Bowel Preparation for Hemorrhoidectomy
No, you do not need mechanical bowel preparation before elective hemorrhoidectomy. Standard preoperative fasting guidelines are sufficient, with clear liquids permitted until 2 hours before anesthesia and light meals until 6 hours before surgery. 1, 2
Evidence Against Routine Bowel Preparation
Mechanical bowel preparation (MBP) provides no clinical benefit for hemorrhoidectomy and should not be used routinely, as it causes dehydration, electrolyte imbalances, and patient discomfort without improving surgical outcomes. 1
A randomized prospective clinical trial of 40 patients undergoing Milligan-Morgan hemorrhoidectomy demonstrated that MBP had no effect on any intraoperative or postoperative variables, including operating time, intraoperative bleeding, surgeon comfort, presence of stool in the anal canal, mucosal edema, postoperative bleeding, infection rates, pain scores, or time to first bowel movement. 3
The American Society of Colon and Rectal Surgeons explicitly recommends against routine mechanical bowel preparation for most elective colorectal procedures, including hemorrhoidectomy, as it offers no advantage and causes unnecessary patient burden. 1, 2
Standard Preoperative Fasting Protocol
Clear liquids are permitted until 2 hours before anesthesia induction, which is sufficient for safe anesthesia administration and does not require additional bowel cleansing. 2
Light meals are permitted until 6 hours before surgery, following standard Enhanced Recovery After Surgery (ERAS) protocols that have been validated across multiple surgical specialties. 4, 2
Carbohydrate loading with 400 mL of complex carbohydrate drink 2 hours before surgery may reduce insulin resistance and improve outcomes, though this is optional for hemorrhoidectomy. 2
Important Distinctions
This recommendation applies only to elective hemorrhoidectomy, not to complicated hemorrhoids requiring emergency surgery or other colorectal procedures. 1
For rectal surgery with anastomosis (which is NOT hemorrhoidectomy), combined MBP with oral antibiotics is strongly recommended, but this does not apply to standard hemorrhoid surgery. 4, 2
The evidence against bowel prep for hemorrhoidectomy is distinct from colorectal surgery, where the debate centers on whether to combine MBP with oral antibiotics—for hemorrhoidectomy, even this combination is unnecessary. 4, 1
Clinical Pitfalls to Avoid
Do not confuse hemorrhoidectomy with colorectal resection protocols—the latter may require bowel preparation in specific circumstances (particularly rectal surgery), but hemorrhoidectomy does not involve bowel anastomosis and therefore has different requirements. 4, 2
Avoid ordering Fleet enemas or oral purgatives on the morning of surgery, as the randomized trial specifically showed no benefit from this practice. 3
Do not delay surgery to perform bowel preparation, as this adds unnecessary patient discomfort and healthcare costs without improving outcomes. 1, 3