Bowel Preparation Prior to Intrathecal Baclofen (ITB) Pump Placement Surgery

When people have an Intrathecal Baclofen (ITB) pump placed, constipation can be a significant problem during 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, those with constipation after surgery need multiple medications and additional IV fluids to correct the problem. Constipated patients typically have a lot of belly pain. They are also 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 surgery.

• 3 days before surgery, give one mini enema, such as Enemeez or Docusol Mini-Enema (5ml/283mg Docusate Sodium) in the morning, if you/your child will be near home. As an alternative to Enemeez, you can use Pedia-Lax. It is important to give the mini-enema so that the fluid reaches the bowel wall and is not in the stool.
• 2 days before surgery, give another mini enema.
• 1 day before surgery, give a Fleets enema. Please choose the size of the Fleets enema appropriate for you/your child. Typically, adults and children 12 years and older 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 you/your child's current bowel regimen, including any medications you/they may be on. We recommend this protocol even if you/your child is having regular, daily bowel movements, as there may still be a large amount of retained stool. Avoiding dehydration is essential in the days leading up to surgery. Drinking water throughout the day and up to 12 ounces per day of a sports drink (i.e., Gatorade) will help. We have found that this protocol reduces many of the problems caused by constipation 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.