⌵What Is Bowel Preparation?

Bowel preparation is a pre-surgical cleansing process designed to remove stool and bacteria from the intestines. It typically involves dietary adjustments, laxative medications, and enemas. The aim is to minimize the risk of infection, prevent complications, and provide the surgeon with a clear surgical field, especially important for procedures involving the pelvic area.

⌵1. Bowel Preparation for Skin Graft Vaginoplasty

For skin graft vaginoplasty, bowel preparation may not always be as extensive as for intestinal surgeries, but it remains important for maintaining a sterile surgical environment.

Step-by-Step Skin Graft Bowel Preparation

📅 Three Days Before Surgery

• Begin a low-fiber diet to reduce bowel content.

📅 Two Day Before Surgery

• Take 4 pills of Senolax (Sennoside 7.5 mg)
• Use U-Enema(suppository only):
  Gently insert the enema tip into the rectum with a slight side-to-side movement, pointing toward the navel. Do not force the tip. Squeeze the bottle to release the full amount of solution into the rectum, then remove the tip. Hold your position until the urge to evacuate becomes strong (usually 1–5 minutes).

📅 One Day Before Surgery

• Take the first bottle of Xubil (45 cc)at the indicated time.
• Take the second bottle of Xubil (45 cc)at the indicated time.
• If bowel is not clear by late evening:
  Use U-Enema again
  Note: Additional enema may have an extra cost.

💧 Hydration Tips:

• Drink plenty of fluids throughout the preparation period to stay hydrated.
• If diarrhea occurs, continue to sip water and electrolyte solutions regularly to maintain hydration and electrolyte balance.

How it works

Medications and enemas work by loosening stool and flushing the bowel, ensuring no obstruction or bacterial buildup remains.

⌵2. Bowel Preparation for Laparoscopic Colon Vaginoplasty

For laparoscopic colon vaginoplasty, bowel preparation is more intensive because part of the colon will be used to create the vaginal canal.

Laparoscopic Bowel preparation includes

📅 Four Days Before Surgery

• Dietary changes:Begin a low-fiber diet to reduce bowel content.

📅 Two Day Before Surgery –

• Bisacodyl 5 mg (Laxative pills): Take two pills at the indicated time.
• U-Enema rectal solution:

1. 1. Insert the nozzle into the anus and fully compress the bulb syringe in one motion so the entire solution enters your bowel.
   2. Hold the bulb compressed for 10–15 seconds before removing the nozzle.

📅 One Day Before Surgery 

• Xubil (45cc): Drink the full bottle at the indicated time.
• Niflec (powder for oral liquid):
  1. Dissolve one sachet of Niflec in cold water to make 2 liters (2000 mL).
  2. Drink the first 1000 mL in the first hour (about 200 mL every 10 minutes).
  3. Drink the remaining 1000 mL in the second hour.
  4. Complete the entire 2 liters within 2 hours.

💧 Hydration & Electrolyte Replacement:

• While experiencing diarrhea from Niflec, drink at least 5–6 bottles of water throughout the day.
• Dissolve 1 sachet of electrolyte powder (T.O.S) into 250 mL of drinking water and sip regularly to maintain hydration and electrolyte balance.

How it works

PEG solutions draw water into the bowel, softening and flushing stool, while enemas clear the rectum—creating a sterile and unobstructed surgical field.

⌵3. Bowel Preparation for Laparoscopic PPV Vaginoplasty

Peritoneal Pull-Through Vaginoplasty (PPV) uses peritoneal tissue from the abdominal cavity. While bowel involvement is less than with colon vaginoplasty, preparation is still crucial to avoid contamination.

PPV Bowel Preparation Guideline

📅 Two Days Before Surgery

• Dissolve one sachet of Niflecpowder in about 2 liters (2000 mL) of cold water.
  Drink the first 1000 mL within the first hour (about 200 mL every 10 minutes).
  Finish the remaining 1000 mL in the second hour.
  Please complete the entire 2 liters within 2 hours.

📅 One Day Before Surgery 

• Take the first dose of Xubil solution (45 cc)at the indicated time.
• Use U-Enema(external use):
  Gently insert the enema tip into the rectum with a slight side-to-side movement, pointing toward the navel.
  Do not force the tip to avoid injury. Squeeze the bottle to release the full solution inside, then remove the tip.
  Maintain position until you feel a strong urge to evacuate (usually 1 to 5 minutes).
• Take the second dose of Xubil solution (45 cc)at the indicated time.

💧 Hydration & Electrolyte Replacement

• While experiencing diarrhea from the Xubil solution, stay hydrated by drinking plenty of water, at least 5 to 6 bottles throughout the day.
• Dissolve 1 sachet of electrolyte powder (Ora-saline)into 250 mL of drinking water and sip regularly to maintain hydration and electrolyte balance.

🔔 Important

• If your bowel is still not clear, you will need to use U-Enema
• Additional enema use will incur a cost of 1,000 THB.

How it works

The process ensures the bowel is minimally filled, reducing pressure on surrounding tissues during surgery and minimizing infection risks.

⌵Why Is Bowel Preparation Important Before Vaginoplasty?

Reduces infection risk by removing bacteria and stool from the intestines.

Improves surgical visibility for precise and safe tissue handling.

Prevents complications such as leakage, inflammation, or delayed healing.

Supports faster recovery and reduces hospital stay duration.

⌵Benefits of Proper Bowel Preparation

Enhances surgical safety and outcomes.

Decreases the risk of post-operative infections.

Improves patient comfort post-surgery.

Allows for smoother anesthesia management.

⌵Considerations Before Bowel Preparation

Always follow the exact instructions provided by our WIH surgeon.

Inform the nursing team about any allergies or reactions to laxatives.

Stay hydrated to avoid electrolyte imbalance.

Avoid solid foods when instructed to follow a liquid diet.

FAQ