Bariatric Surgery provides an unparalleled tool that can be used to overcome morbid obesity, but because the procedure is extreme, the patient is exposed to new potential problems. Be well informed and pay attention to changes in your body. Don’t be afraid to go to the doctor. You don’t want your wonderful new life compromised by a hit you weren’t watching for.

Watch for These Bariatric Post-Op Problems

1. Vomiting – Avoid bringing up your food by chewing well, waiting 30 seconds between bites, and limiting the size of the bite you put in your mouth. Call your surgeon immediately if you are unable to keep water down. Vomiting may be caused by eating too fast, eating too much, not chewing food to the consistency of applesauce, drinking liquids with or too soon after your food, or a stricture which is a narrowing of the surgical opening from the pouch to the intestine.

2. Food Blockages can occur when you haven’t chewed food well and it gets stuck in the outlet between your pouch and intestines. Usually, the food will soften and work its way through on its own. While the food is clogged, it can be very uncomfortable and you will be able to feel pressure of the blockage. It is not a good idea to drink fluids on top of the clogged food, but a few small sips of very warm water can sooth tissues and loosen the food. A food blockage can cause vomiting.

3. Dumping Syndrome is technically only supposed to happen with gastric bypass but it is common in those who have been ‘sleeved’. Dumping is not simply ‘throwing up’ but a condition caused by an intolerance to foods that are high in sugar or fat.

When a food rich in fat, sugar, carbs or all three enters the intestines without first being even partially digested by gastric juices present in the full stomach – the body struggles to dilute the offending food, creating an unpleasant autonomic response.

This reaction occurs shortly, within five to fifteen minutes after eating. and includes a combination of nausea, vomiting hot flash, cold sweats, sharp cramps, diarrhea and overwhelming fatigue. This reaction is so unpleasant that most will avoid foods that caused the episode.

Dumping syndrome is negative reinforcement that helps many to avoid bad foods. Some erroneously consider themselves ‘lucky’ they don’t get sick after eating sugar, but this strong behavioral deterrent can remain a strong ally for years.

4. Reactive hypoglycemia is a set of symptoms created by low blood sugar usually 60 to 90 minutes after eating a meal high in carbohydrates. It can also be caused by skipping a meal or going too long without eating. Symptoms of hypoglycemia may include sweats, rapid heartbeat, headache, nausea, vomiting, lightheadedness, confusion, irritability, and inability to focus.

The problem is caused by an imbalance between blood glucose and insulin in the blood. The rush of insulin stays in the blood after the glucose from the meal has been used. This over correction causes low blood glucose or hypoglycemia. It is frightening to lose control of the senses and in extreme cases some are unable think clearly or recognize what is happening. Keep a protein bar or nuts in your bag at all times, so if you have not eaten and feel the tell tale headache coming on, you can stop the progression. To treat reactive hypoglycemia, drink a few ounces of juice or skim milk or a few bites of a low glycemic food, cheese or peanut butter on a cracker, to offset the insulin.

To prevent reactive hypoglycemia, eat three well-balanced meals that include protein and vegetables. Some prefer to manage the onset condition by eating five small meals each day. Eat the protein first, followed by the vegetables. If the symptoms continue, contact your clinic or bariatric nurse clinician.

5. Alcohol Use – do not use alcohol the first year after surgery. After that use alcohol with great caution, understanding that its effects are greatly amplified when compared to before bariatric surgery. With bariatric organ manipulation, the alcohol is not digested before reaching the intestines. It is rapidly absorbed into the body at full potency and you could become very drunk or even incapacitated in a short period of time. Alcohol poisoning can damage your liver or even cause death.

There is also a risk of addiction to alcohol after surgery that could affect your health, relationships and well-being.

6. Transfer behaviors or cross addiction – Many use food to satisfy emotional needs. When this is no longer possible after weight loss surgery, they turn to other behaviors instead, including alcohol abuse, excessive shopping, gambling, or promiscuous sexual behavior. These behaviors can be damaging and dangerous. Call your surgical center and ask for help.

7. Constipation after bariatric surgery is common because of pain medications, surgical interruption of the GI tract and small amount of food being eaten. If constipation becomes uncomfortable, or you have gone seven to ten days without a bowel movement, its important to treat the situation before needing a manual extraction. (yep, that is just what it sounds like)

Most patients know to use stool softeners but softening is not enough. The wavelike movements must be restored in order to move softened stool out of the body. A laxative slowly and gently squeezes the colon. Most doctors say its okay to take Colace as a softener and Dulcolax as the laxative. Take both in the evening before bedtime with plenty of water and the situation should correct itself in the morning. A second attempt is occasionally needed. If you still do not go, contact your doctors office as you will need their help.

After things are back to normal, include higher fiber foods in your diet – a tablespoon of ground flax seed has a nutty flavor and a flavorful addition to a protein smoothie. Drink at least 64 ounces of water each day between meals. Use of Colace or Miralax can keep stool soft and moving along.

8. Gas problems are also common after bariatric surgery. Gas is used to separate the organs during surgery and is absorbed more quickly upon walking after surgery. When you begin eating, if you have intestinal gas pains try to determine which foods are creating the problem and eliminate them. Gas and rumbling is usually caused by dairy products, as lactose intolerance is common in new post ops. Straws and chewing gum can also cause gas due to gulping and swallowing air. Even though yogurt is a dairy product, the live bacterial cultures produce the enzyme that digests lactose.

