Constipation, Prolapse; Female, Surgical Procedure, Unspecified
Conditions
Keywords
postoperative constipation, minimally invasive surgery, apical prolapse, prolapse
Brief summary
The goal of this clinical trial is to test the use of a laxative before surgery in women having surgery to fix pelvic prolapse that do not have constipation. The main question it aims to answer is: Does use of a laxative before surgery lessen the discomfort of bowel movements after surgery? Participants will be asked to complete questionnaires before and after surgery. Researchers will compare using the laxative before and after surgery versus only after surgery to see if there is less discomfort with bowel movements after surgery.
Detailed description
The purpose of this study is to evaluate if there is a difference in bother related to constipation between a pre-operative versus post-operative start of a bowel regimen for patients undergoing surgery for pelvic organ prolapse This will be a multi-institution, single-blind, randomized control trial utilizing questionnaires and chart review to evaluate effect of pre-operative bowel regimen on post-operative constipation. 1. Study team and surgeons will be blinded to group assignments, participants will not be. 2. Participants will be randomized after consent is obtained, and at least 1 week prior to planned surgery, via computer-generated blocks in a 1:1 ratio between study group (pre-operative and post-operative use) and control group (post-operative only use) of polyethylene glycol 3350 (PEG)
Interventions
DRUGPolyethylene Glycol 3350
\*Polyethylene glycol 3350 (PEG) will be used within it's FDA indication and dosing for constipation. Each 17-gram dose of PEG is to be mixed in 8oz of liquid.
Sponsors
University Hospitals Cleveland Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 89 Years
Healthy volunteers
No
Inclusion criteria
* Patients assigned female sex at birth undergoing an apical prolapse procedure including: sacrocolpopexy, sacrospinous ligament suspension, uterosacral ligament suspension, or colpocleisis. Planned urogynecologic procedure may include hysterectomy, adnexectomy, colporrhaphy, perineorrhaphy, or treatment of stress urinary incontinence. * Planning to undergo primary procedure as above via minimally invasive route: vaginal or laparoscopic (including robotic-assisted). Including those that have an unplanned conversion intraoperatively of minimally invasive route to open laparotomy.
Exclusion criteria
* Diagnosis of irritable bowel syndrome, inflammatory bowel disease, slow transit constipation, obstructed defecation, or symptomatic constipation at time of study screening and recruitment. (Slow transit constipation and obstructed defecation defined as per American Gastroenterological Association 2013 constipation statement. Symptomatic constipation defined as any of the following: Bristol Stool Scale score of 1 or 2, PAC-SYM score greater than 1.0, self-reported 2 or less bowel movements per week.) * Current use of pharmacologic laxative agent ≥1x/week (prescription or OTC) for the treatment of constipation symptoms * Allergy or intolerance to polyethylene glycol 3350 * Planning to undergo surgery via laparotomy * Scheduled for any concurrent non-urogynecologic procedure, ex abdominoplasty * History of large bowel resection, surgical treatment of constipation, or anal sphincter surgery * History of sacral neuromodulation * Current or prior radiation therapy to the abdomen or pelvis * Current or prior diagnosis of malignancy * Unable to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PAC-SYM | Pre-operative, 1 week post-operative, 2 weeks post-operative | Patient assessment of constipation symptoms (PAC-SYM) is a validated 12-item questionnaire with reported average score 0-4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PAC-QOL: Patient assessment of constipation quality of life measure | Pre-operative, 2 weeks post-operative | — |
| Time to first bowel movement | 1 week post-operative | after surgery in approximate hours/days |
| Doses of PEG used | 1 week post-operative, 2 weeks post-operative | polyethylene glycol 3350 (PEG) doses of 17 grams powder mixed in 8oz of liquid |
| Rescue laxative use | 1 week post-operative, 2 weeks post-operative | Use of additional laxatives or enemas |
| Satisfaction with pain after surgery | 1 week post-operative | Satisfaction with pain after surgery |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORDavid Sheyn, MD
University Hospitals Cleveland Medical Center
Outcome results
None listed