Managing Digestive Issues After a Hysterectomy

Our Registered Dietitians at Ignite Nutrition specialize in a number of different areas, including gut health and women’s health. For many people, these two areas can overlap. In particular, women who have had a hysterectomy have a high likelihood of experiencing digestive issues after their surgery. I’ve certainly seen this in my experience working with women who have GI issues. Today, we’ll explore the connection between hysterectomies and digestive issues, and how nutrition can play a role in managing symptoms.

What is a Hysterectomy?

A hysterectomy is a surgical procedure to remove the uterus. It may be done for a variety of reasons, including gynecologic cancer, fibroids, endometriosis, uterine prolapse, abnormal bleeding, and chronic pelvic pain. In fact, hysterectomies are one of the most common surgeries performed among women.

Digestive Issues After a Hysterectomy

Because a hysterectomy occurs close to the bowels, the surrounding nerves and pelvic floor could potentially become damaged during the procedure. In addition, removal of the uterus can cause other organs like the intestines and bladder to shift downwards. For this reason, changes in bowel habits are common after having a hysterectomy.

Some of the gastrointestinal symptoms commonly seen after a hysterectomy include:

• Gas and bloating
• Constipation
• Straining for a bowel movement
• Stool incontinence

These symptoms may occur immediately after your surgery, but for some people, these symptoms can persist even after they’ve recovered from surgery.

Diet and Hysterectomy

For women who have experienced changes in digestion and bowel habits after hysterectomy surgery, diet can play an important role in managing these new and varied symptoms.

As a dietitian specialized in both gut health and women’s health, here are some of my favourite post-hysterectomy diet tips!

Fibre

Fibre plays three main roles in your digestive system:

• Maintaining gut motility (how quickly things move through the gut)
• Maintaining appropriate stool consistency
• Feeding your gut bacteria

Women should aim for about 25 grams of fibre per day. Research shows that many people living in North America struggle to hit this target and generally only consume about 15 grams per day. I’ve definitely seen this struggle with my own patients as well – it can be difficult to meet those goals!

Fibre comes from plant-based foods such as whole grains, fruits, vegetable, pulses (like chickpeas and lentils), nuts, and seeds. There are two main types of fibre: soluble and insoluble.

Soluble fibre is a type of fibre that dissolves in water and forms a gel. This helps create a soft, well-formed stool and adding bulk. For people struggling with stool incontinence, this can help improve the sensation of a bowel movement and potentially reduce stool incontinence. Soluble fibre can be found in oats, legumes, psyllium husk, chia seeds, flax seeds, and avocado.

Insoluble fibre is a type of fibre that doesn’t form a gel in the digestive tract. Instead, it helps stool move through the bowels more quickly and helps keep bowel movements regular. If you’re struggling with constipation, increasing insoluble fibre can be a great way to get things moving! Insoluble fibre can be found in wheat bran, whole grain breads and cereals, flax seeds, fruit with the skin, pulses, and nuts and seeds.

Dietary Variety

You’ve probably heard the saying “variety is the spice of life”, but did you know that research shows that people who have more dietary variety have better overall health and wellbeing? Dietary variety is determined by the number of different foods you eat at least once per week. In particular, focus is placed on whole foods like whole grains, vegetables, fruit, dairy, lean proteins and vegetarian protein sources like beans, chickpeas and lentils. My favourite suggestion to give my patients to increase dietary variety is to aim to get 30 different “plant points” per week. Getting a wide variety of plant-based foods weekly ensures that your gut bacteria are being well fed by fibre. While we still don’t know exactly how, a healthier gut microbiome may be associated with better digestive health.

Meal Timing and Spacing

If you’re struggling with gas and bloating, meal timing and spacing can be important to consider. Skipping meals or eating large portions may worsen gas production. For this reason, it’s best to try eating small, frequent meals throughout the day rather than eating large meals.

Eating Behaviours

Did you know that for many people, bloating isn’t caused by what they eat. But rather, how they eat? If you’re struggling with bloating after your hysterectomy, try slowing down and ensuring you chew your food well. By slowing down, you’re less likely to swallow as much air, which can improve symptoms of bloating.

Low FODMAP Diet

One of the most prevalent dietary factors associated with bloating is poor absorption of short-chain carbohydrates called FODMAPs. Consumption of food containing FODMAPs may result in fermentation leading to gas production. A low FODMAP diet, in which high FODMAP foods are limited for a period of time, may be recommended to reduce bloating and gas. It’s important to talk to your doctor or dietitian before starting a low FODMAP diet, as it’s quite restrictive.

Take Home Message

If you have recurrent bowel symptoms after a hysterectomy, discuss it with your family doctor to ensure that you get properly screened for other gut disorders that may be contributing to your symptoms.

Do you feel like having a hysterectomy has caused digestive issues? If so, schedule an appointment with one of our gut health dietitians to learn more about how dietary interventions may help manage your symptoms.