INTRODUCTION

INDICATIONS
IDEAL BOWEL PREPARATION
TYPES OF BOWEL PREPARATION
ADJUNCTS
SPECIAL SITUATIONS
COMPLICATIONS
CONCLUSION

Bowel Preparation has evolved in the last century.

Goligher reported outcomes of mechanical
bowel preparation in the 1970s.
In 1980 Davis et al Formulated Polyethylene
glycol (PEG).
It became routine for most surgeons in the 1990s.
It was thought to offer less postoperative risks.
Sodium phosphate was then developed.
Chang et al. developed a method of pulsed rectal
irrigation combined with magnesium citrate.

There are approximately 109 to 1011

anaerobic bacteria and 105 to 107 aerobic
bacteria in the colon, per gram of stool.
The normal colonic flora comprises
approximately 20 species of aerobic
bacteria and more than 50 species of
anaerobic bacteria.
Bacteroides fragilis is the most frequently
cultured species, followed by clostridia and
peptostreptococci.

Recently, the role of bowel preparation has

been questioned.
Colonocytes receive nutrients from
fermentation of FFA.

Colonoscopy
Contrast studies
Colonic surgery
Bowel manipulation
Plain radiographs (lumbosacral x-rays)
Encourage postoperative intestinal motility

Efficient
Not time consuming
Should not alter colonic anatomy or
physiology
Comfortable
Not alter body fluid & electrolytes
Safe
Cheap

 Dietary

restriction
3-5 days of low residue diet/ clear fluids.
Use of cathartics e.g. senna, castor oil,
bisacodyl.
Repeated enemas.
Safe & effective.
Time consuming, uncomfortable for pt,
electrolyte disturbances, depletes pt, poor
compliance.
Diet alone is ineffective.

 Whole

gut lavage
Using high volumes (7-12L) of saline
solution or balanced electrolyte solutions.
Mannitol was used (1-2L)
Effective in bowel preparation
Uncomfortable for pt, electrolyte shift,
poorly tolerated

Non absorbed sodium sulfate based liquid.

Required large volumes (2-4L)
No solid food for at least two hours prior to
ingestion of the solution. 240 ml /10
minutes until rectal output is clear or 4 L .
Dosage for nasogastric administration is 2030mL/min (1.2-1.8L/hr).
Safer, faster, effective, well tolerated.

used in renal insufficiency, ascites, cirrhosis,

congestive cardiac failure
Prophylactic antiemetics are required
Salty taste, smell from sulphates
Sulphate free & low volume solutions have
been developed.
Best for paediatric & elderly pt.

NaPO4 is a low-volume hyperosmotic

solution which contains 48g (400mmol) of
monobasic NaP and 18 g (130mmol) of
dibasic NaPO4 per 100 ml.
Less volumes are required,
diluted prior to drinking to prevent emesis
and must be accompanied by significant
oral fluid to prevent dehydration.
Equally effective and better tolerated.

Has rare, but severe electrolyte imbalances

Not used in renal insufficiency, ascites,
cirrhosis, congestive cardiac failure
Not safe in paediatric & elderly pt.
Causes colonic mucosal lesions
Available as tablets (32-40tabs)

8-10L of saline introduce into the colon

over 20-30mins.
A closed circuit is used to prevent spillage.
Performed through a caecostomy,
appendectomy, balloon catheter in terminal
ileum.
Allows for primary resection & anastomosis.

Flavoring
Nasogastric/Orogastric Tube
Carbohydrate-Electrolyte Solution
Enemas e. g tap water ,Soap Suds
Bisacodyl (dulcolax)
Laxatives: Magnesium citrate, Picolax
(sodium picosulfate/magnesium citrate),
senna
Simethicone ; antiflatulent, antigas

 Inadequate

bowel preparation can result in

missed lesions.
cancelled procedures.
increased procedural time.
increase in complication rates.
Elderly patients.
Paediatric pt.

Bowel obstruction
Perforated bowel
Inflammatory bowel disease

Fluid & electrolyte imbalance.

Abdominal pain/ cramping.
Nausea & vomiting.
Fluid overload
Bloating
pulmonary aspiration, Mallory-Weiss tear,
PEG-induced pancreatitis and colitis, lavageinduced pill malabsorption, cardiac
dysrhythmia,

Safety and effectiveness of the procedure is

directly related to the quality of the bowel
preparation done in anticipation of the
procedure.
Preparations associated with the best
patient compliance safety, comfort, in order
to achieve the best results are favourable

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