Please read this leaflet as soon as possible and well in advance of your appointment. If you do not follow the advice on how to prepare for your procedure it may not be possible to do it and you may have to return on another day

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 leaflet

The aim of this leaflet is to help you prepare and empty your bowel for your procedure.

Introduction

You have been advised by your hospital doctor / practitioner to have an investigation to look at your bowel. To reduce the risk of complications and to give clear views, your bowel must be empty.

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. If you have been given KLEAN PREP please follow the instructions that are in the packet. The instructions are different for a morning or afternoon appointment so please make sure you check your appointment time.

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, since the laxative was prescribed for you, your health has become worse in any way 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.

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. Try to 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.
• Read all of the instructions for your particular appointment and laxative a few days before your appointment. It is important that you 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 you to have 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 tends to work 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.
• If you have problems with long term constipation, taking an additional daily laxative for 5 to7 days before you start the bowel preparation medication, may help to empty the bowel more effectively. If you have been advised to take senna in addition to the bowel preparation please take each evening for 5 to 7 days before you start the bowel preparation medication.
• 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 for your own comfort whilst taking your bowel preparation.
• If you have any problems or concerns after taking the bowel preparation, you may ring the enquiry numbers on page 2 of this booklet. Out of hours please contact the NHS non- emergency service on 111.

Two days before your procedure

For 2 days before your procedure eat a low fibre diet. Choose only items from the ‘foods allowed’ list. Stop eating foods on the ‘foods to avoid’ list. This helps to clear your bowel.

Foods to avoid

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

Oats (including biscuits containing oats)

Brown pasta or rice

Pickles or chutneys

Sausage rolls or pastries

Vegetable soup

High fibre breakfast cereals including Weetabix, porridge, bran, muesli and granola

Foods Allowed

Milk (including non-dairy alternatives), plain yoghurt

Cheese, eggs, butter, margarine

Rice Krispies and cornflakes

White bread or toast, white pitta, white rice or pasta

White fish or chicken – boiled, steamed or grilled (not fried)

Smooth peanut butter, Marmite, honey, clear jam (no seeds)

Mayonnaise, salad cream

Plain ice cream (any flavour – no fruit or nut pieces)

Clear jelly (not red), boiled sweets, chocolate (no fruit or nut pieces)

Salt, pepper, sugar, sweeteners

Clear fluids (no alcoholic drinks)

Tea and coffee (with only a small amount of milk) including herbal teas

Water, squash, sports drinks

Fizzy drinks such as cola, lemonade, fizzy water

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

Poached/scrambled egg on white toast

Boiled egg with white toast

Plain yoghurt (no fruit) with honey

Toasted white muffin or croissant with butter/dairy free spread and honey

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 (soya product for vegetarians/vegans) 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 clear jam (no 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)

Plain rice cakes

Boiled sweets

Jelly sweets

Madeira cake or other plain sponge cake without jam or fruit/nuts

Plain scones (without fruit)

Custard cream, rich tea or shortbread biscuits (no other biscuits are allowed)

Hot chocolate drink

Milkshakes

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

Step 1

• 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

Step 2

• Drink one glassful (250ml) of the Moviprep every 15 to 30 minutes until you have drunk it all (taking about 1 to 2 hours).
• Do not drink it too quickly as it may make you feel sick.
• It may help with nausea to drink it through a straw
• You should drink an additional 500ml of water or clear fluids (from the list given) with each litre of Moviprep taken. This is important to help clear the bowel.

When to take Moviprep if your appointment is between 8.00 am and 1.00 pm

The day before the procedure

Take a low fibre diet from the ‘foods allowed’ list.

Stop eating at 1.30 pm. Do not eat anything after 1.30 pm but drink plenty of clear fluid (1-2 litres) throughout the day from the list given at the end of this leaflet.

At 5.00 pm make up the first litre of Moviprep and drink it over 1 to 2 hours. It is important to drink an additional 500ml of clear fluids during the evening (choose from the list given).

The solution will cause you to pass watery diarrhoea so you should stay near a toilet.

The day of the procedure

Do not eat anything solid until after 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 9.00am and you have a distance to travel you may wish to take this a little earlier (do not take before 3.00 am).

It is important to drink an additional 500ml of clear fluids (from the list given) 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 will stop after 1 to 2 hours. Allow 2 hours for the Moviprep to work after finishing the second litre, before leaving for your appointment.

When to take Moviprep if your appointment is after 1.00 pm

The day before the procedure

Take a low fibre diet from the ‘foods allowed’ list at the end of this leaflet.

Stop eating at 4.00 pm. Do not eat anything after 4.00 pm but drink plenty of clear fluid (1-2 litres) throughout the day from the list given.

