Post Esophagectomy diet~Foods 2 eat~foods 2 avoid~bowel problems usually persist 4 A time but will B

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LorettaMarshall
LorettaMarshall Member Posts: 662 Member
in Esophageal Cancer #1

Dear Jesse:

You posted a letter to us at this link:  https://csn.cancer.org/node/312916 in which you wrote the following: 

“Nov 10, 2017 - 12:29 pm - Hello I just recently had an esophagectomy and I am wondering is it normal to have trouble using the bathroom??? Can anyone give me any advice on how to have one normally without taking anything such as a suppository, enema or prune juice any information would be helpful”.

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 So Jesse, since bowel problems are a common culprit after an esophagectomy, I thought I may as well put it on a separate topic so others who are looking for help as well may find the references below my name helpful.  You’ve got a problem for sure.  Most often post-op Esophageal Cancer patients seem to have to deal with a condition called “dumping syndrome” rather than constipation.  I write from the viewpoint of a caregiver to my husband William, who was diagnosed with Esophageal Cancer, Stage III (T3N1M0) at age 65.  He had successful surgery but afterwards his problem was dealing with the “dumping syndrome.”  However, I, as a Stage IV cancer patient, having had intestinal resectioning, together with removal of several “non-essential” organs, as part of my Cytoreductive Surgery, so I certainly know what problems bowel irregularities entail.    

Laughingly I said to my husband, “You know I’ve never been diagnosed with ‘IRRITABLE’ bowel syndrome, but I know what it’s like to be irritable when suffering with “irregularity”.  With emphasis on the word “irritable”, an old joke about the circus came to mind.  Now stay with me for a minute Jesse.   

Now sad to say, Barnum & Bailey Circus held their last circus performance this past March 2017.  We paid the way for our grandson to go to see the last circus here in town.  He has two children, and we wanted them to have the memory of going to the circus, seeing the clowns crammed into a tiny car, as well as the ones walking on stilts that made them seemingly 12 feet tall!  Then there was the cotton candy, etc.  That is another “Americana” memory that I’m sorry my grandchildren and great grandchildren will not get to enjoy any longer. It’s been customary here for the circus animals to be unloaded at the train station near where the circus will be held.  Folks would always bring their children downtown to watch the animals as they pass by on their way to the civic center in the middle of town.  So that’s the joke I always think about when grappling with constipation.    

Now back to “irritable”—Seems 2 little boys were watching the circus animals march down Main Street. They were oohing and aahing about the size of the animals and talking about which one was the “meanest!”  Looking at a lion, one boy said to the other, “Here comes the meanest animal what am!” His pal disagreed.  He said, “Naugh here comes the meanest animal what am.  He’s a “tiger-gator.  Cause he’s got the head of a alligator on one end, and the head of a tiger on the other end!”  His friend said, “Well how does he go to the bathroom?”  Surprised The other boy said, “HE DON’T—THAT’S WHAT MAKE HIM SO MEAN!”  YellSo days when there are no problems, I can be as gentle as a lamb.  On other days when nothing is “working”, I’m a “tiger-gator!” Undecided

So Jesse, seems the most I can do for you is give you some web references that might give you a clue as to what to do.  Paul61 has answered you and said that most EC patients have to deal with the "dumping syndrome" rather than constipation.  I agree. Most post-surgical EC patients have to deal with the problem of food moving too quickly through the digestive system.  Also, it’s difficult to eat the many “mini” small meals one has to consume in a day, and still get enough liquid in their system at the same time.  It’s best to drink liquids in between meals, because your new “gastric tube” is limited as to its intake capacity.  So for you, it might be a matter of not getting enough fluids daily.  It might also be the kinds of foods you are eating.  And as Paul says, pain killers can be a cause of constipation.  I just read today where 40% of opioid users suffer from constipation.  Not knowing what meds you might be taking, I can only suggest that you read the links listed here.  Some recommend foods to eat, and foods to avoid.  

