Gut and Hormone Health After Surgery (or a Stressful Event)

Your gut and endocrine (read: hormonal) health can really suffer after you have a big surgery. One of the most common things I see is if you have had a hip arthroscopy, or really any surgery, prepare to have some serious gut health interruptions. Why can you expect your gut health and hormone health after surgery to get disrupted?

Here are some of the reasons why your gut health can suffer post-op: 

• For starters, your normal routine is interrupted. That alone is stressful and can put you into a sympathetic or “fight, flight, or freeze” response. When that happens, digestion becomes “optional” to the body. 

Would you feel like doing mundane tasks if you were being chased by a tiger? Highly unlikely. So that’s why you need to be in a peaceful environment that is conducive to calm and quiet when you are healing or getting ready to go into surgery. Not having that can mean the difference between recovering or not. 

• Second, you may not feel like or be able to exercise, and movement is how we get our bowels to move (normally). Exercise has a significant effect as a treatment option for constipation. Read about how movement helps manage constipation 

• You are female. Women are up to 7x more likely to experience constipation than men. The reasons are unclear, but are thought to be related to hormones (which is part of what is also negatively impacted after surgery). Read more about increased risk of constipation as a female.

• You may be in pain, a lot of pain, during your recovery. Pain alone, without medications, can slow or halt digestion. But when you add in beneficial and often necessary pain management, the risk of digestive woes skyrockets. It is because medications like oxycodone and/or morphine (known as opioids) are well known to cause constipation ranging from mild to severe in nature. Read more about opioid-induced constipation.  

• Your body will be in healing mode – which means you will have a natural inflammatory response going on in your body to assist with healing. Inflammation sows the seeds of indigestion and gut dysbiosis. It does this by setting up conditions for adverse responses at the level of adipocytes (fat cells), immune cells, brain cells, as well as local increase in cytokine (an inflammatory biomarker) concentration. 

Changes in Gut and Hormonal Health After Surgery Can Lead to Chronic Inflammation

Unfortunately, all of these things can lead to chronic or persistent inflammatory states, which is why you want to have your functional medicine practitioner follow you closely by tracking levels of hsCRP (high sensitivity C reactive protein), and other biomarkers of uncontrolled inflammation. This can include measuring for things like insulin resistance (fasting glucoses levels and or HgA1C) and treating any immune deficiencies. See the table below for normative ranges of hsCRP. CRP is merely an indicator or biomarker of a disease process that is causing cell death due to inflammation.

Wolfe F. The C-reactive protein but not erythrocyte sedimentation rate is associated with clinical severity in patients with osteoarthritis of the knee or hip. J Rheumatol. 1997;24(8):1486-1488.

Ridker PM, Libby P. Risk Factors for Atherothrombotic Disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa; Saunders Elsevier; 2007: chap 39.

Next, what happens is a cascade or snowball effect, or what we often call a sequela in functional medicine and pelvic health. 

What we often see is, if gut health is impaired and causing gut dysbiosis, then hormonal dysregulation is bound to occur. Why is this important? Because in pelvic health rehab – which includes not only hip arthroscopy but recovery from any obstetric, gynecological, or pelvic surgery – cortisol and your hormones are large and in charge of your overall health. There is a definitive link, and critical crosstalk between sex hormones and the gut microbiome. Read more about the gut microbiome and sex hormone related diseases.  

What does it mean for your hormone health if you have gut dysbiosis? 

First of all let’s define gut dysbiosis. Gut dysbiosis is an imbalance of the gut bacteria in the gastrointestinal tract. It can cause a myriad of symptoms and conditions, including but not limited to intestinal permeability (leaky gut), diarrhea, bloating, constipation, slow digestion, acid reflux, and additionally – hormone imbalance. 

What about gut health and estrogen metabolism? Meet the Estrobolome 

This interplay between the gut microbiome and hormone balance is called the estrobolome. Dr. Aviva Romm defines it this way: 

“You have an entire microbiome department solely dedicated to the task of regulating your estrogen levels. It’s called the estrobolome, and it’s a unique microbiome within your gut microbiome, made up of a collection of bacteria with special genes that help you metabolize estrogen. The estrobolome is central to keeping your estrogen levels, which are ever dynamic throughout your monthly menstrual cycles – and life cycles – juuuuust right.”

Read this article on what gut health has to do with your estrobolome.

Additionally, the estrobolome is not just important in cycling women, it’s important for everyone, because men and women have estrogen, and if it’s not being metabolized correctly, bad things happen. Having a healthy estrobolome is critically important because it can make all of these conditions much worse or contribute to them occurring: 

• PMS
• Endometriosis
• PCOS
• Breast tenderness and swelling
• Cardiovascular disease
• Estrogen-driven cancers(endometrial, cervical, ovarian, and breast cancer)
• Diabetes and other metabolic disorders
• Cognitive function
• Peri- and menopause symptoms such as hot flashes, night sweats, mood changes, osteopenia, osteoporosis, hair loss, dry skin, painful intercourse, and a host of over 100 symptoms associated with menopause 

In addition to estrogen metabolism, fluctuations in simple estrogen, progesterone, and testosterone levels, as well as cortisol, also impact the composition of the gut microbiome.  In turn, negatively impacting your pelvic and orthopedic physical therapy outcomes. 

A negatively impacted gut microbiome, hormone levels, or metabolism can: 

• Create bladder and bowel urgency and frequency 
• Make you feel like you cannot completely empty the bowel or bladder
• Contribute to leakage/incontinence and/or fecal staining 
• Make sex painful 
• Cause painful bladder syndrome (stinging, burning with urination) 
• Lead to weight gain
• Cause low libido 
• Create vaginal dryness and/or atrophy
• Cause low energy 
• Lead to poor muscle mass and difficulty building muscle mass
• Decrease sleep quality 
• Cause brain fog 
• Lead to bacterial overgrowth in the small intestine or vagina 
• Cause emotional mood swings shifts
• Create depressive feelings and/or anxiety 
• Lead to generally poor digestion (constipation, indigestion, reflux, diarrhea) and poor nutrient absorption 

It is critical for your practitioner then, to be well versed and know what to look for when it comes to gut microbiome health, estrobolome health, and overall hormone balance and metabolism. Missing that piece of the puzzle can prolong your recovery from any pelvic surgery, specifically hip arthroscopy, since it is so intimately tied to pelvic floor health. 

Some of the ways a functional medicine pelvic health practitioner will go about improving gut microbiome and estrobolome health, as well as overall hormone balance and metabolism include: 

• Eliminating highly processed foods from the diet – because they generally have low fiber, which prevents the gut from creating short chain fatty acids [SCFA] and can even destroy healthy gut bacteria (check out this article to learn more about controlling inflammation through diet)
• Use Integrative Medicine to treat chronic stress and pain 
• Identify medications, like chronic antibiotic or antacid use, the latter of which, for example, impairs nutrient absorption like calcium, which can lead to osteoporosis and decrease necessary stomach acid for digestion. 
• Use Lifestyle Medicine to treat poor sleep, nutrition, remove hormone disruptors commonly found in foods, the environment, beauty products, and household cleaners 
• Prescribe a physical activity/mindful movement program
• Prescribe pelvic and orthopedic physical therapy for your post-operative rehab 

These are just a scratch on the surface of what Functional, Integrative, and Lifestyle Medicine can do to help you fully recover from hip arthroscopy and/or other pelvic surgeries.