Does a Preoperative Bowel Regimen Change Time to First Bowel Movement After Sacral Colpopexy?

Objectives: The objective of this study was to determine if pre-operative use of polyethylene glycol can improve defecatory dysfunction following robotic sacral colpopexy. Our primary outcome was to determine if the pre-operative use of polyethylene glycol decreases time to first bowel movement post-operatively. Our secondary outcomes include degree of pain with first bowel movement and stool consistency.

Methods: This was a randomized controlled trial conducted at a tertiary care center. Eligible patients included those undergoing a robotic sacral colpopexy with or without concomitant hysterectomy or anti-incontinence procedures. Exclusion criteria were: age under 18 or over 90, laparotomy, allergy to polyethylene glycol, posterior colporrhaphy, regular pre-operative use of stool softeners or laxatives, inability to take medication by mouth, chronic kidney disease (Cr > 1.2), esophageal strictures, persistent nausea and vomiting, bowel obstruction, and inflammatory bowel disease. Patients were placed into an experimental or a control group by computer-generated randomization. The experimental group took polyethylene glycol daily for seven days prior to surgery and the control group did not. All patients took polyethylene glycol post-operatively. Demographic data and pain medication usage were collected. All patients maintained a bowel diary to record time to first post-operative bowel movement as well as pain and stool consistency using the visual analog scale (VAS) and the Bristol Stool Chart, respectively. Data were collected in REDCap and analyzed in GraphPad Prism using the Student’s T-test or the Mann Whitney U Test as appropriate. A p-value of 0.05 was used to denote significance.

Results: A total of 101 women were screened and 43 have completed the study to date. Twenty-one women were randomized to the control group and 22 to the experimental group. Patients were majority white and non-hispanic (88%) with an average age of 63 ± 7.4 years. There was no significant reduction in the number of hours to first bowel movement when pre-operative polyethylene glycol was used (54.2 ± 24.2 vs. 48.0 ± 22.9, p = 0.39). However, there was a significant reduction in pain scores (4 [2,5] vs. 1 [0,2], p < 0.001) and improvement in stool consistency (2 [1,4] vs. 4 [3,4], p = 0.002) of the first post-operative bowel movement. Post-operative opioid use was low overall and did not differ significantly between groups.

Conclusions: In this preliminary analysis, pre-operative administration of polyethylene glycol did not decrease time to first post-operative bowel movement following robotic sacral colpopexy. However, patients who took polyethylene glycol pre-operatively exhibited less pain with their first post-operative bowel movement and had improved stool consistency. More data is needed to determine if pre-operative use of polyethylene glycol can be considered to enhance patient comfort with bowel movements after robotic sacral colpopexy.