As for my husband, the dumping syndrome was the culprit.  In time, things were fine. So I’m hoping that your “tiger-gator” days will be few and in time you’ll be good as new.  It will take several months to acclimate to a new schedule where neither constipation or diarrhea is a problem.  Believe me, things will get better.  Assuming you’re in good health otherwise, you will get back to being your old self in due time.  It takes time Jesse.  It could be several months for your system to get accustomed to a new diet regimen.  So I’m hoping that some of the informational links below will be helpful. 

Loretta (Wife of William- DX Nov. 2002, Adenocarcinoma @ the GE junction, (EC T3N1M0), Ivor Lewis Minimally Invasive Esophagectomy, May 17, 2003, by Dr. James D. Luketich at University of Pittsburgh Medical Center.  We’re still celebrating being EC cancer free with no recurrence.)

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1.       https://www.healthline.com/health/digestive-health/constipation-after-surgery#1

Managing Constipation After Surgery

All surgeries are stressful and can take a major toll on your body. Constipation, an often-unanticipated side effect, can make the healing process even more uncomfortable.

Symptoms of constipation include:

  1. having less than three bowel movements a week
  2. experiencing a sudden decrease in bowel movements
  3. needing to strain during bowel movements
  4. bloating or increased gas
  5. abdominal or rectal pain
  6. having hard stools
  7. feeling full after bowel movements

Keep reading to find out potential causes of constipation and how to deal with it.

Causes of Constipation After Surgery

Several factors may contribute to constipation after surgery. These include:

  1. narcotic pain relievers, such as opioids
  2. general anesthesia
  3. an inflammatory stimulus, such as trauma or infection
  4. an electrolyte, fluid, or glucose imbalance
  5. prolonged inactivity
  6. changes to diet, especially insufficient fiber

Dealing with Constipation After Surgery

Lifestyle and dietary changes may help prevent constipation after surgery or, at least, lessen its duration.

Start walking around as soon as your doctor gives you the go-ahead. Not only can this help with constipation, but it can also help with the overall healing process while reducing the chances of dangerous blood clots.

Try to limit your postoperative narcotics use. If you can tolerate the pain and your doctor approves, opt for acetaminophen (Tylenol) or ibuprofen instead.

You should also plan to take a stool softener, such as docusate (Colace), after surgery.

A fiber laxative, such as psyllium (Metamucil), may also be helpful. Purchase a laxative or stool softener before your surgery so that you have it available when you get home.

Eat More Fiber

A high-fiber diet may include:

  • whole grains
  • fresh fruits
  • vegetables
  • beans

You should also drink plenty of fluids, preferably water, in the days leading up to surgery and after. A high-fiber diet can also help you avoid being constipated before surgery. That, in turn, can help you to avoid postoperative constipation. You may also want to add prunes and prune juice to your post-surgery diet.

Finally, avoid constipating foods. These may include:

  • dairy products
  • bananas
  • white bread or rice
  • processed foods

You may need stimulant laxatives, suppositories, or enemas to produce a bowel movement if you have severe constipation.

According to the Mayo Clinic, prescription drugs that draw water into your intestines to stimulate a bowel movement may be prescribed if over-the-counter laxatives aren’t enough. Linaclotide (Linzess) or lubiprostone (Amitiza) are two such medications…”

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2.        http://www.upmc.com/patients-visitors/education/nutrition/pages/esophagectomy.aspx

“UPMC Content 2

Diet After an Esophagectomy

An esophagectomy (ee-soff-uh-JEK-tuh-mee) is surgery to remove the esophagus. After this type of surgery, it is common to have some problems eating for a few months.

What can I expect after surgery?

For the first few months after surgery, you may have problems such as:

§  Weight loss

§  Dumping syndrome (nausea, diarrhea, abdominal cramping, light-headedness)

§  Excess gas

§  Trouble swallowing

Your diet plan after surgery is designed to lessen your discomfort and allow you to enjoy eating…”

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3.       http://www.upmc.com/patients-visitors/education/nutrition/pages/dumping-syndrome-diet.aspx

“UPMC Content 2

Dumping Syndrome Diet - Dumping syndrome sometimes happens after stomach surgery.

