Gastric bypass surgery is one of the most common procedures for obesity treatment. Those patients who undergo procedures such as Roux-en-Y gastric bypass (RYGB) typically lose approximately 60% of their body weight, which is an adequate level to encounter weight-related health problems, including type 2 diabetes mellitus.

Pain immediately after surgery is expected, but for some patients persistent gastrointestinal symptoms and chronic pain may persist. If the symptoms are sufficiently problematic it should not be taken for granted. Patients must consider these symptoms before having to choose gastric bypass surgery as a treatment option.

What Causes Abdominal Pain After Gastric Bypass Surgery?

Pain is a subjective thing. The way to rate and scale pain is different for everyone. Pain after gastric bypass surgery is usually an unwanted outcome that needs to be cared for properly.

This article will explain the sites and possible causes of pain and some options how to control pain after gastric bypass surgery.

Upper Abdominal Pain after Gastric Bypass

There may be many reasons for stomach pain after gastric bypass. It may even surface years after having surgery.

• Eating habits – Stomach pain after gastric bypass can occur because a smaller pouch of the stomach is left behind. Eating more significant portions will stretch it. That leads to an uncomfortable feeling of fullness and nausea. Eating slowly and in smaller portions will help with relieving pain.
• Vitamin deficiency – Gastric bypass stomach pain can also be caused by a vitamin deficiency. As nutrient absorption is reduced after gastric bypass, the bar for vitamin deficiency to occur is much lower than for the average person. Vitamin deficiencies can be detected based on lab tests.
• Chronic gastric bypass abdominal pain after gastric bypass has been linked to vitamin deficiencies of Iron and/or Vitamin D. Adding supplements after consulting your doctor should help in pain relief.
• Acid reflux/heartburn is another contributing factor to stomach pain after gastric bypass.
• Gastric pouch ulcers, marginal ulcers, hiatal hernia: consult your surgeon for evaluation if you believe you may have these conditions. You may need an endoscopy.

Left-Sided Pain after Gastric Bypass

• During surgery, some surgeons make an incision right below the ribs to staple the rerouted intestines. During this process, stretching occurs that can bruise the muscles and damage the nerves. This can cause horrible pain on the left side after gastric bypass. Generally, pain is felt below the ribs, and it lasts transiently for a few weeks after surgery. However, pain is reproduced with posture changes and by moving the torso. Over time, you may adapt and learn how to accommodate the discomfort.

Lower Abdominal Pain After Gastric Bypass

• Constipation, diarrhea, and IBS are commonly linked to obesity. Usually, pain is diffuse and crampy in the lower abdomen.
• Constipation is controllable after gastric bypass if you follow appropriate treatment instructions.

Gas Pain After Gastric Bypass

• A key element in performing gastric bypass surgery is to inflate the abdomen with CO2. This helps to make room for performing the procedure; however, after surgery is over, some CO2 remains.
• As naturally, CO2 gas collects on the left side of the abdominal cavity. The most common complaint is a pain in the upper left corner of the abdomen and sometimes left shoulder. The best method to relieve the pain is to walk as soon as possible. Walking will increase the absorption rate, as it makes gas move more.
• Doing deep breathing exercises helps to push out gas as it puts more pressure on the abdominal cavity.

Back Pain After Gastric Bypass

• Lower back pain is a common problem that has been linked to obesity. Increased body weight puts more mechanical pressure on the spine. Gastric bypass surgery treats back pain by inducing weight loss. In many cases, lower back pain improves.

Chest Pain After Gastric Bypass

• If at any point chest pain is experienced - heart or lung problems must be considered. Please consult your doctor for evaluation.
• Chest pain might be related to the incision made in the upper abdomen during procedure. This is usually an incision site pain.
• Chest pain after eating may be a sign of esophageal dysmotility called dysphagia. It improves with time and medications. However, eating small chunks of food and chewing correctly helps a lot of battling this pain.

