One of the common complaints after bariatric surgery which is weight loss surgery is abdominal pain. The question remains is abdominal pain normal or not? About 50 percent of abdominal pain is common after bariatric surgery but the other 50 percent requires a immediate attention at the ER.
Thousands of gastric bypass surgeries are done each year in Canada and the United States. In some cases this surgery for weight loss is the last resort for clinical obesity with complications such as diabetes and liver damage. Although the surgery is necessary there are complications from the surgery that can be both benign or life threatening.
Abdominal pain is the most common complication. According to Am J Surg,author of this publication in the US Library of Medicine, obese people feel abdominal pain more intensely than slender people.
What causes abdominal pain?
The most common reason for abdominal pain after bariatric surgery is malabsorption of food. Patients are faced with a new way of eating which can take awhile to get used to. The operation can change the feeling of fullness and may cause some people to eat more than their new stomach pouch can handle; thus creating abdominal pain. The key to avoid this kind of abdominal pain can be lessened or eradicated by eating small portions very slowly as recommended by the bariatric team.
The sources of foods which causes the abdominal pain vary among people but usually regulates six months or so after the operation. Typical foods that cause abdominal pain in the first six months are: bread, pasta rice, meats, some fruits and vegetables. Again the key here is to avoid the foods or eat very slowly to see if the food can be tolerated and digested properly.
Gluten allergies, iron and vitamin B12 deficiencies and bacterial growth
Gluten allergies and iron and vitamin B12 deficiencies can also trigger abdominal pain. Patients must continue to take these vitamins and minerals along with others which have been prescribed by the bariatric team. Another cause for abdominal pain is the growth of bacteria in the dysfunctional portion of the stomach.
Constipation and gas
Constipation and gas are very common after bariatric surgery and can be the source of abdominal pain. Drinking more water can relieve the constipation. Diarrhea and gas again can be caused by malabsorption of food. It usually goes away in time. Obese individuals and people who suffer from irritable bowel syndrome or constipation before the surgery may find that the condition worsens after surgery.
Esophageal motility disorders
Esophageal motility disorders which is an obstruction of the usual descent of food from the esophageal (food pipe) to the stomach. This obstruction can lead to a problem with swallowing (dysphagia) and chest pain.
Dumping syndrome though not usually associated with pain can cause cramping a bloating in some individuals. Dumping syndrome can also cause nausea, vomiting and dizziness. Dumping syndrome usually occurs after eating foods high in sugar grease and fat.
This abdominal pain is associated with the type of food that is eaten. The pain can also radiate to the top right side and shoulder. The condition is fairly common among post bariatric surgery patients. Whereas Choledocholithiasis (gallstones) causing the biliary disease is not usually associated with bariatric surgery).
Sphincter of Oddi dysfunction
The sphincter of Oddi is a valve which opens and shuts when food is absorbed. It opens to release pancreatic juices into the duodenum of the small intestine to help digest food and closes afterward. If the sphincter of Oddi is malfunctioning it can cause abdominal pain.
Stomach Pouch disease
Gastrogastric fistula is a condition that occurs when the pouch is not completely separated from the rest of the stomach. The ulcer is a result of acid buildup that occurs when stomach acid from the old stomach creeps into the new gastric pouch. The acid seeps through the small opening called a fistula. The condition is rare but occurs between 2 to 15 percent of the time. This condition can cause abdominal pain and the patient would require revision surgery. Ulcer disease may be caused by the acids in the duodenum or the old stomach or it can be caused by the use of NSAID such as Tylenol, Aspirin, and Ibuprofen.
Gastroesophageal reflux diseaseGastroesophageal reflux disease commonly known as GERD is a disorder that often afflicts the obese. It can continue after bariatric surgery. It does go away in 85 percent of the patients after surgery. However, the remaining 15 percent may continue to have the symptoms. Hiatal hernias is often a problem contributed to obesity and both these conditions can persist after surgery and cause abdominal pain. In extreme cases corrective surgery becomes an option for the hiatus hernia.
Stenosis can occur in up to 27 percent of patients after having weight loss surgery. Stenosis in the narrowing of a valve or blood vessel connected to different organs in the body, in this case it would in the bowel or intestines. It can also be a cause for ulceration and biliary disease or pouch problems. It can manifest in trouble swallowing and sometimes there is abdominal pain.Small bowel-related disease
There are several small bowel related disease such as “ventral and trocar site hernias, adhesive disease, internal hernias, and rarely, intussusception that can cause abdominal pain”.
Since there are many reasons for abdominal pain after bariatric surgery it is best to contact the doctor or bariatric team should it occur rather than remain silent and risk further complications.