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The Effect of Preoperative Fiber on Postoperative Bowel Function After Pelvic Reconstructive Surgery: A Randomized Controlled Trial.

  • 2022-05-24
  • Urogynecology (Philadelphia, Pa.) 28(8)
    • Deepali Maheshwari
    • Cynthia D Hall
    • Xibei Jia
    • Abhilasha Tangada
    • Emily K Wu
    • Katherine Leung
    • Michael K Flynn

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 36
Population
women undergoing pelvic organ prolapse surgery
Methods
randomized controlled trial, 3.4 g psyllium fiber supplementation twice a day for 1 week before surgery or no fiber supplementation before surgery
Duration
1 week before surgery
Funding
Unclear

Importance

There are limited studies evaluating the effect of preoperative interventions on postoperative bowel function after prolapse surgery.

Objective

The objective of this study was to evaluate if preoperative fiber intake reduces time to first bowel movement after surgery for pelvic organ prolapse.

Study design

We performed a randomized controlled trial of women undergoing pelvic organ prolapse surgery between July 2019 and May 2021. Participants were recruited at their preoperative visit and randomized to receive either 3.4 g psyllium fiber supplementation twice a day for 1 week before surgery or no fiber supplementation before surgery. Postoperative bowel regimen was standardized for both groups. Participants completed a bowel diary for their first postoperative bowel movement after surgery characterized by the Bristol Stool Scale and any associated pain or urgency. The primary outcome was time to first bowel movement. Secondary outcomes included pain associated with first bowel movement.

Results

Eighty-four patients were enrolled in the study. Seventy-one patients had complete data for primary analysis, with 35 patients in the intervention group and 36 patients in the control group. Demographic and perioperative characteristics were similar between the groups. There was no difference found between the groups with respect to time to first bowel movement (control: 68.3 [SD, 25] hours vs intervention: 66.5 [SD, 23] hours, P = 0.749). There was no difference found with pain associated with first bowel movement (visual analog scale median [interquartile range] control: 2.0 [0.0-4.0] vs intervention: 2.0 [1.0-4.0]; P = 0.655).

Conclusions

Preoperative fiber supplementation before prolapse surgery does not improve time to first bowel movement after surgery.

Research Insights

  • Psyllium Husk→Improved Bowel Movement Frequency

    There was no difference found between the groups with respect to time to first bowel movement (control: 68.3 [SD, 25] hours vs intervention: 66.5 [SD, 23] hours, P = 0.749).

    Effect
    Neutral
    Effect size
    Small
    Dose
    3.4 g psyllium fiber twice a day for 1 week before surgery
  • Psyllium Husk→Reduced Pain with First Bowel Movement

    There was no difference found with pain associated with first bowel movement (visual analog scale median [interquartile range] control: 2.0 [0.0-4.0] vs intervention: 2.0 [1.0-4.0]; P = 0.655).

    Effect
    Neutral
    Effect size
    Small
    Dose
    3.4 g psyllium fiber twice a day for 1 week before surgery
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