Dumping syndrome is caused by large amounts of food passing quickly into the small intestine. This causes symptoms like abdominal pain, cramping, nausea, diarrhea, dizziness, weakness, rapid heart beat, and fatigue. This diet will help stop the symptoms of dumping syndrome…”

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4.       http://www.todaysdietitian.com/newarchives/011012p28.shtml

“Nutrition Support for Esophageal Cancer Patients — Strategies for Meeting the Challenges While Improving Patient Care”

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5.       https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment

“Treatment for Constipation - How do doctors treat constipation?

Treatment for constipation depends on

  • what’s causing your constipation
  • how bad your constipation is
  • how long you’ve been constipated

Treatment for constipation may include the following:

Changes in eating, diet, and nutrition

Changes in your eating, diet, and nutrition can treat constipation. These changes include

  • drinking liquids throughout the day. A health care professional can recommend how much and what kind of liquids you should drink.
  • eating more fruits and vegetables.
  • eating more fiber.

Read about what you should eat to help prevent and relieve constipation and foods to avoid if you are constipated.

Exercise and lifestyle changes

Exercising every day may help prevent and relieve constipation.

You can also try to have a bowel movement at the same time each day. Picking a specific time of day may help you have a bowel movement regularly. For example, some people find that trying to have a bowel movement 15 to 45 minutes after breakfast helps them have a bowel movement. Eating helps your colon move stool. Make sure you give yourself enough time to have a bowel movement. You should also use the bathroom as soon as you feel the urge to have a bowel movement…”

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6.       https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/eating-diet-nutrition

“Eating, Diet, & Nutrition for Constipation - How can my diet help prevent and relieve constipation?

You can drink water and other fluids, such as fruit and vegetable juices and clear soups, to help the fiber in your diet work better. This change should make your stools more normal and regular. Ask your doctor about how much you should drink each day based on your health and activity level and where you live.

Depending on their age and sex, adults should get 22 to 34 grams of fiber a day.3 Older adults sometimes don’t get enough fiber in their diets, because they may lose interest in food. If you are older and have lost interest in food, talk with your doctor if

  • food doesn’t taste the same as it once did
  • you don’t feel hungry as often
  • you don’t want to cook
  • you have problems chewing or swallowing

Talk with your doctor to plan a diet with the right amount of fiber for you. Be sure to add fiber to your diet a little at a time so that your body gets used to the change.

Use this table as a tool to help replace less healthy foods with foods that have fiber.

Examples of Foods That Have Fiber 3

Beans, cereals, and breads

Fiber

½ cup of beans (navy, pinto, kidney, etc.), cooked

6.2–9.6 grams

½ cup of shredded wheat, ready-to-eat cereal

2.7-3.8 grams

⅓ cup of 100% bran, ready-to-eat cereal

9.1 grams

1 small oat bran muffin

3.0 grams

1 whole-wheat English muffin 

4.4 grams

Fruits

  

1 small apple, with skin

3.6 grams

1 medium pear, with skin

5.5 grams

½ cup of raspberries

4.0 grams

½ cup of stewed prunes

3.8 grams

Vegetables

  

½ cup of winter squash, cooked

2.9 grams

1 medium sweet potato, baked in skin

3.8 grams

½ cup of green peas, cooked

3.5-4.4 grams

1 small potato, baked, with skin

3.0 grams

½ cup of mixed vegetables, cooked

4.0 grams

½ cup of broccoli, cooked 

2.6-2.8 grams

½ cup of greens (spinach, collards, turnip greens), cooked

2.5-3.5 grams

What should I avoid eating if I'm constipated?

If you’re constipated, try not to eat too many foods with little or no fiber, such as

  • cheese
  • chips
  • fast food
  • ice cream
  • meat
  • prepared foods, such as some frozen meals and snack foods
  • processed foods, such as hot dogs or some microwavable dinners

References

[3] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 . 7th ed. Washington, D.C.: U.S. Government Printing Office; 2010.”

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7.       https://www.webmd.com/digestive-disorders/constipation-after-surgery#1

“Constipation After Surgery: Tips for Relief…IN THIS ARTICLE

 

 

 

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