Patients who undergo laparoscopic bariatric surgery usually have a shorter hospital stay.When you return to your hospital room after surgery, you will be closely monitored by your nurses. Along with periodic monitoring of your vital signs — blood pressure, pulse, temperature and respiration — your nurses will encourage and help you to perform deep breathing, coughing, leg movement exercises and to get out of bed. These activities can help prevent complications. Report any symptoms of nausea, anxiety, muscle spasms, increased pain or shortness of breath to your nurse.
To varying degrees, it is normal to experience fatigue, nausea and vomiting, sleeplessness, surgical pain, weakness, light-headedness, loss of appetite, gas pain, flatulence, loose stools and emotional ups and downs in the early days and weeks after surgery. Please discuss any concerns you have with your doctors and nurses.
- Gauze pads
- Bandage tape
- Cotton balls
- Hydrogen peroxide
- Heating pad
Nausea may be related to insufficient chewing, fullness, sensitivity to odors, pain medication, not eating, post-nasal drip or dehydration. In the first days after surgery, nausea usually can be treated with medications called antiemetics. It is very important to take your nausea medication as prescribed by your surgeon.
Rarely, nausea can be so severe that it prevents patients from drinking adequate amounts of liquids. If this happens, you will need to come back to the hospital to receive intravenous (IV) fluids. Persistent vomiting may lead to dehydration and electrolyte imbalance, which may cause vitamin deficiencies.
Odors can sometimes be overwhelming after surgery. If you are dry heaving, try sniffing a few drops of peppermint essential oil on a handkerchief. Avoid perfumes and scented lotions. If food odors bother you, try having someone else prepare your meals or prepare bland foods.
Learn to recognize when you are full. This will not happen immediately, but by eating very slowly, it will become easier.
Should you have difficulty drinking due to nausea, try peppermint tea, fennel tea, decaffeinated green tea, or hot or cold water with lemon. Sucking on a cinnamon stick may sometimes help alleviate nausea.
If you believe your pain medication is causing nausea, call your surgeon’s office to request a prescription change.
Remember to stay hydrated by sipping fluids all day long. You need to drink a minimum of 1.5 to 2 liters of fluids per day, or more if you are sweating.
Vomiting is often caused by eating inappropriately. Initially, it can be difficult to gauge how little food will satisfy your hunger — chances are, you will feel full with very little food. A couple of teaspoons may be all you can eat at one time.
Possible causes of vomiting include:
Eating too fast
- Not chewing food properly
- Eating food that is too dry
- Eating too much food at once
- Eating solid foods too soon after surgery
- Drinking liquids with meals or right after meals
- Drinking with a straw
- Lying down after a meal
- Eating foods that do not agree with you
To prevent vomiting:
- Chew your food well.
- Keep your food moist.
Eat only half of what you anticipate eating. If there is still space, and you still feel hungry, you can always eat more.
Strictly follow your recommended post-surgery diet.
If you experience prolonged vomiting, stop eating solid foods and sip clear liquids such as clear and very diluted juice, broth and herbal tea. Should you have difficulty swallowing foods or keeping foods down, please call your surgeon.
Vomiting may indicate that your stomach pouch is blocked. If vomiting continues for more than 24 hours, contact your surgeon. Vomiting can lead to severe dehydration, a serious condition that needs medical attention. Contact your surgeon if you believe you may be dehydrated.
Dehydration will occur if you do not drink enough fluids. Symptoms include fatigue, dark colored urine, fainting, nausea, low back pain and a whitish coating on the tongue. If you experience these symptoms, you will need to have blood work done to establish the severity of dehydration. Dehydration may also lead to bladder and kidney infections.
Contact your surgeon if you believe you may be dehydrated.
To prevent dehydration:
Buy a sports bottle and take it with you everywhere so you can sip water all day.
Drink at least 1.5 to 2 liters of fluids per day. Increase this amount if you are sweating.
