for both the patient and their family. In your father's case, it seems that he is experiencing significant delays in bowel movement and gas passage, which can be attributed to several factors related to the surgery and the body's healing process.

After surgery, especially abdominal surgery, it is common for patients to experience a temporary slowdown in bowel function, known as postoperative ileus. This condition can occur due to several reasons, including the effects of anesthesia, manipulation of the intestines during surgery, and the body's natural response to trauma. The intestines may take time to "wake up" and resume normal peristalsis, which is the wave-like muscle contractions that move food through the digestive tract.

In your father's case, the fact that he has not been able to pass gas for a week is concerning, and it is essential to address this issue promptly. Here are some potential solutions and considerations:
1. Physical Activity: While you mentioned that your father has been walking, it is crucial to encourage him to continue this activity as much as possible. Gentle movement can stimulate bowel activity and help alleviate gas buildup.

2. Nutritional Support: Although he cannot eat or drink until he passes gas, once he is cleared to do so, a diet high in fiber can help promote bowel movements. Foods such as fruits, vegetables, and whole grains can be beneficial. However, this should only be introduced once he is able to pass gas.

3. Medications: While you mentioned that medications have been ruled out, it may be worth discussing with the healthcare team the possibility of using prokinetic agents, which can help stimulate bowel motility. These medications can encourage the intestines to move more effectively.

4. Nasal Gastric Tube: The use of a nasogastric (NG) tube is often a temporary measure to relieve pressure in the stomach and intestines. It is essential to monitor the output from the NG tube and communicate any changes to the healthcare team. If the output is primarily green liquid, it indicates that gastric secretions are still being produced, which is a normal response.

5. Monitoring for Complications: It is crucial to keep an eye out for signs of complications such as bowel obstruction or adhesions. If your father experiences severe pain, vomiting, or a significant change in his condition, it is vital to seek immediate medical attention.

6. Consultation with Specialists: If the situation does not improve, it may be beneficial to consult with a gastroenterologist or a surgeon specializing in gastrointestinal issues. They can perform further evaluations, such as imaging studies, to determine if there are any underlying issues contributing to the slow bowel movement.

7. Patience and Support: Recovery from surgery can be a slow process, especially for older adults. Providing emotional support and reassurance can help alleviate some of the stress associated with these symptoms.

In conclusion, postoperative gas issues and slow bowel movement can be complex and multifactorial. It is essential to maintain open communication with your father's healthcare team and advocate for his needs. With time and appropriate interventions, it is likely that his bowel function will improve.

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