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What To Look Out for After Bariatric Surgery

Gastrointestinal Health

February 12, 2024
Bariatric Surgery

Whether you’ve recently had gastric bypass, gastric sleeve, or another form of weight loss (bariatric) surgery, you likely have questions about your recovery. This process can be a long journey, and you need to be as prepared as possible to help you stay your healthiest. This article covers several important aspects of healing and making the most of your bariatric procedure. If you have any additional questions about the information provided here, make sure to ask your bariatric surgeon or healthcare provider to learn more.

What Is Bariatric Surgery?

Bariatric surgery is an operation used to help people lose weight after diet and exercise changes have failed. There are several types of bariatric surgery that change your digestive system. Some work by limiting the amount of food your stomach can hold, and others limit the amount of nutrients that are absorbed. Since your stomach holds less food and doesn’t absorb as many calories as before, you’ll start to lose weight.

Bariatric surgeons typically choose 1 of 2 common surgeries — the sleeve gastrectomy (gastric sleeve) or Roux-en-Y gastric bypass. During a sleeve gastrectomy, the surgeon removes the stomach and staples off a large portion, removing around 80% of the stomach. This creates a “gastric sleeve” of the remaining 20% of the stomach. During a gastric bypass, the surgeon cuts the top portion of the stomach away from the bottom portion to create a small pouch (roughly the size of a walnut) that holds 1 ounce of food. They then cut the small intestine away from the bottom of the stomach and connect it with the small pouch. This technique “bypasses” a large portion of the stomach and the small intestine, preventing the absorption of more calories. The small pouch means you can only eat very small snacks and meals.

Both surgeries come with their pros and cons, but the general guidelines for recovery and staying healthy are similar.

Staying Healthy After Bariatric Surgery

Healing from bariatric surgery is only one part of the journey — you also need to be prepared to make lifelong changes that ensure you maintain your weight loss afterward. Your surgeon and bariatric team have likely provided you with plenty of information about your diet and the necessary adjustments to make your surgery a success. Here are 7 important aspects of staying healthy after bariatric surgery.

1. Keep an Eye on Your Incisions

Before you’re discharged from the hospital or surgery center, your surgeon or nurse will give instructions on caring for your incisions. Depending on the type of surgery you’ve had, you may have several small incisions from a minimally invasive laparoscopic procedure. The incisions may be a few inches long with stitches and glue covered by gauze and adhesive. The stitches will dissolve on their own over time, and the glue will peel as your body repairs the incision.

Be sure to keep a close eye on your incisions and keep them clean. Don’t try to peel off the glue on your own or pick off the stitches. Your body will take care of them itself as you heal. Avoid submerging your incisions (taking a bath, swimming, or sitting in hot tubs) until they’ve completely healed. Keep the areas clean with gentle soap and warm water. If the incisions start to itch, you can apply Aquaphor or Vaseline to help.

Some clear discharge draining from your incisions is normal. Call your doctor if you notice any signs of infection, including:

  • The discharge becomes cloudy or smelly
  • Your incisions are red, irritated, and painful
  • You’re running a fever of 101.5°F[MC1]

As your incisions continue to heal, they may form red, purple, or dark pink scars. They usually fade within a year of your surgery. Be sure to put sunscreen on your surgical scars and cover them as needed to protect them from sun damage.

2. Some Bloating and Constipation Is Normal

During your bariatric surgery, the surgeon pumps air into your abdomen to help separate your stomach from your other organs. Your body will naturally get rid of this gas in the days following your surgery, but you may notice you’re more bloated or gassy than normal. Abdominal pain can also accompany the bloating, causing more discomfort. Doctors usually recommend walking around to help air move through your body.

You may also find yourself more bloated even after healing from bariatric surgery. Your stomach is much smaller now, meaning ingesting air while eating can cause more discomfort than before. Your stomach may also not digest food as well, leaving more for your gut bacteria to digest. This can create gas that makes you feel bloated and full sooner. Sage Bariatric Institute recommends:

  • Limiting certain sugars, including fructose (found largely in fruits) and sugar alcohols found in sugar-free products
  • Avoiding carbonated beverages like sparkling water and soda, which can also expand your stomach pouch/sleeve
  • Slowing down while eating and avoiding quickly gulping beverages
  • Drinking from a bottle or straw

Anesthesia from surgery can also affect your gastrointestinal system, leaving you constipated and in discomfort. You’ll be drastically changing your diet as well, meaning you’re eating less fiber and food in general. Many people have fewer bowel movements after bariatric surgery or become easily constipated. University of California San Francisco (UCSF) Health recommends adding a powdered laxative to your daily routine to help. Dairy products with cow’s milk can also cause constipation, so you may want to try limiting your daily consumption of yogurt, cheese, and milk.

3. Make Sure You’re Getting Enough Protein

Bariatric Surgery

After bariatric surgery, your body needs the right fuel to heal properly. Your surgeon has likely talked to you about the importance of getting enough protein in your diet daily. This is especially important when healing because your body needs protein to repair the incisions and heal your stomach/intestines. The recommended amount of protein varies per person following bariatric surgery. Your doctor or a registered dietitian has likely given you a healthy range of protein to eat or drink per day. Be sure to stick to this range as closely as possible.

While healing, it’s important to drink protein shakes throughout the day to hit your protein goal. (See my article on protein powders for the best one to take.) After you’ve transitioned to your soft food and regular diets, it’s best to get protein with foods like lean meats, eggs, cottage cheese, and tofu. Your doctor or dietitian can help you re-evaluate your protein goals to stay healthy.

