Satisfaction with Polyethylene Glycol 3350 Following Urogynecologic Surgery

Objectives: Constipation is prevalent after pelvic reconstructive surgery. While several studies have investigated postoperative bowel regimens objectively, including time to first bowel movement, few have evaluated patient concerns surrounding the first bowel movement and satisfaction with prescribed regimens. The purpose of this study is to assess patient expectations of bowel movements following urogynecologic surgery and to examine patient satisfaction with polyethylene glycol 3350 (PEG) at 1 and 6 weeks postoperatively.

Methods: This prospective study includes participants undergoing pelvic reconstructive surgery for prolapse at a single academic institution from December 2023 - April 2024. Participants were counseled to take 17g of PEG daily after surgery. Recruited participants completed the Wexner Constipation Questionnaire preoperatively to assess baseline bowel habits and questions soliciting expectations surrounding the first postoperative bowel movement. Questionnaires were repeated at 1 and 6 weeks. Participant satisfaction with PEG at 1 and 6 weeks and perception of change in bowel movements were assessed through a 5-point Likert scale and the Patient Global Impression of Improvement Scale (PGI-I), respectively. Paired t-test, Chi Square, and logistic regression were utilized where indicated.

Results: Of 72 participants enrolled, 69 completed the study. The median expected time to first bowel movement was one day, which differed from the actual median time of two days. Preoperatively, 58.8% of participants reported concern about the first bowel movement, primarily the need to strain. Of those concerned, 47.5% experienced difficulty; preoperative bowel concerns and postoperative bowel movement difficulty did not impact 1- week PGI-I scores. Approximately 61% of participants used a second bowel agent at 1-week. At 1-week after surgery, 53.6% of participants continued PEG with a satisfaction rate of 65.2%. Participants primarily discontinued PEG because “they were not constipated”. PEG satisfaction at 1-week was associated with a likelihood to continue PEG (86.8% vs. 13.2%, p = < 0.001), PEG satisfaction at 6-weeks (100% vs. 0, p = < 0.001), and improved 1-week PGI-I scores (89.7% vs. 10.3%, p=0.03). After adjusting for age, posterior repair, chronic constipation, and general anesthesia, PEG satisfaction at 6 weeks remained significantly associated with PEG satisfaction at 1 week [OR 6.1, 95%CI 1.1-32.6]. Adherence to PEG decreased to 29% at 6-weeks, primarily due to loose bowel movements. PEG satisfaction at 6-weeks was modestly reduced (60.9%) and was associated with decreased Wexner Constipation scores (-1.6 +/- 3.2 vs. 1.5 +/- 2.7, p=0.01) and avoidance of a second bowel agent (48.9% vs. 51.1%, p < 0.001). PGI-I scores at 6-weeks revealed 61.8% of participants reported improved bowel movements; this was not associated with PEG satisfaction unlike at 1-week, 84.4% vs. 15.6%, p=0.26.

Conclusions: Patients are overall satisfied with PEG following urogynecologic surgery. Concerns and experience with first bowel movement did not impact perceived postoperative bowel improvement.