9. Gallstones are clumps of cholesterol and other matter that form in the gall bladder. During rapid or massive weight loss, there is a greatly increased risk that your body will make gallstones and it is common for a bariatric post op to need a procedure to remove the gall bladder secondary to the bariatric surgery.

Symptoms of gallstones would include feeling a steady, severe pain on the right side of your abdomen going to your back that starts soon after eating a meal. You might also feel bloated or nauseated and vomit after meals as the condition progresses. Call your surgeon if you present these symptoms. Some surgeons prescribe a medication called Actigall for their higher risk patients to take for a few months after surgery to help prevent gallstones from forming.

Stay tuned for the other half of our list! There are more issues to watch out for.

25 thoughts on “Watch for These Bariatric Problems!

    • Estella Denault says:

      I’ve been having gas problems. Can’t figure out what is causing it. What did you do to help I’m one year out

  1. Cynthia says:

    Be aware of the possibility of Wernicke’s Encephalopathy that is not alcohol related. This is being seen more now in bariatric patients in the form of thiamine deficiency. This is a serious illness. Characterized with shaking, balance and memory problems as well as visual changes.

      • Alison Garcia says:

        Hi! You can get more thiamin from these sources: yogurt, several varieties of seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts. Those are all great ways to get that ever important thiamin, or B1.

  2. Vickie says:

    Thank you for an informative article. We should all listen and be aware of changes in our bodies. Seeking medical help and being an advocate for better health. Thank you.

  3. Mari Mckellip says:

    Have been experiencing low blood sugar and also vomiting EGD shows hiatal hernia. The Dr is considering a radio frequency abalation. however insurance will not pay most likely. If that denial comes then we will be doing a revision from Sleeve to gastric bypass and repair the hernia at the same time. When having a revision of this type is the pain really bad and does the pt have to have an NG tube for a while?

    • Susan Maria Leach says:

      Mari, I understand you are scared and I am sorry that you need more surgery. No one wants that. The medical team is very good at managing any pain you may have. Make sure you speak up. You will probably feel better without that hernia giving you such trouble! Susan

    • Susan Maria Leach says:

      Unfortunately, orange juice is NOT a food for someone who has had obesity surgery as it has too much sugar and liquid calories. Maybe Crystal Light Sunrise Orange drink will work as its super good!

  4. Carol says:

    Thank you for addressing the reactive hypoglycemia. I developed this at about 18 months out from the sleeve procedure, even though my diet was compliant. Just waiting too long to eat. This had never been discussed with me as a possibility and I didn’t know what was happening or what counter measures to take. I would just lay down until the symptoms passed. Again, I had no idea what was really happening or how dangerous it can be and my blood sugar would drop really low. I talked to my Dr about it and was told to eat some protein to counter act the symptoms, but some protein choices take time to metabolize. Now, I know to eat something with a some carbohydrates (to bring the blood sugar back up) along with the protein to stabilize.

    • kathy says:

      Hi. I know how you feel with the hypoglycemia. I had my surgery back in 1997 and when I get that way, I grab a piece of cheese. I start to feel better very shortly afterwards. Cheese works pretty quickly.

      • Marg says:

        I agree with you, Kathy. I also had my surgery back in earlier 1997 and cheese has always been my go-to solution. I was also told by a local physician that skim milk is the simplest sugar that your body breaks down easily. I have also used skim milk and that works great, as well.

  5. Melissa Lamprey says:

    I am 22 months post op tomorrow 1/26/17 gastric bypass.Gallbladder removed 2/4/17.I am really confused and need some help.I constantly have gas bubbles or air bubbles when I eat or drink something.Very uncomfortable they are stuck and won’t break up.Or after a couple bites of food I am burping and hiccuping very loudly uncontrollably.I do have pancreas issues on Creon high doses.I have Exocrine Pancreatic Insufficiency.Also tmi sorry does anyone else have issues with gas that will clear a room when they pass it?And how long does it take to rid the body of the gas used in the surgery?

    • Suzanne Shaw says:

      It sounds like you are eating way too quickly and not chewing well. Remember to take bite no bigger than the tip of a pencil eraser, and chew until liquid. Rest your fork or spoon between bites. It should take you 20 min to finish meals, eating BEYOND that time will actually push the food through faster and cause you to overeat.

  6. Mily says:

    Had my sleeve done a year ago. I’ve lost 115 lbs. I’ve been experiencing some dull pain under my rib cage on my LEFT side. It comes and goes. Sonogram shows nothing. My spleen is slightly enlarged but the doctor is not concerned. I do have a several gall stone and sludge. (other side which cause me no discomfort at this time) already input would be appreciated.

  7. Karen says:

    I m am 2 years out Dec 2018, I had no issues till like 2 months ago can’t keep anything down not even liquids. It feels like it goes down only to my bottom of rib cage and that’s as far as it goes. Then back up . I also had problems same time with the texture of food and nothing taste right anymore it feels like it gets thick in my month. I went from 362lb to 135lb and still losing I’m nothing but skin and bones please help
    Karen Barker

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