4. Persistent Nausea and Vomiting Requires Medical Attention

As you might expect, bariatric surgery usually causes some nausea and vomiting as your stomach adjusts. You may become nauseous after surgery if you’re not chewing your food well enough or you’re dehydrated. Certain pain medications and smells may also make your stomach churn when eating. Your surgeon will likely send you home with anti-nausea and anti-vomiting medications to help within the first few days after surgery. It’s important to take slow sips of your protein shakes and drink plenty of water to stay hydrated. You can also help calm your stomach and get added hydration by sipping on green or peppermint tea or drinking cold water with a squeeze of lemon.

After you’ve switched your diet to soft foods and eventually work your way back to your regular diet, it’s important to stay mindful while eating. You may become sick to your stomach and vomit if you’re eating too much too fast, trying to eat solid foods before you’re ready, or you’re not chewing your food well enough. Here are some tips to help avoid vomiting:

  • Take small bites and chew your food thoroughly
  • Eat small, frequent meals and snacks throughout the day as opposed to 2-3 large meals
  • Recognize when you’re eating too fast (which many struggle with after surgery) and slow down
  • Stop eating when you’re full
  • Avoid drinking liquids while you’re eating (a general rule of thumb is to wait 30 minutes after eating)
  • Avoid lying down after eating to help food move through your stomach

While some nausea and vomiting are normal, you should let your doctor know if it happens more often than not around mealtimes. If you’ve recently switched to soft or regular foods and you’re vomiting, move back to your liquid diet for a few days. Your stomach might not be ready for those foods yet. If you’re vomiting several times within 24 hours, it may be a sign that you’re not digesting food and moving it into your intestines. Call your surgeon or bariatric healthcare team and let them know what’s happening. Excessive vomiting can lead to dehydration, which may be dangerous if left untreated.

5. Expect Some Hair Loss

It can be alarming to see more hair falling out in the shower or in your brush after your bariatric surgery. Hair loss is common in people who rapidly lose weight, especially after a weight loss procedure. In fact, studies show that just over half of people who have bariatric surgery experience some sort of hair loss while healing. The good news? This hair loss is usually temporary and will improve on its own within 6 months to 1 year after surgery.

Penn Medicine recommends getting a minimum of 60-80 grams of protein per day to help stave off hair loss. You can always add an extra protein shake or powdered protein to your diet to boost your intake. After you’ve fully healed, be sure to eat a variety of nutrient-dense foods like fruits and vegetables to boost your vitamin levels.

Your body may also not be getting enough vitamins and minerals to support healthy hair growth. Taking your bariatric multivitamins and supplements is an important part of staying healthy after surgery, and they’ll help with hair loss as well. Your surgeon or dietitian can recommend a bariatric vitamin that’s made with more than the recommended daily intake (RDI) of vitamins and minerals. You’ll also need daily vitamin D, vitamin B12, and calcium supplements. Your bariatric surgeon may also recommend a multivitamin and folic acid or folate. It’s important to get vitamins and supplements formulated with bariatric surgery in mind, as your stomach can’t absorb nutrients as well as before.

6. Drink Plenty of Water To Avoid Dehydration

Bariatric Surgery

People who have had bariatric surgery are more likely to become dehydrated, as their stomachs can’t hold as much liquid as they used to. You’ll need to adjust your water intake after surgery by taking small sips constantly throughout your day. Your surgeon will likely recommend getting at least 64 ounces (8 cups) of water and low-calorie/sugar-free beverages every day. This goal may seem lofty at first, but your body will adjust over time.

Here are some tips to help you avoid dehydration:

  • Get a reusable water bottle and keep it on your desk or nearby at all times
  • Try to drink 8 ounces of fluid between every snack and meal
  • Set an alarm or reminder to drink water throughout the day
  • Flavor your water with lemon or sugar-free drink mixes
  • Avoid or limit caffeinated beverages like coffee and tea, which may make dehydration worse

If you notice any signs of dehydration — such as feeling thirsty, dark urine, fatigue, nausea, or a white coating on your tongue — call your surgeon or healthcare provider. You may need intravenous (IV) fluids to rehydrate.

7. Be Wary of Dumping Syndrome

You may have heard your surgeon mention “dumping syndrome” at some point during your bariatric surgery education. As the name suggests, this condition occurs when your stomach “dumps” undigested food into your intestines too quickly. During an episode of dumping syndrome, you may notice symptoms within:

  • 10-30 minutes of eating, known as early dumping
  • 1-3 hours of eating a sugary meal or snack, known as late dumping

Early dumping tends to occur after a larger, concentrated meal, causing your intestines to release hormones that move circulating blood to your intestines. This causes bloating, diarrhea, a racing heartbeat, and sometimes fainting. Late dumping typically happens after eating foods with too much sugar. Your body releases more insulin to use the sugar, which leads to rebound low blood sugar later on. Signs of late dumping syndrome include confusion, hunger, sweating, and tremors.

To avoid dumping syndrome, be sure to eat small meals and snacks throughout the day and avoid sugary foods. If you continue experiencing symptoms, talk to your bariatric surgeon or healthcare team.

Articles authored by Dr. Connor are intended to facilitate awareness about health and wellness matters generally and are not a substitute for professional medical attention or advice from your own healthcare practitioner, which is dependent on your detailed personal medical condition and history. You should always speak with your own qualified healthcare practitioner about any information in any articles you may read here before choosing to act or not act upon such information.
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