Please read this patient information as soon as possible and well in advance of your appointment. It has been divided into two parts:
PART 1 contains important advice on how to prepare for your procedure. If you do not follow these instructions, it may not be possible to do the bowel examination and you would have to return on another day.
PART 2 contains information on the different types of bowel preparation medications. You must follow the instructions for the type of bowel preparation you have been given.
- CITRAFLEET/PICOLAX – please read pages 8 and 9
- PLENVU – please read pages 10 and 11
- MOVIPREP – please read pages 12 and 13
Helpline or enquiries (8.30am to 5.00pm Monday to Friday)
For appointments and general enquiries
Boston 01205 445072
Grantham 01476 464366 / 01205 445072
Lincoln 01522 573849
Louth 01507 631415 / 631437
For procedure related enquiries (8.30am to 6.00pm Monday to Friday)
Boston 01205 446559
Grantham 01476 464085
Lincoln 01522 573016 / 01522 512512 ext 458669
Louth 01507 631236
For more information please see: www.ulh.nhs.uk/services/endoscopy
BOWEL CANCER SCREENING PROGRAMME PATIENTS: Please ring 01522 597548 for all enquiries
Aim of the information
The aim of this information is to help you prepare and empty your bowel for your procedure. Please read all of the leaflet well in advance of your appointment as it contains important information together with tips and advice.
PART 1
Introduction
You have been advised by your hospital doctor / practitioner to have an investigation to look at your bowel. Your bowel must be empty to give clear views and reduce the risk of complications. You will have been prescribed a laxative medication (also called ‘bowel preparation’) which will cause you to pass watery stools (diarrhoea). Different medications are used so it is important to follow the instructions for the particular medication supplied to you. These are different for a morning or afternoon appointment so please make sure you check your appointment time. Please follow the instructions in this leaflet for taking your bowel preparation.
If you are having a Gastroscopy (OGD) procedure at the same appointment please follow the bowel preparation instructions and stop drinking 2 hours before your appointment time.
If your health has become worse in any way since the laxative was prescribed, or you feel you will not be able to drink the amount of fluid advised, please contact the endoscopy department before you start taking it. Numbers are given at the start of this leaflet.
- Read all of the instructions for your particular appointment and laxative a few days before your appointment. It is important to follow the instructions given, especially the amount of fluid you should drink, as the laxative can cause you to become dehydrated. Symptoms of dehydration include dizziness or light-headedness (particularly on standing up), thirst, headache or reduced urine production (passing less water).
- The bowel preparation will cause watery diarrhoea so you should stay near a toilet. The amount of time this takes varies from person to person – it may start working in 30 minutes to 1 hour but it could be several hours before you feel the need to go to the toilet. The second dose works much more quickly.
- Having a sports bottle (a bottle with a ‘spout’) or some drinking straws may make it easier to drink the bowel preparation.
- Barrier cream may help to prevent soreness around your bottom when you are going to the toilet.
- It may be advisable to have some incontinence pads available whilst taking your bowel preparation.
- If you have any problems or concerns after taking the bowel preparation, please ring the enquiry numbers on the front cover of this booklet. Out of hours please contact the NHS non-emergency service on 111.
- It is normal to feel some nausea but if you start to vomit, you should stop taking it and ring the relevant endoscopy unit as soon as you can to let them know.
Should I take my regular medication?
Unless you have been advised to stop any of your medications you should take them as usual. Take them at least one hour before or after you take your bowel preparation medication.
If you take the oral contraceptive pill you should take other precautions for one week afterwards.
What to do in the week before you take your bowel preparation
- If possible, please do not eat seeded bread or other food containing seeds e.g. cheese biscuits, salad toppings, for 7 days before the procedure as the seeds can take a while to clear from the bowel and make it difficult to get clear views
- Stop taking iron tablets at least 5 days before (7 days if possible)
- Stop taking loperamide (Imodium, lomotil), fybogel and codeine based medications at least 3 days before. If you need to continue taking codeine or other strong painkillers, take a daily laxative for 5-7 days before starting your bowel preparation
- If you have problems with long term constipation, taking an additional daily laxative for 5-7 days before you start the bowel preparation, may help to empty the bowel more effectively
- If you have been prescribed laxido or senna (or both) please take daily for 5-7 days before starting the bowel preparation
If you have been given KLEAN PREP please follow the advice in this leaflet for food and fluids but make up and take the Klean prep as per the packet instructions.
