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What to Know About Postoperative Ileus (POI)

Some surgical patients lose bowel function after an operation. The situation can persist for days and is usually one of the main reasons why hospitals and other surgical centers want you to go to the bathroom before you leave. If you’ve ever had surgery, you likely remember that nurses and other staff exhorted you to use the bathroom before letting you check out. Why? Because they want to make sure your body is working well, so you don’t run into problems when you get home.

The condition when people lose bowel function after surgery is called postoperative ileus, or POI, for short. It’s most common in people who go through abdominal surgeries, and the cause isn’t very clear. Thankfully, POI isn’t all that harmful, and it usually resolves itself with some level of intervention. There is, though, cause for concern because surgeons and other medical personnel want to ensure there is no obstruction after a surgical procedure.

POI is associated with any type of abnormal gastrointestinal pattern. The digestive system stops moving, and there is usually a lack of appetite and abdominal distention. Let’s take a look at postoperative ileus, its causes, treatments, and other important information you should know.

POI Risk Factors

Even though we know that POI usually resolves with little to no intervention, there are certain risk factors you should be aware of to guarantee proper treatment. There are some pre existing factors for people who go into surgery. Having gastrointestinal disease, lack of physical activity, and other factors can increase the risk of POI. Overall, POI affects around 9% of surgery patients. Percentages are higher for people who have operations on their intestines, particularly the small intestine.

Typically, POI is accompanied by feelings of discomfort in the stomach and other parts of the abdomen. Patients regularly report pain and nauseousness and note a lower level of postoperative satisfaction when POI exists.

The good news is that POI often resolves in two or three days. Sometimes, however, it can last up to a week. Return of full bowel function usually comes in fits and stages, but eventually, everything returns to normal.

Causes of POI

While the causes of POI are not always 100% clear, we do know some things that increase the risk of bowel troubles after surgery. For example, the use of opioids and other pain relievers can affect bowel function by slowing the body’s signaling and normal systems functions. In what is called slow intestinal motility, patients fail to go to the bathroom because things simply aren’t pushing through their bodies. Their intestines are stuck, and it takes time for the digestive system to normalize.

Similarly, when patients come out of surgery, they usually are still dealing with the lingering effects of general anesthesia. This can impact the colon and trigger POI. The human colon lacks cell gap junctions, so it’s at a higher risk of POI. This is why nurses check on postop patients frequently and encourage them to use the bathroom as quickly as possible. Once you go to the bathroom, they feel more confident that everything is normal and the effects of anesthesia are moving in the right direction.

Treatment Options for POI

As we’ve stated a few times, the vast majority of POI cases resolve naturally in time. Patients typically can self-manage pain and nausea without any prescription medicines. There are, however, several prescription medicines, like Metoclopramide, Propranolol, Neostigmine, etc., that doctors use to treat POI patients.

Additionally, some doctors encourage the use of over-the-counter laxatives for treatment. Though no randomized, double-blind trials exist, laxatives ease the burden of processing foods on the digestive system and can loosen any blockages in the intestines.

Ipamorelin is a pentapeptide that is being studied to determine whether it can boost the efficacy of POI treatments. In research, Ipamorelin shortened the time to the first meal by approximately 12 hours. There is hope that new research can combine other therapies to include ipamorelin to deliver a synergistic effect with other compounds to increase efficacy and provide a better option for treatment.

Finally, there is some evidence to suggest that chewing gum can shorten the POI window and help patients return to normal after surgery. The thinking is that gum chewing stimulates the physiological response and prompts the GI system into action. In a study of postoperative patients, those who chewed gum were shorter, indicating that chewing gum can shorten the length of hospital stays and reduce pain and nausea.

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