Bowel Preparation Before Vaginal Prolapse Surgery: A Randomized Controlled Trial
Open accessAbstract
OBJECTIVE: To compare surgeons' intraoperative surgeon acceptability or assessment of the operative field regarding bowel contents and patients' satisfaction with or without a mechanical bowel preparation before reconstructive vaginal prolapse surgery. METHODS: In this single-blind, randomized trial, women scheduled to undergo vaginal prolapse surgery with a planned apical suspension and posterior colporrhaphy were allocated using block randomization to an intervention or control group. Surgeons were blinded to patient allocation. One day before surgery, mechanical bowel preparation instructions consisted of a clear liquid diet and two self-administered saline enemas; the participants in the control group sustained a regular diet and nothing by mouth after midnight. The primary outcome was surgeons' intraoperative assessment of the surgical field regarding bowel content as measured on a 4-point Likert scale (1, excellent; 4, poor). Secondary outcomes included participant satisfaction and bowel symptoms. The primary outcome was determined by intention-to-treat analysis and other analyses were per protocol. RESULTS: Of the 150 women randomized (75 women to intervention and control group), 145 completed the study. No differences existed in the demographic, clinical, and intraoperative characteristics between groups (P>.05). Surgeons' intraoperative assessment rating was 85% "excellent or good" with bowel preparation compared with 90% for participants in the control group (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.21-1.61; P=.30). The bowel preparation group was less likely to report "complete" satisfaction compared with the participants in the control group (OR 0.11, 95% CI 0.04-0.35; P<.001). Abdominal fullness and cramping, fatigue, anal irritation, and hunger pains were greater in the bowel preparation group (all P<.01). CONCLUSION: Before reconstructive vaginal surgery, mechanical bowel preparation conferred no benefit regarding surgeons' intraoperative assessment of the operative field, reflected decreased patient satisfaction, and had increased abdominal symptoms. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01431040. LEVEL OF EVIDENCE: I.
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Four trials reported on bowel function (Ballard 2014; Deng 2019; Liu 2020; Sassani 2020).
“Four trials reported on bowel function (Ballard 2014; Deng 2019; Liu 2020; Sassani 2020).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Ballard 2014
Seven trials reported on adverse events (bladder injury, bowel injury, readmission to hospital within 30 days) (Ballard 2014; Fernandez-Gonzalez 2019; McClurg 2014; Pauls 2013; Rahn 2023; Sassani 2020; Westermann 2016).
“Seven trials reported on adverse events (bladder injury, bowel injury, readmission to hospital within 30 days) (Ballard 2014; Fernandez‐Gonzalez 2019; McClurg 2014; Pauls 2013; Rahn 2023; Sassani 2020; Westermann 2016).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Ballard 2014
Six trials with a total of 695 women evaluated POP surgery with or without bowel preparation.
“POP surgery with or without bowel preparation: six trials with a total of 695 women (Adelowo 2017; Ballard 2014; Deng 2019; Estanol 2011; Liu 2020; Sassani 2020).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Ballard 2014
In women undergoing POP surgery, bowel preparation versus no bowel preparation may result in no clinically relevant difference in bowel injuries (OR not estimable, bowel prep 0% (0/75) versus no bowel prep 0% (0/75); 1 study, 150 women).
“Based on evidence from a single trial (Ballard 2014), there may be no clinically relevant difference in bowel injuries between women given or not given bowel preparation undergoing POP surgery (OR not estimable, bowel prep 0% (0/75) versus no bowel prep 0% (0/75); 1 study, 150 women; Analysis 5.2).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Ballard 2014
Three trials reported on awareness of prolapse (Ballard 2014; Barber 2014; Mueller 2017).
“Three trials reported on awareness of prolapse (Ballard 2014; Barber 2014; Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Ballard 2014
The Materials and Methods and Results identify Ballard 2014 as a randomized trial of bowel preparation before prolapse surgery. Its reported outcomes concern the surgical field, patient satisfaction with bowel preparation, and bowel symptoms; no passage in our copy reports awareness of prolapse as an outcome (searched: “awareness of prolapse” and postoperative prolapse symptoms). (LLM, conf=0.76)
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- Authors
- Ballard, A. C., Parker-Autry, C. Y., Markland, A. D., Varner, R. E., Huisingh, C., & Richter, H. E.
- Affiliations
- University of Alabama at Birmingham (US)
- Venue
- Obstetrics & Gynecology
- Published
- 2014-02
- Volume
- 123
- Issue
- 2
- Pages
- 232-238
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC3909883
- OpenAlex
- W1977460239
- Cited by
- 33
- References
- 14
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 6 · 2015: 5 · 2014: 2
- FWCI
- 4.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000165)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK068389)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- bowel preparation, vaginal prolapse surgery, mechanical bowel preparation, saline enema, clear liquid diet, apical suspension, posterior colporrhaphy, patient satisfaction, abdominal symptoms, pelvic organ prolapse
- MeSH terms
- Adult, Aged, Cathartics, Enema, Female, Humans, Middle Aged, Preoperative Care, Surveys and Questionnaires, Gynecologic Surgical Procedures, Uterine Prolapse, Single-Blind Method, Treatment Outcome, Patient Satisfaction, Plastic Surgery Procedures
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