GLP-1s + Colonoscopy Aftermath Debacle

NOTE: This is my experience.

I have medical training and knew what to do. Unless you have also had medical training
(and I don’t mean Dr. Google),
PLEASE CONSULT YOUR HEALTHCARE PROVIDER OR GO TO THE EMERGENCY ROOM!
I have no connections, nor am being endorsed by anyone, or selling anything
that I mention in this post. 

The Down and Dirty

I had a colonoscopy three weeks ago and had to adhere to the new anesthesia regulations about surgeries when it comes to people on GLP-1s.

The length of time various GLP-1 medications continue to impact a patient were considered in developing these recommendations. Example recommendations include:

If daily dose: Consider holding day of surgery/procedure.
If weekly dose: Consider holding one week before surgery/procedure.

I wrote about the experience in Surgery on GLP-1s: Anesthesia Risks which included how GLP-1s affected my own colonoscopy.

This post, however, is about the post-colonoscopy experience with my Mounjaro. There was no information about when to start the injection again. I had been off for eight days prior to the colonoscopy, so when I went home, I took my Mounjaro shot.

As far as I can tell, no post-op or post-procedure studies have been done. This is one reason I am sharing mine. Well, besides I over-share anyway.

When I was looking for studies, I also took a peek at post-colonoscopy complications and found this:

The most common cause of abdominal pain and distention after colonoscopy is ileus, which is mostly caused by sympathetic over-stimulation, excessive air insufflations, and the effects of opiates used for sedation.

I have not seen my records so can’t speak about the opioids that might have been used during my sedation, but will be asking for them asap. Oh, look at this piece of information:

Opioids can slow the whole digestive tract’s motility (the movements inside the gut). Reduced motility is one of the causes of constipation and of other symptoms of opioid-induced bowel dysfunction (abnormal functioning of the gut).

So not only do we have the GLP-1 slowing everything down in the GI tract, but now we’ve added opioids. In “Bowel Movements After Surgery: What to Expect,” these statements were made:

Many people experience constipation after surgery due to the following factors:

• Medications. Pain medications, diuretics, muscle relaxants, and anesthesia can cause constipation in some people. Opioids, in particular, can reduce bowel movements.

• Dietary changes. Some people may need to avoid food before surgery, while others may need to restrict or change their diet for some time after the operation. Too little fluid and food can cause constipation.

• Complications of Constipation After Surgery:

  • Anal fissure – An anal fissure occurs when a large or hard stool causes skin in the anus to tear.

  • Fecal impaction – Chronic constipation can cause hard stool to become stuck in the intestines.

(emphasis mine)

My Story of Impaction or Ileus

I say “Impaction OR Ileus,” because I was not technically diagnosed. I lean more towards ileus, but that’s because my experience was so horrible.

Of course, the goal is to not get constipated at all when on GLP-1s like Ozempic and Mounjaro. I’ve been on Mounjaro (10mg, 12.5mg, and 15mg) for seven months now and nothing like this has happened until today. Well, it’s probably been happening for a couple of weeks, but today, my stool was impacted.

A fecal impaction is a large lump of dry, hard stool that stays stuck in the rectum. It is most often seen in people who are constipated for a long time.

The real life definition is not being able to poop for anything in the world. It feels like a brick is inside your butt and you want to cry thinking you’re going to have to go the hospital and have surgery to get the brick out.

Agony

Yes, the perfect word. Agony.

I woke up today needing to have a BM, but nothing was happening.

I was on Trulicity for a year without any constipation.

I had slower BMs with the Mounjaro, but I have taken magnesium a couple of times a day for months and that helped. If that didn’t, I took a decent dose of Milk of Magnesia (MoM) and things were fine after that. In January, I quit Diet Coke and started drinking 40, then 80, and now at least 120 ounces of water a day. I was sure any constipation was totally out of my possible experiences. I now walk at least 2.5 miles a day, increasing the amount daily. Okay, so exercise is supposed to make constipation nearly impossible, too.

When I knew things had slowed down too much, I began an aggressive strategy to get things moving. Last week I took a couple of laxatives a day, but that didn’t move anything. I took a hefty dose of MoM yesterday to get it all out. Nothing.

This whole week, I have been meticulous with my diet and even included eating three Dragon Fruits which are almost pure fiber and guaranteed to make a GLP-1er poop.

Not me.

Professional Poop Counselor

I was a midwife and birth worker for over 30 years, so I know a thing or two about the body and how to deal with innard complications. I have counseled women and their families for decades about bowel movements and how to avoid constipation or diarrhea. You would think I could help myself! Apparently, the “side effect” of constipation with GLP-1s added to the colonoscopy and anesthesia was more than my body could take.

I had an appointment this morning that I walked to and from, all the while needing to poop. I tried while at their office, but nothing.

Once I got home, I tried again. And again. Nuthin’.

Desperation

I was sweating and scared I was going to have to go to the hospital. I freakin’ knew what to do, but was avoiding the ultimate procedure as best as I could.

