Constipation After Hysterectomy: Your First Bowel Movement, What Helps and When to Call

ByThe PartialHysterectomy.net Editor

Constipation is one of the most common complaints in the first days after a hysterectomy, and the first bowel movement is something many people quietly worry about. Your bowels usually slow down for a few days after surgery, and strong painkillers make this worse. The NHS says you may need laxatives for the first few bowel movements so that you do not have to strain.[1] In an Australian study of women having other keyhole (laparoscopic) gynecologic operations, not hysterectomy, 7 in 10 were constipated in the week after the operation.[2] The good news is that this phase is usually short, and simple steps help. This guide explains why it happens, when to expect your first bowel movement, what helps, and which symptoms mean you should call your surgeon.

Why your bowels slow down after surgery

Several things slow the gut at the same time after a hysterectomy:

  • Anesthesia and the operation itself. The bowel lies right next to the uterus and is moved aside or handled during surgery. After abdominal surgery the bowel can stop working normally for a while even though nothing is blocking it. Doctors call this ileus.[3]
  • Opioid painkillers. Medicines such as oxycodone, hydrocodone, tramadol and codeine slow the movement of the gut and are a known cause of ileus.[3] In the Australian study above, 85% of the women took opioids after surgery.[2]
  • Eating and drinking less. Fasting before surgery, nausea and a small appetite for a few days mean less food and fluid moving through.
  • Moving less. Lying in bed for longer than usual slows things down further.
  • Fear of pain. Many people hold back because they are worried about their stitches or about pain when they push. Holding back makes stool harder and drier.

When to expect your first bowel movement

Passing gas usually comes first and is a good sign that your bowels are waking up. The first bowel movement typically takes a few days. In randomized trials of women having pelvic surgery (in one of them, half of the women had a hysterectomy), the average time to the first bowel movement was about 3 days, and roughly 3 to 4 days in women who took no laxative or only a stool softener.[4][5][6] In the Australian study, about a third of women had not had a bowel movement by the end of the third day.[2]

So going two or three days without a bowel movement after surgery is common and, on its own, is not a reason to panic, as long as you are passing gas, can eat and drink, and your belly is not getting more swollen or painful. You may be sent home before you have had one; ask your team what they expect and what to do if nothing has happened by a certain day. What matters is the whole picture, which is covered in the warning signs section below.

For a broader picture of what each stage of recovery feels like, see our week-by-week hysterectomy recovery guide.

Get ready before surgery

A little planning makes the first week easier:

  • Ask about the bowel plan at your pre-op visit. Ask whether you will go home with a laxative or stool softener, how often to take it, and when to stop. Hospitals use different routines.
  • Tell your team if you are already prone to constipation, have irritable bowel syndrome, or take medicines that constipate, such as iron tablets or some antidepressants. In one trial, women who normally had only one or two bowel movements a week took about a day longer to have their first one after surgery.[6]
  • Stock up at home on easy fruit (prunes, kiwifruit, pears), soups, a water bottle you can keep beside you, and whatever laxative your surgeon recommends, so nobody has to rush to the pharmacy later.
  • Consider a small footstool for the bathroom (more on this below).

Our list of things to do before your hysterectomy covers the rest of the preparation.

What helps your bowels get going

Drink plenty of fluids

MedlinePlus, the US National Library of Medicine’s patient site, advises drinking at least 8 cups (2 liters) of water a day after a hysterectomy and eating plenty of fruit and vegetables to help prevent constipation.[7] Unless your doctor has told you to limit fluids (for example because of heart or kidney problems), aim for pale yellow urine. Warm drinks in the morning help some people.

Get up and walk a little, often

Spending time out of bed helps you heal faster.[8] You do not need long walks: short, gentle trips around the room or the house several times a day are enough at first. Many people also find that moving around helps trapped gas pass.

Eat fruit, vegetables and fiber as your appetite returns

The NHS recommends drinking plenty of fluids and eating more fruit and fiber to help your bowels after a hysterectomy.[1] Start with what you can manage: small meals, soups, cooked vegetables, oatmeal, wholegrain bread and fruit. Add fiber gradually, with extra fluid, because a sudden large increase can cause bloating.

