Constipation After C-section: Causes, Easy Treatment

Question: What causes hard stool or constipation after c-section? What home remedies soften stool after surgery?

Having to go through nine months of carrying a baby may be troubling for a lot of women, and most times, it may take some time for you to completely recover from the physical and emotional stress of pregnancy.

While some women may undergo normal vaginal delivery, it may require an extra effort for some women with a possibility of a c-section.

A c-section comes with its risks, and though serious complications do not happen all the time, it is possible for women to have internal bleeding, infection of the abdominal incision, blood clots, and, very rarely, death. Your doctors and midwives will monitor you closely to pick up these problems early. NICE

While these are serious complications, you may only encounter minor issues after your surgery, and constipation after c-section is a very common experience for women. MSD Manuals

First of all, constipation after c-section is not entirely abnormal. This is because, after your surgery, your body undergoes some changes that can slow down the movement of food in your intestine resulting in constipation. It is especially common in the first few days after delivery when you are in pain, tired, and not yet moving around normally. MyHealth Alberta

Having said that, it is important you inform your doctor of any concern you have after your surgery. This is because, sometimes, very severe constipation and inability to pass stool or gas, with worsening pain and vomiting, could be due to a more serious problem like intestinal obstruction or injury to the gut.

During a c-section, an incision is made in your abdomen and uterus, and it is possible to see parts of your intestine during the procedure. If there is trauma to your gut (this is rare), it will possibly stop you from defecating and passing gas and is usually accompanied by worsening abdominal pain, vomiting, fever, and sometimes a swollen, tight abdomen. You should see your doctor urgently if you notice this.

But don’t panic, it’s very unlikely that this will happen, and in most cases, constipation after c-section occurs because of effects of pain medications, anesthesia, dehydration, reduced movement, and also, the prescriptions you have been taking right before and after your surgery. ACOG+1

This article explains the main reasons you have constipation right after or months after your surgery, and how to quickly ease your symptoms and feel okay.

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What causes constipation after c-section?

If you are worried why you have constipation after your surgery, here’s why it happens:

1. Pain medications during and after surgery

During your operation, especially in countries with developed health facilities, epidural or spinal anesthesia is used to make you completely feel no pain during the procedure.

So, after your surgery, you will need pain medications to make you feel calm during your recovery. One group of those medications used are opioids (like morphine, tramadol, codeine-containing tablets), and while they do an excellent job as painkillers, they also have some side effects like dizziness, nausea, sedation, vomiting, and constipation. ACOG+1

Opioids act on your intestines and make the movement of your gut slower than normal. Because of this slow movement, it now takes a longer time to empty your bowel, and so, your body tries to absorb so much water from your stool resulting in constipation.

Many hospitals now use a multimodal pain plan (paracetamol, NSAIDs, local blocks) to reduce how much opioid you need after c-section, partly to reduce constipation and other side effects. ACOG+1

2. Dietary changes before and after surgery

Another reason you could experience constipation right after your surgery is dietary modification around your surgery.

Typically, to prevent regurgitation of food from your stomach or any other complication during your surgery, your doctor will require that you do not take any food (including water) few hours before your surgery.

Because of this, your stool is not getting enough water, meaning, you may experience constipation for a while.

In the past, women were often kept “nil by mouth” for a long time after c-section. Newer enhanced-recovery guidelines now support early drinking and light meals once you are fully awake and stable, to help your bowels wake up and reduce constipation. Ovid+1

However, there may still be a short period (hours) where you do not eat or drink much, and this, together with blood loss and sweating, can make you dehydrated and contribute to hard stool.

3. Effect of anesthesia

I’ve already mentioned that anesthesia is critical to make you relax and feel no pain during your surgery. But here’s the thing, your intestines also relax too, meaning that it will need some time for gut movement to return, resulting in constipation or “slow bowels” for a few days.

4. No quick ambulation after your surgery

After your surgery, you are confined to your bed for the first few hours to allow you to heal from the stress of surgery.