Two days before your procedure eat a low fibre diet
ONLY have foods from the Foods you can eat list (there are also some meal suggestions on page 6).
Foods you can eat from 2 days before your procedure
Milk, including non-dairy alternatives, plain yoghurt
White fish or chicken (boiled/steamed not fried)
Cheese, eggs, butter, margarine
Clear jelly (not red), boiled sweets, chocolate (no fruit or nut pieces)
White bread or toast, white pitta, white rice or pasta
Smooth peanut butter, Marmite, honey, clear jam (no seeds)
Mayonnaise, salad cream
Plain ice cream, any flavour – no fruit or nut pieces
Rice Krispies and cornflakes
Salt, pepper, sugar, sweeteners
Foods NOT allowed from 2 days before your procedure
Red meat, including burgers and sausages
Pink or oily fish such as salmon
Fruit and vegetables including potatoes
Salad – tomatoes, lettuce, cucumber, peppers, celery, olives
Seeded or brown bread
High fibre breakfast cereals including Weetabix, porridge, bran, muesli and granola
Oats, including biscuits containing oats
Brown pasta or rice
Pickles or chutneys
Sausage rolls or pastries
Vegetable soup
Clear fluids to take once you have stopped eating (no alcohol)
Tea and coffee (with a very small amount of milk), herbal teas
Water, clear apple juice, squash, sports drinks, clear jelly (not red)
Fizzy drinks such as cola, lemonade, fizzy water. You may suck (not chew) boiled sweets or mints
Meat extract drinks (e.g. Bovril or Oxo), vegetable bouillon, very clear soups (no bits)
Sugary fluids to maintain blood sugar levels for those with diabetes include clear apple juice, full sugar jelly (not red), full sugar fizzy drinks such as Lucozade, cola.
Suggestions for low fibre meals / snacks
Breakfast – choose from:
Rice crispies / cornflakes with milk or non-dairy alternative
White toast with butter/dairy free spread and honey/Marmite/smooth peanut butter
Toasted white muffin or croissant with butter/dairy free spread and honey
Boiled egg with white toast
Plain yoghurt (no fruit) with honey
Poached/scrambled egg on white toast
Lunch/midday meal and evening meal – choose from:
Cheese omelette
Scrambled/poached egg on white toast
Cheese on white toast
Baked/poached chicken or tofu/paneer and white rice – add a chicken or vegetable stock cube for flavour
Poached or baked white fish such as cod/haddock and butter
White pasta and chicken or soya product with white sauce or plain cream cheese
Cheese or non-dairy alternative and crackers (only cream crackers or water biscuits – no other crackers are allowed)
Cheese/egg mayonnaise/cream cheese or non-dairy alternative sandwich made with white bread
Plain cooked chicken and mayonnaise in white pitta bread
White plain bagel with plain cream cheese (or non-dairy alternative)
Clear jelly (not red) and vanilla ice cream
Plain yoghurt (no fruit) and honey, or jam without seeds
Flavoured fromage frais (no bits)
Chocolate mousse
Custard
White milk puddings such as rice pudding, tapioca or semolina
Snacks – choose from:
Chocolate (without fruit/nuts)
Boiled sweets
Madeira cake or other plain sponge cake without jam or fruit/nuts
Custard cream, rich tea or shortbread biscuits (no other biscuits are allowed)
Milkshakes
Plain rice cakes
Jelly sweets
Plain scones (without fruit)
Hot chocolate drink
PART 2
PICOLAX / CITRAFLEET (Sodium Picosulfate)
How to prepare PICOLAX or CITRAFLEET
In the box there are 2 sachets. Mix the contents of one sachet with about 150ml of cold water and stir for 2 to 3 minutes before drinking. Do not worry if the solution becomes warm or hot – allow it to cool a little before drinking.
For morning appointments between 08.00 am and 1.00 pm
The day before the procedure
In the morning, choose foods from the ‘foods you can eat’ list on page 5 and drink at least one large glass (approx. 250ml) of clear fluid (see page 5), EVERY HOUR from 12 noon to 9.00 pm.
It is important that you drink a total of two and a half litres of fluid throughout the day.
Stop eating at 1.30 pm (do not eat anything more until after the procedure).