Avoid beverages that contain caffeine; they are diuretic and can dehydrate you. Unsweetened herbal iced tea is OK.
If you have difficulties drinking due to nausea, suck on ice chips.
It is normal to have one to three bowel movements of soft stool per day. It may be foul smelling and associated with flatulence. Most of these changes resolve as your body heals and you adapt to changes. Please call your surgeon if you have persistent diarrhea.
After bariatric surgery, the amount of food you consume is greatly reduced, and the quantity of fiber or roughage you consume may be much smaller. As a result, the amount of bowel movements you have will be reduced, causing less frequent bowel activity and sometimes constipation. If this becomes a problem, you may want to try a stool softener to avoid rectal difficulties.
To keep your bowel movements regular:
Remember that your stools will be soft until you eat more solid food.
Lactose intolerance and high fat intake are generally the culprits of loose stool and diarrhea. Avoid all high-fat foods and cow’s milk products, other than yogurt.
Use your pocket journal to help recognize problem foods.
If cramping and loose stools (more than three per day) or constipation persist for more than two days, please call your surgeon’s office.
Everyone has gas in their digestive tract. Bariatric patients have a shortened bowel, which can cause gas to be more odorous and expelled more forcefully. Gas comes from two main sources: swallowed air and normal breakdown of certain foods by harmless bacteria that are naturally present in the large intestines.
Foods high in carbohydrates cause gas; those high in fat and protein cause very little.
The foods that are known to cause more gas are beans, vegetables, some fruits, soft drinks, whole grains, wheat, bran, cow’s milk and cow’s milk products, foods containing sorbitol and dietetic products.
To help prevent flatulence:
Eat your meals more slowly, chewing food thoroughly.
Lactose intolerance is generally the culprit of gas. Discontinue eating all cow’s milk products. Yogurt is OK.
- Avoid chewing gum and hard candy.
- Avoid drinking with a straw.
- Eliminate carbonated beverages.
Remedies for flatulence include Lactobacillus acidophilus (a probiotic or “good bacteria” that aids digestion), natural chlorophyll and simethicone.
To minimize the risk of developing a hernia, avoid heavy lifting for three months after surgery. You may notice a bulge under the skin of your abdomen. This is part of your bowels that are not being contained in the abdomen, due to a weakness in the abdominal wall at the site of your surgical incision. You may feel pain when you lift a heavy object, cough or strain during urination or bowel movements. The pain may be sharp and immediate. In some cases, the pain may be a dull ache that gets worse toward the end of the day or after standing for a long period of time. If you think you may have a hernia, please call your surgeon for a consultation.
Surgery is the only way to repair a hernia. If the hernia pops out and will not go back into place when you lie down, and is causing you pain and vomiting, it can result in an emergency. Call your surgeon’s office or your primary care doctor immediately if this occurs.
Thrush and Yeast Infections
You may notice a white, cottage cheese-like coating on your tongue after surgery. Your tongue may also be very red and inflamed. Most likely you have thrush, which is a yeast overgrowth in the mouth. Often, this is due to large amounts of antibiotics taken before surgery. Call your primary care doctor if you have an oral infection or a rash on your skin.
Taking Lactobacillus acidophilus in addition to following the regimen prescribed to you after surgery may help prevent thrush.
Vaginal yeast infections are caused by yeast called Candida albicans. Yeast are tiny organisms that normally live in small numbers on the skin and inside the vagina. If the environment of the vagina becomes less acidic, too many yeast can grow and cause an infection.
Symptoms of a vaginal yeast infection include itching and burning of the vagina and around the outside of the vagina (vulva), a white vaginal discharge that may look like cottage cheese, and swelling. If you have symptoms of a yeast infection, call your primary care doctor or gynecologist.
You can help prevent yeast infections by avoiding tight-fitting or synthetic clothing, wearing cotton underwear, not wearing pantyhose every day, and not douching or using feminine sprays. You may also take Lactobacillus acidophilus in addition to the regimen prescribed to you after surgery.