Because of this inactivity, it also affects the movement of your gut. In fact, after your surgery, your doctor wants you to get moving around quickly (with support and only as you feel safe). Research shows that early mobilization after cesarean helps bowel movement return, reduces constipation and reduces some other complications like blood clots. PMC+1

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When to worry about a hard stool or no stool after c-section

Most of the times, constipation is not something you should be scared of. It happens to a lot of women after c-section. Usually, it takes some time for your body to get back to normal, and you need to be patient during your recovery.

Having said that, some signs may indicate that you will need to see your doctor right away. Here are some of those danger signs:

Continuous fever for days

Fever after c-section is not a good sign. It means something may be wrong, and likely, it could be due to ongoing infection or inflammation.

If your bowel is mistakenly traumatized during your procedure, you will experience fever, and inability to pass stool and gas, often with a swollen, painful abdomen. See your doctor or return to the hospital immediately.

Persistent vomiting

Constipation and vomiting after your surgery is also not a good sign. It could happen from minor anesthesia effect, though, in cases of gut trauma or intestinal blockage, you will also have similar symptoms. Talk to your doctor urgently.

Abdominal distention and pain

Abdominal distention and pain after c-section are tricky because your womb is still trying to contract in few days after your surgery.

However, if you feel excruciating abdominal pain and swelling with no stool or gas for more than 2–3 days, it is not a good sign. See your doctor.

Other red flags include: blood in your stool, sudden severe chest pain or breathlessness, or constipation that lasts more than about 3 weeks despite lifestyle changes and simple treatments. Cleveland Clinic+1

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How to relieve constipation after c-section

Because straining, hard stool, and constipation after c-section can be discomforting, we’ve put together steps that can quickly ease your symptoms:

Take small diets and snacks

Your body takes in food through the mouth and removes feces from the other end (the anus). So, this is pure logic; if you take in food, your body will automatically signal removal of feces from the other end.

Start with light, easy-to-digest meals (pap, oats, fruits, soups) and build up to normal meals as you feel better, unless your doctor advises otherwise. Ovid

Take a lot of water

Water helps to keep you well-hydrated and soften your stool. It’s also important you avoid excessive caffeinated beverages and alcohol because they could increase dehydration.

Most adult women are advised to aim for at least 8 glasses of fluid a day (unless your doctor has restricted your fluids). NIDDK

Eat lots of fiber diet

Taking lots of fiber helps push your gut content quickly to aid defecation. So, take lots of vegetables, fruits, whole-grain cereals, rice, bread, pasta and beans. If you are very constipated, introducing fiber slowly and drinking enough water helps prevent bloating. NIDDK+1

Get moving

Try to move around after your surgery as this can help your gut movement return. The quicker you ambulate after your surgery (safely, with support), the less likely you will have severe complications from constipation. Nursing CE Central+1

Talk to your doctor about medicines that soften stool

If diet, water and movement are not enough, your doctor or midwife may recommend a stool softener (like docusate) or a gentle laxative (such as polyethylene glycol, lactulose, or a bulk-forming agent). These medicines pull water into the stool or make it softer and are commonly used after childbirth. Do not take strong “purgatives” on your own without medical advice, especially soon after surgery or if you are breastfeeding. Mayo Clinic+2NIDDK+2

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Are there serious complications from constipation?

Your doctor knows that constipation after surgery can have undesirable consequences. So, they quickly help you to prevent constipation from happening or becoming severe.

If stool is allowed to stay in your gut for too long, it can get too hard and sometimes lead to fecal impaction, where stool is stuck in the rectum, or contribute to bowel blockage in people who already have other problems with the intestines. NIDDK

This may require further actions by your doctor ranging from digital rectal examination to dislodge your stool, medicines given by mouth or rectally (suppositories or enemas), or, rarely, surgery.

Other complications of constipation are rectal prolapse, hemorrhoids, and wound breakdown from excessive straining. Very rarely, severe untreated constipation can worsen pelvic floor problems later in life. Cleveland Clinic

If you are worried, or your symptoms are not improving after a few days of home measures, speak with your doctor, midwife or surgeon for safe, personalized advice.