Patel, M., Schimpf, M.O., O'Sullivan, D.M., & LaSala, C.A. (2010). The use of senna with docusate for postoperative constipation after pelvic reconstructive surgery: A randomized, double-blind, placebo-controlled trial. American Journal of Obstetrics and Gynecology, 202, 479.e1–479.e5.

To compare the time of first bowel movement (BM) following pelvic reconstructive surgery in patients randomized to placebo or senna with docusate.

Patients were enrolled prior to surgery. After surgery, patients were randomized to either senna with docusate or placebo. Dosing was as follows.

• Take two tablets on the first night postoperation.
• If no BM, take two tablets the following morning.
• If no BM, take three tablets in the evening.
• If no BM the following morning, take three additional tablets twice daily until BM, or take magnesium citrate.

• The study reported on a sample of 93 women.
• Mean patient age was 59.5 years (SD = 12.6) in the senna with docusate group and 56.2 years (SD = 10) in the placebo group.
• The sample comprised patients with nonmalignant gynecologic and genitourinary cancer undergoing pelvic reconstructive surgery. Vaginal parity was 2 in the senna with docusate group (range 0–4) and 3 in the placebo group (range 0–7).

• Single site
• Inpatient
• Hartford Hospital in Connecticut

Patients were undergoing the active treatment phase of care.

This was a randomized, double-blinded, placebo-controlled trial.

• Seven-day bowel diary (baseline)
• Bristol Stool Scale
• Degree of strain and pain (11-point visual analog scale from 0 to 10)
• Medications taken
• Daily diary

• A significant difference existed in time of first BM in the senna with docusate group compared with the placebo group (3 days, SD = 1.5 versus 4 days, SD = 1.5; p < 0.002).
• More patients in the placebo group needed to use magnesium citrate to initiate a BM than in the senna with docusate group (43.6% versus 7%, p < 0.001).

The use of a stool softener with a laxative such as senna with docusate decreases the time to first BM following pelvic reconstructive surgery compared with placebo and lessens the need for use of magnesium citrate.

• The sample size was small (fewer than 100 patients).
• The study lacked an intention-to-treat analysis.

Nurses should be proactive in the management of patients' bowels following reconstructive surgery. Management with medications such as senna with docusate may be an option for patients following this form of surgery.