Wooden bowl of dried prunes on a burlap cloth, surrounded by fresh plums on a blue wooden table
Prunes are a simple food to try. In studies of chronic constipation they worked about as well as a psyllium fiber supplement, although the evidence is weak.

Prunes and kiwifruit. Prunes are a traditional remedy, and there is some research behind them. In a trial at the University of Southern California, 77 women having benign gynecologic surgery took a stool softener with or without about 4 ounces of prunes a day. Overall, the prunes did not shorten the time to the first bowel movement, but women who managed to eat more than 12 prunes were more likely to have one during the study period.[9] The 2025 British Dietetic Association guidelines on chronic constipation (not specifically after surgery) found that prunes and kiwifruit worked about as well as psyllium fiber for several symptoms, based on low or very low quality evidence.[10] In other words, they are a reasonable, safe thing to try, not a guaranteed fix.

Chewing gum: a small, harmless extra

Chewing gum after surgery may “trick” the gut into starting up, a bit like eating does. A Cochrane review of 81 trials found that it shortened the time to the first bowel movement by about half a day on average, although most trials were small, of poor quality and mostly after bowel surgery or cesarean section.[11] A 2024 review of 9 studies in laparoscopic gynecologic surgery found that gum chewers passed gas about 4 hours sooner, but there was no clear difference in the time to the first bowel movement.[12] If you like gum, it is cheap and low-risk; sugar-free gum in large amounts can itself cause gas or loose stools.

Laxatives and stool softeners

Many surgeons send patients home with a bowel medicine. The main over-the-counter types are:[13]

  • Stool softeners such as docusate (Colace). They make stool easier to pass but usually take 1 to 3 days to work.[14]
  • Osmotic laxatives such as polyethylene glycol (MiraLAX) or milk of magnesia, which draw water into the bowel.
  • Stimulant laxatives such as senna or bisacodyl (Dulcolax), which make the bowel muscles contract.
  • Fiber (bulk-forming) supplements such as psyllium (Metamucil) or methylcellulose (Citrucel). These need plenty of water.

What does the research say after pelvic surgery? A 2023 systematic review found only four good trials, but they suggest that a laxative works better than nothing, and that combining medicines works better than a stool softener alone.[15] In one trial, senna with docusate brought the first bowel movement forward by about a day compared with a placebo (3.0 vs 4.1 days), and far fewer women needed an extra laxative (7% vs 44%).[5] In another, a combination regimen worked about half a day faster than docusate alone.[6] Adding polyethylene glycol to docusate did not make the first bowel movement come sooner, although women taking it needed fewer extra laxatives.[4]

Practical points:

  • Follow the plan your surgeon gives you, and ask before adding a second product. Taking several on top of each other can swing you into diarrhea and cramps.
  • Keep taking it while you are on opioid painkillers, unless your stools become loose.
  • Magnesium products (milk of magnesia, magnesium citrate, magnesium oxide) are effective, but check with your doctor or pharmacist first if you have kidney disease.
  • Stool softeners are meant for short-term use. MedlinePlus advises not taking docusate for more than a week unless your doctor tells you to, and calling your doctor if stools are still hard after a week.[14]
  • Ask before using a suppository or enema, especially after a vaginal hysterectomy or prolapse repair, where the stitches are close to the rectum.

Use opioid painkillers only as long as you need them

Good pain control matters: pain makes it harder to walk, breathe deeply and sleep, which all slow recovery. But because opioids slow the gut,[3] it helps to use non-opioid pain relief such as acetaminophen (Tylenol) or ibuprofen as your surgeon advises, and to step down from opioids as soon as your pain allows. Most people can stop taking pain medicine within about two weeks of a laparoscopic hysterectomy.[7] Never change your pain medicines without checking with your team if you have kidney, liver or stomach problems.