All menstruating women should take an iron supplement to prevent anemia, or iron deficiency. Please contact your doctor to find out which iron supplement is best for you.
Signs of iron deficiency anemia include paleness, decreased work performance, weakness, difficulty maintaining body temperature, fatigue, dizziness and shortness of breath.
Iron deficiency may also be caused by low vitamin A levels. Vitamin A helps to mobilize iron from its storage sites, so a vitamin A deficiency limits the body’s ability to use stored iron. This results in an “apparent” iron deficiency because hemoglobin levels are low, even though the body can maintain an adequate amount of stored iron.
Temporary Hair Loss and Skin Changes
Hair thinning or loss is expected after weight loss. It is temporary, but can still be disheartening for patients.
During the phase of rapid weight loss, calorie intake is much less than the body needs, and protein intake is marginal. Your body reacts to this deprivation in various ways, with a common side effect being hair thinning. This is a transient effect and resolves itself when nutrition and weight stabilize. Hair loss usually occurs anywhere from three to nine months after surgery.
To minimize hair loss, take your multivitamins daily and consume at least 75 grams of protein per day. Nioxin shampoo has been shown to be helpful for some patients, as well as biotin tablets or powder.
We recommend avoiding hair treatments and permanents to prevent stressing your hair from the outside, too.
Skin texture and appearance may also change after bariatric surgery. It is not uncommon for patients to develop acne or dry skin after surgery, since protein, vitamins and water intake are also important for healthy skin.
Scars are expected after any surgery. The size of your scars depends on the type of bariatric surgery you had (open versus laparoscopic), the sutures used and how your body heals. If you would like to make your scars less visible, once your incisions are fully healed, you may start using silicone pads and scar-minimizing creams to make the scars look softer, smoother, flatter and closer to your skin’s natural color.
Be sure to keep your scars out of the sunlight to help them heal properly.
Sexuality and Pregnancy
You may resume sexual activity when you feel physically and emotionally stable.
Women need to use a mechanical form of birth control, as fertility may be increased with weight loss and oral contraceptives may not be fully absorbed.
Many severely obese women are also infertile, because the fatty tissue soaks up the normal hormones and makes some of its own as well. This may confuse the ovaries and uterus and cause a lack of ovulation. As weight loss occurs, this situation may change quickly.
You may start planning a pregnancy after weight loss stabilizes, but it is imperative not to become pregnant during the first 18 months after your surgery, since both you and the baby need to be healthy and safe.
If you do become pregnant, please arrange for your obstetrician/gynecologist to contact your surgeon’s office. They will discuss specific information about your surgery, so they can work together to provide you with the best prenatal care.
A Lifelong Commitment
After surgery, you must be committed to regularly taking vitamins and supplements, eating healthfully, attending follow-up appointments with your doctor, exercising and participating in support groups for life. Your emotional and physical well-being depends on this commitment.
Lack of exercise, poorly balanced meals, constant grazing, eating processed carbohydrates and drinking carbonated beverages are common causes of regaining weight after surgery. You will need to manage your food intake and exercise for the rest of your life.
Adhering to healthy nutrition guidelines after weight loss is essential for long-term success and weight maintenance. For optimal health, we recommend incorporating all of the food groups according to the American Dietetic Association (ADA) guidelines.
In a reduced calorie state, the body’s natural tendency is to use muscle for immediate energy needs. Therefore, it is essential to follow a strict fitness program after surgery. Exercising at least three times a week conserves lean muscle mass, burns fat and increases your potential for long-term success.
Because bariatric surgery changes the digestive process, lifelong vitamins and nutritional supplements are essential. Vitamin deficiencies are often predictable and preventable. Take your vitamins and supplements and commit to seeing your surgeon on a regular basis for lab work and follow-up.
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.