Sitting on the toilet and beginning to cry, I made an Instacart order for five bottles of a Fleet enema. I was clearly out of my mind. They were delivered 20 minutes later and I was crying in earnest by that time.

I’ve given several hundreds of Fleet enemas and at least a hundred HHH enemas (High, Hot, and Helluva-Lot), so am clear about how enema insertion goes.

I laid a towel down, white, like a goofball. I intended to get on the floor and lie on my left side (the water can flow downhill to the colon in that position). I was still crying, but trying to chill because I had what I needed to get the job done.

Before lying down, I grabbed several purple Nitryl gloves, lube, baby wipes, and a pillow. And my phone in case I needed to call someone for help.

Reminders of Being Seriously Fat

I began to get on the floor and had flashes of memories of falling and not being able to get up without help. One time during lockdown, I had to call EMS because no one was home when I fell. It took four EMTs to help me and I shat on the floor as I was lifted up to standing. I weighed 400 pounds that day. Definitely one of the most humiliating experiences ever.

Today, it was very difficult to get on the bathroom floor and knew when I got down there, it was going to be hell getting back up. I had to put that out of my mind for the moment. Except, with an enema, it’s a race to get to the toilet (which was 6 inches away from me) and I began worrying again about how fast I was going to be able to get back up. Too late to change plans. I certainly wasn’t going to lie on my bed to do the enema!

I put gloves on and picked up the Fleet bottle.

Talking Without Saying Anything Disturbing

I will talk in euphemisms for this part.

You know when you’re going to frost a cake with those cool pre-filled tubes of icing? How if you’ve used them before and had them for a longggg time, they harden in the tip you forgot to take off? And then you have to get a toothpick to poke at the crusty icing in the decorative tip and you try and try to poke a hole in it and it just won’t work? How you squeeze the tube and poke at the same time and nothing penetrates that hardened icing? How the toothpicks just break over and over again, making a big mess you’re going to have to clean up now, too?

You only have the one tube and need it for the cake. The birthday party is less than an hour away, so there’s no time to get a new tube that is soft and easy to squeeze, so you plot how best to get through the cemented icing, knowing there is creamy icing inside the tube you have to have. You can’t mess up your newly manicured nails, so put pretty purple gloves on, and begin to manually chip away at the hardened mess at the end.

You ignore the challenge and are intensely focused on the job at hand. (Literally.)

When you finally get all the cement off the tip and the end of the tube, you squish the icing onto the cake and it is a bloody mess, but you shake your head and just keep going because the guests are coming over soon and you have a LOT to clean up.

Getting Back on the Saddle

It was just as difficult getting off the floor at 200 pounds as it was at 350 pounds. I could do it, but it was slow and very painful on my knees. Once I gathered myself and could think again, I cried with relief and began cleaning up. The bathroom was a wreck and several towels needed to be washed and bleached.

It’s eight hours after the ordeal and I am still wigged out by it. If I didn’t know what I know as a former midwife, I would have gotten that done in the hospital. The thought of going to the ER because I was “impacted” sent me into despair. So I manually disimpacted myself. Not something for the faint of heart or without prior education about what you’re doing.

I called a nurse-friend of mine to make sure the extra coloring in my stool was okay or if I needed to go to the ER. She said to watch it and if I was bleeding on a towel, go in. Thankfully, it stopped quickly. I researched why it happened, but will leave that to you to do if you want to know more.

A Ton of Prevention Instead of a Ton in the Colon

I set to researching what in the heck had just happened and learned the information I wrote about up where I started the post. My head was spinning reading the advice and the warnings about what to do and what not to do to keep from getting constipated (or impacted) again. I decided to try the fiber route and found capsules by Better Fiber by Organics Ocean (available only from the company). It’s on its way and I’ll let you know how it goes after I try it for a week.

My daughter, also on Mounjaro, swears by a type of magnesium called Oxy-Powder (found on Amazon, too), also capsules. She is sent me a bottle and I will let you know if that works, too.

I’m on a mission to avoid this again and, if I can, help others avoid the same fate as well.

Quick note, however. Fiber might not be the right choice after surgery! And too much fiber can make you feel terrible and also constipate you. Awesome! Who decides the right amount for our bodies? We do through trial and error. Oh, my.

GI Docs & Anesthesiologists Need to Educate Themselves

They have done an alright job on pre-surgery and procedure advice when it comes to GLP-1s. They are still watching to see if they need to change the protocol even more. But, the aftercare is completely lacking. This is unacceptable.

And if you are going to have surgery, bring this up with the doctor and the anesthesiologist. Most people don’t see the anesthesiologist until immediately before the surgery, so an in-office visit or virtual appointment might be called for. If I have to have surgery again, you can bet I will be better armed.

If you have had surgery or a procedure with post-op GI complications and are on GLP-1s, please comment below so I know I am not alone.

In the meantime, take your fiber, drink tons of water, and walk your bottom off… so your bottom doesn’t fill up with poop!

I’m on a mission!