Making the first bowel movement easier

The first bowel movement after surgery is often uncomfortable, even with medicines.[6] Heavy straining puts pressure on the healing tissues, which is why the NHS recommends laxatives so you do not have to strain.[1] These tips help many people:

  • Go when you feel the urge. Do not put it off, as stool gets harder the longer it stays in.
  • Raise your feet. Resting your feet on a small footstool so that your knees are higher than your hips, and leaning forward with your forearms on your thighs, puts the body in a more natural position for emptying.
  • Support your belly. Holding a small pillow or folded towel gently against your incisions can make you feel more secure.
  • Breathe, do not hold your breath. Let your belly relax and breathe out slowly rather than bearing down hard with your breath held.
  • Take your time, but do not sit for very long periods. If nothing happens after a few minutes, get up and try again later.

Our guides on how to sit after a hysterectomy and preventing prolapse after a hysterectomy explain why avoiding long-term straining matters for your pelvic floor.

Gas, bloating and a swollen belly

Trapped gas and bloating often come together with constipation in the first week. After laparoscopic surgery, the gas used to inflate the abdomen can also cause shoulder-tip pain for a day or two. Walking, small meals and treating constipation usually help. Swelling that comes and goes for weeks or months is common too; our article on swelly belly after a hysterectomy explains it, and our guide on how to sleep after a hysterectomy has tips for getting comfortable at night.

Does a hysterectomy cause long-term constipation?

Older, mostly retrospective studies raised the worry that a hysterectomy might cause lasting constipation. Better-designed prospective studies have not confirmed this:

  • A Dutch study of 413 women followed for three years after a hysterectomy for benign conditions found that only 2% of women without constipation before surgery developed it afterwards. Of those who were constipated before surgery, nearly half no longer were three years later.[16]
  • An Israeli study compared women having a hysterectomy with women who did not have surgery and found no difference in constipation, stool frequency or straining at 3 and 12 months.[17]
  • A Swedish study following 120 women for three years found no rise in constipation or difficulty emptying the rectum after abdominal or vaginal hysterectomy. It did find a small increase in mild symptoms of leaking gas or stool, especially in women who had a tear of the anal sphincter during childbirth.[18]

Radical hysterectomy for cancer is different: it removes more tissue around the cervix and can affect the nerves to the bowel and bladder, so bowel changes are more likely and worth discussing with your oncology team. If you had a simple hysterectomy and constipation lasts beyond the first few weeks, or your bowel habits change in a way that is new for you, see your doctor rather than assuming it is “just the surgery”.

When to call your doctor

Most constipation after a hysterectomy is a nuisance, not a danger. But a slow or blocked bowel, and rarely a bowel injury from surgery, can look like constipation at first. Contact your surgeon promptly if you:[3][7][19]

  • cannot pass any gas and have not had a bowel movement
  • have nausea or vomiting, or cannot keep food or fluids down
  • have a belly that is becoming more swollen, hard or painful
  • have pain that your pain medicine is not controlling, or pain that gets worse after the first few days instead of better
  • have a fever above 100.5°F (38°C)
  • still have no bowel movement after taking the laxatives your team recommended for a few days, or your stools are still hard after a week of a stool softener[14]
  • see blood in your stool, or have frequent watery diarrhea, especially after antibiotics; five or more episodes a day lasting more than a day or two, fever or severe cramps can be signs of a bowel infection called C. difficile colitis[20]

Bowel injuries during laparoscopic hysterectomy are rare, around 1 in 256 operations in a large review, and most are found and repaired during surgery. In about 4 in 10 cases, though, the injury was only diagnosed more than a day later, and a late diagnosis is what makes these injuries dangerous.[21] That is why fever, worsening belly pain, a swollen belly or vomiting after surgery should always be checked quickly. If you feel very unwell, have severe pain, or are vomiting repeatedly, go to the emergency room or call 911.

For other recovery questions, see our frequently asked questions about hysterectomy and our guide to laparoscopic hysterectomy.