At 6.00 pm make up the first litre of Moviprep and drink it over 1 to 2 hours. It is important to drink an additional 500ml of clear fluids during the evening (choose from the list given).

The solution will cause you to pass watery diarrhoea so you should stay near a toilet.

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 important to drink an additional 500ml of clear fluids during the morning (from the list given) up to 2 hours before your appointment, then stop drinking until after the test.

Once again you will have watery diarrhoea which will stop after 1 to 2 hours. Allow 2 hours for the Moviprep to work after finishing the second litre, before leaving for your appointment.

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’). 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. It may help to drink it through a straw.

Dose 1

• empty the contents of the sachet into a measuring container that can hold 500mls of fluid.
• add water to make up to 500ml and stir until dissolved
• drink the full contents of the container over 30 minutes
• do not drink it too quickly as it may make you feel sick
• drink an additional 500mls of clear fluid over the next 30 minutes

Dose 2

• empty the contents of both sachet A and sachet B into a measuring container that can hold 500mls of fluid
• add water to make up to 500ml and stir until dissolved
• drink the full contents of the container over 30 minutes
• do not drink it too quickly as it may make you feel sick
• drink an additional 500mls of clear fluid over the next 30 minutes

When to take PLENVU if your appointment is between 08.00 am and 1.00 pm

The day before the procedure

Take a low fibre diet from the ‘foods allowed’ list.

Stop eating at 1.30 pm. Do not eat anything after 1.30pm but drink plenty of clear fluid (1-2 litres) throughout the day from the list given.

At 5.00 pm take Dose 1 of the Plenvu and drink it over 30 minutes. It is important to drink an additional 500ml of clear fluid over the next 30 minutes.

The solution will cause you to pass watery diarrhoea so you should stay near a toilet.

The day of the procedure

Do not eat anything solid until after the procedure.

At 5.00am take Dose 2 of the Plenvu and drink it over 30 minutes. It is important to drink an additional 500mls of clear fluid over the next 30 minutes. If your appointment is before 9.00am and you have a distance to travel you may wish to take it a little earlier (do not take before 3.00 am) Again you will have watery diarrhoea which should stop after 1 to 2 hours.

When to take PLENVU if your appointment is after 1.00 pm

The day before the procedure

Take a low fibre diet from the ‘foods allowed’ list.

Stop eating at 2.00pm. Do not eat anything after 4.00pm but drink plenty of clear fluid (1-2 litres) throughout the day from the list given

At 5.00 pm take Dose 1 of the Plenvu and drink it over 30 minutes. It is important to drink an additional 500ml of clear fluid over the next 30 minutes.

The solution will cause you to pass watery diarrhoea so you should stay near a toilet.

The day of the procedure

Do not eat anything solid until after the procedure.

At 9.00am take Dose 2 of the Plenvu and drink it over 30 minutes. It is important to drink an additional 500mls of clear fluid over the next 30 minutes. If your appointment is early in the afternoon and you have a distance to travel you may wish to take this a little earlier. Again you will have watery diarrhoea which should stop after 1 to 2 hours.

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.

When to take PICOLAX or CITRAFLEET if your appointment is between 08.00 am and 1.00 pm

The day before the procedure

Take a low fibre diet from the ‘foods allowed’ list.

Drink at least one large glass (approx. 250ml) of clear fluid from the list given, every hour from 12.00 noon to 9.00 pm. It is important that you drink a total of two and a half litres of fluid.

Stop eating at 1.30pm. Do not have anything to eat after 1.30 pm.

Between 4.00 pm and 6.00 pm take one sachet of Picolax or Citrafleet

The solution will cause you to pass watery diarrhoea so you should stay near a toilet.

The day of the procedure

Do not eat any solid food until after the examination.

At 5.00 am. Mix the second sachet and drink as before. If your appointment is before 9.00 am and you have a distance to travel you may wish to take this a little earlier (do not take before 3.00 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 6.00 am and drink at least 250ml every hour up to 2 hours before your appointment, then stop drinking until after the test.

When to take PICOLAX OR CITRAFLEET if your appointment is after 1.00 pm

The day before the procedure

Take a low fibre diet from the ‘foods allowed’ list.

Drink at least one large glass (approx. 250ml) of clear fluid from the list given, every hour from 12.00 noon to 9.00 pm. It is important that you drink a total of two and a half litres of fluid.

Stop eating at 4.00 pm. Do not have anything to eat after 4.00 pm. However, it is important that you drink plenty of clear fluid from the list given.

Between 4pm and 6pm take one sachet of Picolax or Citrafleet.

The solution will cause you to pass watery diarrhoea so you should stay near a toilet.

The day of the procedure

Do not eat any solid food until after the examination.

At 9.00 am. 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.