Bowel Preparation Prior to Selective Dorsal Rhizotomy (SDR) Surgery
When children undergo surgery such as a selective dorsal rhizotomy, constipation can be a significant problem the first few days after surgery. Change in normal activity patterns and diet after surgery can lead to constipation. Anesthesia and pain medicines can also worsen constipation.
Often, children with constipation after surgery require multiple medications, need IV fluids for a longer period of time, have a lot of abdominal pain, and are at a higher risk of surgical site contamination from stool. To help prevent these issues, we recommend a bowel evacuation program, or a “clean out” before your child’s surgery.
The cleanout begins three days before surgery with one mini enema, such as Enemeez or Docusol Mini-Enema (5ml/283mg Docusate Sodium). You can also use Pedia-Lax as an alternative to Enemeez. This should be done in the morning if your child will be near home. Two days before surgery, give your child another mini enema. The day before surgery, give your child a Fleets enema. Please choose the size of the Fleets enema appropriate for your child (typically, children 12 years and older would need the adult size), or as directed by your provider. These enemas are over-the-counter products and can be purchased online, or from your local pharmacy. Be aware of product count when purchasing, as these products are typically packaged as multiples. Administer enemas as instructed on the product’s packaging.
Continue your child's current bowel regimen, including any medications they may be on. We recommend this protocol even if your child is having regular, daily bowel movements, as they may still have a large amount of retained stool. Encourage fluid intake in the days leading up to surgery to avoid dehydration. Gatorade is recommended up to 12 ounces per day. We have found that this protocol minimizes many of the problems caused by constipation in children after surgery and helps with a faster recovery.
We would like you to have your pre-surgery prep medications filled in advance of your surgery. Our Gillette Pharmacy can fill your prescription, assist you in having the prescription filled at a different pharmacy, and assist you in working with your insurance if you experience coverage challenges.
This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team. If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.