Between 4.00 pm and 6.00 pm take one sachet of Picolax or Citrafleet (see mixing instructions above). YOU MUST continue to drink clear fluids through the evening (past 9.00 pm if you wish) as this will help to clear the bowel and keep you hydrated.
The solution will cause watery diarrhoea so you should stay near a toilet. It may work in 30 minutes to an hour, but it might be several hours before you need to use the toilet. The second dose works much more quickly.
The day of the procedure
At 5.00 am. Mix and drink the second sachet (prepare as above). If your appointment is before 9 am and you have a distance to travel you may wish to take this a little earlier (do not take before 3 am). Again you will have watery diarrhoea which should stop after 1 to 2 hours
You must continue to drink plenty of fluid from the list given – start at 6 am and drink at least 250ml every hour up to 2 hours before your appointment, then stop drinking until after the test.
HINTS AND TIPS
- Using a barrier cream, for example Vaseline or Sudocrem, around your anus (bottom) when you are going to the toilet may help to prevent soreness
PICOLAX / CITRAFLEET (sodium picosulfate)
For afternoon appointments after 1.00 pm
The day before the procedure
In the morning choose foods from the ‘foods you can eat’ list on page 5 and drink at least one large glass (approx. 250ml) of clear fluid from the list on page 5, EVERY HOUR from 12 noon to 9.00 pm.
It is important that you drink a total of two and a half litres of fluid throughout the day.
Stop eating at 4.00 pm (do not eat anything more until after the procedure).
Between 4.00pm and 6.00pm mix and drink one sachet of Picolax or Citrafleet (see mixing instructions on page 8). YOU MUST continue to drink clear fluids through the evening (past 9.00 pm if you wish) as this will help to clear the bowel and keep you hydrated.
The solution will cause watery diarrhoea so you should stay near a toilet. It may work in 30 minutes to an hour, but it might be several hours before you need to use the toilet. The second dose works much more quickly.
The day of the procedure
At 9.00am. Mix the second sachet and drink as before. Again you will have watery diarrhoea which should stop after 1 to 2 hours.
You must continue to drink plenty of fluid from the list given – start at 8.00 am and drink at least 250ml every hour up to 2 hours before your appointment, then stop drinking until after the test.
HINTS AND TIPS
- Using a barrier cream, for example Vaseline or Sudocrem, around your anus (bottom) when you are going to the toilet may help to prevent soreness
PLENVU
How to prepare PLENVU
Each box of Plenvu contains 2 sealed bags marked Dose 1 (single sachet) and Dose 2 (two sachets labelled ‘Dose 2 sachet A’ and ‘Dose 2 sachet B’).
To prepare Dose 1
- empty the contents of the sachet into a jug
- add water to make up to 500ml and stir until dissolved, which may take up to 8 minutes
Dose 2
- empty the contents of both sachet A and sachet B into a jug
- add water to make up to 500ml and stir until dissolved, which may take up to 8 minutes
For morning appointments between 08.00 am and 1.00 pm
The day before the procedure
In the morning, eat only foods from the ‘foods you can eat’ list on page 5.
Stop eating at 1.30 pm (do not eat anything more until after the procedure) and drink 1-2 litres of clear fluid throughout the day from the list given on page 5.
At 5.00 pm drink the 500mls Dose 1 of Plenvu (see mixing instructions above) AND 500mls of clear fluid over 60 minutes. You may alternate between the Plenvu and the clear fluid.
The solution will cause watery diarrhoea so you should stay near a toilet. It may work in 30 minutes to an hour, but it might be several hours before you need to use the toilet. The second dose works much more quickly.
The day of the procedure
At 5.00 am drink 500mls Dose 2 of Plenvu AND 500mls of clear fluid over 60 minutes. You may alternate between the Plenvu and the clear fluid. If your appointment is before 9.00 am and you have a distance to travel you may wish to take it a little earlier (do not take before 3 am). Again you will have watery diarrhoea which should stop after 1 to 2 hours. You may continue to drink clear fluids up to 2 hours before your appointment.
HINTS AND TIPS can be found at the bottom of the next page
PLENVU
For afternoon appointments after 1.00 pm
The day before the procedure
Eat only foods from the ‘foods you can eat’ list on page 5.
Stop eating at 4.00 pm (do not eat anything more until after the procedure) and drink 1-2 litres of clear fluid throughout the day from the list given on page 5.