Sources

  1. NHS. Hysterectomy: recovery. nhs.uk
  2. Berlund P, Reddington C, Cheng C, Healey M. Constipation after elective laparoscopy for benign gynecological indications: a prospective observational study. Journal of Minimally Invasive Gynecology. 2023;30(10):827–832. pubmed.ncbi.nlm.nih.gov
  3. MedlinePlus. Intestinal obstruction and ileus. US National Library of Medicine. medlineplus.gov
  4. Edenfield AL, Siddiqui NY, Wu JM, et al. Polyethylene glycol 3350 and docusate sodium compared with docusate sodium alone after urogynecologic surgery: a randomized controlled trial. Obstetrics & Gynecology. 2016;128(3):543–549. pubmed.ncbi.nlm.nih.gov
  5. Patel M, Schimpf MO, O’Sullivan DM, LaSala CA. The use of senna with docusate for postoperative constipation after pelvic reconstructive surgery: a randomized, double-blind, placebo-controlled trial. American Journal of Obstetrics and Gynecology. 2010;202(5):479.e1–5. pubmed.ncbi.nlm.nih.gov
  6. McNanley A, Perevich M, Glantz C, et al. Bowel function after minimally invasive urogynecologic surgery: a prospective randomized controlled trial. Female Pelvic Medicine & Reconstructive Surgery. 2012;18(2):82–85. pubmed.ncbi.nlm.nih.gov
  7. MedlinePlus. Hysterectomy – laparoscopic – discharge. US National Library of Medicine. medlineplus.gov
  8. MedlinePlus. Getting out of bed after surgery. US National Library of Medicine. medlineplus.gov
  9. Rasouli MA, Dancz CE, Dahl M, et al. Effect of prunes on gastrointestinal function after benign gynecological surgery: a randomized control trial. Langenbeck’s Archives of Surgery. 2022;407(8):3803–3810. pubmed.ncbi.nlm.nih.gov
  10. Dimidi E, van der Schoot A, Barrett K, et al. British Dietetic Association guidelines for the dietary management of chronic constipation in adults. Journal of Human Nutrition and Dietetics. 2025;38(5):e70133. pubmed.ncbi.nlm.nih.gov
  11. Short V, Herbert G, Perry R, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database of Systematic Reviews. 2015;(2):CD006506. pubmed.ncbi.nlm.nih.gov
  12. Tuscharoenporn T, Uruwankul K, Charoenkwan K. Effects of postoperative gum chewing on recovery of gastrointestinal function following laparoscopic gynecologic surgery: systematic review and meta-analysis of prospective studies. Journal of Clinical Medicine. 2024;13(10):2851. pubmed.ncbi.nlm.nih.gov
  13. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Treatment for constipation. niddk.nih.gov
  14. MedlinePlus. Stool softeners. US National Library of Medicine. medlineplus.gov
  15. Woodbury CF, Coughlin AC, Dubois B, Romanova A. Prevention of postoperative constipation in urogynecology patients: a systematic review. Urogynecology. 2023;29(2):175–182. pubmed.ncbi.nlm.nih.gov
  16. Roovers JP, van der Bom JG, van der Vaart CH; HysVA Study Group. Hysterectomy does not cause constipation. Diseases of the Colon & Rectum. 2008;51(7):1068–1072. pubmed.ncbi.nlm.nih.gov
  17. Sperber AD, Morris CB, Greemberg L, et al. Constipation does not develop following elective hysterectomy: a prospective, controlled study. Neurogastroenterology & Motility. 2009;21(1):18–22. pubmed.ncbi.nlm.nih.gov
  18. Forsgren C, Zetterström J, Lopez A, et al. Effects of hysterectomy on bowel function: a three-year, prospective cohort study. Diseases of the Colon & Rectum. 2007;50(8):1139–1145. pubmed.ncbi.nlm.nih.gov
  19. MedlinePlus. Hysterectomy – abdominal – discharge. US National Library of Medicine. medlineplus.gov
  20. MedlinePlus. Pseudomembranous colitis. US National Library of Medicine. medlineplus.gov
  21. Llarena NC, Shah AB, Milad MP. Bowel injury in gynecologic laparoscopy: a systematic review. Obstetrics & Gynecology. 2015;125(6):1407–1417. pubmed.ncbi.nlm.nih.gov

This article is for general information and is not a substitute for medical advice. Always follow the bowel and pain medicine plan your surgical team gives you, and contact them or emergency services if you cannot pass gas, are vomiting, or have worsening belly pain or a fever.

Similar Posts