Other Causes of Pain After Gastric Bypass

Gastric Pouch Pain

Several problems can affect the gastric pouch after gastric bypass and cause abdominal pain, including:

• Ulcer disease
• Fistula
• Reflux disease
• Blockage (stenosis)

Gallbladder Related Causes of Pain

Rapid weight loss increases the concentration of cholesterol, leading to gallstones. Your doctor might prescribe medication to prevent gallstones.

Small Intestine Related Causes of Pain

A healthy digestive tract is rerouted to induce weight loss in gastric bypass surgery. Several small intestinal complications can arise that can lead to abdominal pain:

• Internal hernias
• Adhesions
• Incision site hernias
• Blockage (obstruction)

Red Flags in Pain After Gastric Bypass

Consult your surgeon immediately if you experience the following symptoms after having gastric bypass surgery:

• Excessive or constant vomiting
• Inability keep liquids down
• Severe heartburn
• Horrible abdominal pain
• Left shoulder pain
• Sharp, burning pain below the breast bone
• Nausea, cramps and bloating

Although the complication rate after gastric bypass surgery is low, the most important take-home message regarding stomach pain after bariatric surgery is to follow up with a bariatric surgeon. Bariatric surgeons will be more aware of the side effects of gastric bypass versus primary care physicians.

How Long Will the Pain Last?

The pain after gastric bypass operation usually lasts a few weeks. However, you will notice a significant improvement in the first couple of weeks. It is important to get plenty of rest and avoid any excessive physical activity.

As you heal with time, follow your bariatric surgeon’s recommendations regarding pain medications and diet.

Gastric bypass and absorption of drugs

Absorption of Drugs

When you take medicine, it gets into the stomach, and then it is broken down by stomach acid. Once it is broken down, depending on the properties of a medication, either it gets absorbed in the stomach in acidic medium or absorptive lining of the small intestine in the alkaline medium.

Pain Medication Absorption After Gastric Bypass

After surgery, you have a smaller size of the stomach with less acidity, and since you have lost the surface area of the small intestine, the drug absorption is mostly affected. This problem can be overcome by crushing the medication, opening the capsules, or getting the liquid formulations.

So, these drugs may be needed in altered forms or maybe in higher doses.

What is the Best Pain Medication for Chronic Pain after Gastric Bypass

It is important to know what pain medication you can take after gastric bypass. Pain medications like NSAIDs have an altered effect in gastric bypass patients. As most of these pain killers block mucous production that is protective of the stomach lining, in patients with gastric bypass pain medication (like NSAIDs) are more soluble due to altered acidity. This can increase the risk of:

• Ulcers
• Bleeding
• And even perforations

Avoid Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Gastric bypass patients should not take NSAIDs. This includes:

• Aspirin (Excedrin, Bayer)
• Naproxen (Aleve)
• Ibuprofen (Motrin, Advil, Nuprin)

This also includes prescription NSAIDs:

• Vimovo
• Lodine
• Relafen
• Daypro
• Voltaren
• Indocin

Approved Medication for Pain Relief

Opioids
Opioid drugs such as hydrocodone (Vicodin), oxycodone (Percocet, OxyContin), codeine, and morphine (Avinza, Kadian) can be taken after gastric bypass surgery. However, these medications should be prescribed and used with caution.

Acetaminophen
Pain killers that are acetaminophen-based, such as Tylenol, are recommended for patients who have recently undergone gastric bypass surgery. It is common for opioids and acetaminophen drugs to be prescribed together to help with pain and discomfort.

Bottom line

• Pain after gastric bypass is a complex problem and should not be taken lightly.
• If you have any red flag symptoms, do not wait - consult your surgeon. After all, it may be an early sign of complications. Therefore, better safe than sorry.
• Only pain medications containing acetaminophen (paracetamol) and opioids are safe to use after gastric bypass surgery. NSAIDs should be avoided as they have a higher risk of side effects.
• As a gastric bypass patient, you must protect yourself. When your physician prescribes a drug for you, ask questions. Remind them that you are a gastric bypass patient. Request to know the effects of the drug as they concern you. You may need to change your primary doctor to one who is knowledgeable about gastric bypass and patient needs.
• Hopefully, you have a better idea of dealing and treating the pain with gastric bypass surgery after reading this article.