Yes, I had to do a bowel cleanse before my prostate surgery, just as I had to do before a routine colonoscopy. You know the program – first drink this fluid and then the toilet becomes your new-best friend for the next 12 hours or so.

But why?

Why do you have to go through this not-very-pleasant experience before prostate surgery?

I did some research and came up with two possible explanations.

#1) To clean the intestine of stool, food particles and fecal matter to reduce the chances of infection.

The thinking is that if you do a bowel cleanse before major abdominal or pelvic surgery, you lower your chances of infection. Since the prostate is located deep inside the abdomen, if there is a bowel injury during the operation, the spillage of fecal matter or stool could cause some problems – like infection. (This is called anastomotic leak.)

Cleaning out the intestines before the surgery should lessen these chances (decreases the bacterial load), so surgeons have been recommending a bowel cleanse before abdominal surgery for about the last 100 years – it’s almost a given if you are going to have any kind of pelvic surgery.

Is that still true today?

There are some recent medical studies that seem to conclude that since antibiotics came into use, maybe this practice is not as important as it once was. However, from reading online literature, it appears that almost all surgeons still require a bowel prep today.

Here’s a study of 380 surgical patients that showed that doing mechanical bowel preparation versus not doing mechanical bowel preparation didn’t make much of a difference.

Oded Zmora, MD, Ahmad Mahajna, MD, Barak Bar-Zakai, MD, Danny Rosin, MDColon, et al.  Rectal Surgery Without Mechanical Bowel Preparation. Annals of Surgery.

This second study (below) compared patients who had bowel prep versus patients who did not have bowel prep and found that it also didn’t make much of a difference.

P. Bucher1, P. Gervaz1, C. Soravia1,et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Geneva University Hospital.

As you know, I’m an accountant – not a physician.  I had to do a bowel prep before surgery, and my procedure turned out fine. You must always follow your own physician’s advice and recommendations.

For more information on my bowel prep, click this link for One Day Before Prostate Surgery.

 

#2) To empty the bowel to facilitate removal of the prostate gland.

The prostate gland sits on top of the rectum, so when your surgeon is removing the gland, he or she needs to separate it from the nearby rectal tissue. It’s pretty cramped down there, so If your rectum is filled with fecal matter or stool, it will appear more like a blown up balloon. That’s not what you want.

You want the rectum to be empty and deflated and flexible. This gives your surgeon more room to work and less chance to nick the rectal tissue when removing the prostate gland.

Quotation

“…Based on the close proximity of the rectum to the prostate, rectal injury can occur at any point during the posterior dissection, but is most likely near the apex of the prostate. .. Preoperative oral mechanical bowel preparation and a cleansing enema can minimize the potential for contamination…”

source: http://laparoscopy.blogs.com/prevention_management_3/2011/03/complications-of-laparoscopic-and-robotic-radical-prostatectomy.html