Bowel Preparation for Hemorrhoidectomy
Mechanical bowel preparation is not necessary before elective hemorrhoidectomy. A randomized controlled trial demonstrated that preoperative bowel preparation provides no benefit for intraoperative procedures or postoperative outcomes in hemorrhoidectomy patients 1.
Evidence Against Routine Bowel Preparation
The strongest evidence comes from a prospective randomized trial specifically evaluating Milligan-Morgan hemorrhoidectomy, which found:
- No difference in operating time, intraoperative bleeding, or surgeon comfort between patients who received Fleet enema versus no preparation 1
- No difference in postoperative complications including bleeding, infection, pain scores, or time to first bowel movement 1
- No difference in the presence of stool or enema remnants in the anal canal during surgery 1
This aligns with broader surgical principles from the American Society of Colon and Rectal Surgeons, which recommends against routine mechanical bowel preparation for most elective colorectal procedures, as it causes dehydration, electrolyte imbalances, and patient discomfort without clinical benefit 2.
Practical Approach
For standard elective hemorrhoidectomy:
- No mechanical bowel preparation is required 1
- No enemas are necessary 1
- Standard preoperative fasting guidelines apply: clear liquids until 2 hours before anesthesia, light meals until 6 hours before 2
Special Circumstances
If bowel preparation is desired (surgeon preference or specific clinical scenarios):
- A single Fleet enema on the morning of surgery can be used, though evidence shows no advantage 1
- One study using preoperative bowel cleansing as part of a pain-reduction protocol reported delayed first postoperative evacuation, which theoretically reduces perianal nerve stimulation 3