At 5.00 pm drink the 500mls Dose 1 of Plenvu (see mixing instructions on previous page) AND 500mls of clear fluid over 60 minutes. You may alternate between the Plenvu and the clear fluid.
The solution will cause watery diarrhoea so you should stay near a toilet. It may work in 30 minutes to an hour, but it might be several hours before you need to use the toilet. The second dose works much more quickly.
The day of the procedure
At 9.00 am drink 500mls Dose 2 of Plenvu AND 500mls of clear fluid over 60 minutes. You may alternate between the Plenvu and the clear fluid.
If your appointment is early in the afternoon and you have a distance to travel you may wish to take this a little earlier. You will have watery diarrhoea which should stop after 1 to 2 hours. You may continue to drink clear fluids up to 2 hours before your appointment.
HINTS AND TIPS
- Do not drink it too quickly as it may make you feel sick; some people find it easier to drink if the solution is chilled and they use a straw
- You may wish to make up both doses of Plenvu at the same time and store in the fridge. Once made up the solution should be used within 24 hours
- Using a barrier cream, for example Vaseline or Sudocrem, around your anus (bottom) when you are going to the toilet may help to prevent soreness
Moviprep
How to prepare Moviprep
Each box of Moviprep contains two sealed plastic bags. Each plastic bag contains one sachet marked A and one sachet marked B
- Open one plastic bag and remove sachets A and B
- Pour the contents of one sachet A and one sachet B into a jug. Adding lukewarm water make up to 1 litre and stir until the powder is completely dissolved and the solution is clear or slightly hazy. Cordial or squash may be added (not blackcurrant).
- Some people find it easier to drink if it has been chilled in the fridge. Once made up the solution should be used within 24 hours
For morning appointments between 8.00 am and 1.00 pm
The day before the procedure
In the morning, eat only items from the ‘foods you can eat’ list on page 5.
Stop eating at 1.30 pm (do not eat anything more until after the procedure) and drink 1-2 litres of clear fluid throughout the day (from the list on page 5).
At 5.00 pm make up the first litre of Moviprep (see mixing instructions above) and drink it over 1 to 2 hours. It is very important to drink an additional 500ml of clear fluid during the evening.
The solution will cause watery diarrhoea so you should stay near a toilet. It may work in 30 minutes to an hour, but it might be several hours before you need to use the toilet. The second dose works much more quickly.
The day of the procedure
At 5.00 am make up and drink the second litre of Moviprep over 1 to 2 hours. If your appointment is before 9 am and you have a distance to travel you may wish to take this a little earlier (do not take before 3 am). It is very important to drink an additional 500ml of clear fluids during the morning up to 2 hours before your appointment, then stop drinking until after the test.
Once again you will have watery diarrhoea which should stop after 1 to 2 hours.
HINTS AND TIPS can be found at the bottom of the next page.
MOVIPREP
For afternoon appointments after 1.00 pm
The day before the procedure
Take a low fibre diet from the ‘foods you can eat’ list on page 5..
Stop eating at 4.00 pm (do not eat anything more until after the procedure) and drink 1-2 litres of clear fluid throughout the day from the list given (see page 5).
At 6.00 pm make up the first litre of Moviprep (see mixing instructions on previous page) and drink it over 1 to 2 hours. It is very important to drink an additional 500ml of clear fluids during the evening.
The solution will cause watery diarrhoea so you should stay near a toilet. It may work in 30 minutes to an hour, but it might be several hours before you need to use the toilet. The second dose works much more quickly.
The day of the procedure
At 9.00 am make up and drink the second litre of Moviprep over 1 to 2 hours. If your appointment is early in the afternoon and you have a distance to travel, you may wish to take it a little earlier. It is very important to drink an additional 500ml of clear fluids during the morning up to 2 hours before your appointment, then stop drinking until after the test.
Once again you will have watery diarrhoea which should stop after 1 to 2 hours.
HINTS AND TIPS
- Do not drink it too quickly as it may make you feel sick; some people find it easier to drink if the solution is chilled and they use a straw
- You may wish to make up both doses of Moviprep at the same time and store in the fridge. Once made up the solution should be used within 24 hours
- Using a barrier cream, for example Vaseline or Sudocrem, around your anus (bottom) when you are going to the toilet may help to prevent soreness