How to Take Bowel Preparation Medicine Information for Patients having a Colonoscopy This leaflet gives instructions for how and when to take bowel preparation medicine. Bowel preparation medicine, which is a laxative, needs to be taken before procedures such as colonoscopy, flexible sigmoidoscopy or CT colonography to cleanse and empty the bowel. You should also have a separate leaflet which describes the procedure itself. To get a clear view of the lining of your bowel, it must be as empty and clean as possible. You will need to follow a low fibre diet for 2 days beforehand. You will need to take the laxatives included in your pack with this leaflet. The laxative will give you watery diarrhoea so you must drink adequate fluids and obviously stay close to a toilet. Special Precautions for Bowel Preparation If you are taking any regular medication for stomach, bowel, heart, lung, kidney or other medical conditions, please continue these as normal, you may take your medications with a glass of water on the day of your examination. For patients on warfarin, stop taking this taking warfarin for a metallic heart valve clot) or pulmonary embolism, please do need to make alternative plans to thin your drug 5 days before. However, if you are or previous venous thrombosis (blood not stop it, and do let us know as we will blood around the time of your procedure For patients on Pradaxa (dabigatran), stop taking this drug 3 days before. However, if you are taking this for a metallic heart valve or previous venous thrombosis (blood clot) or pulmonary embolism, please do not stop it, and do let us know as we will need to make alternative plans to thin your blood around the time of your procedure For patients on clopidogrel, do not take it for 7 days prior to your procedure, you may restart it after your procedure. However if you have had a coronary stent inserted less than 12 months ago please do not stop the clopidogrel, and let us know Aspirin 75mg daily is ok to continue. If you have had a heart attack or acute heart failure or a coronary stent inserted recently, it is advisable to wait until your condition has stabilised before having your colonoscopy, usually 3 months. Check with us and your cardiologist. If you are asthmatic, please bring your inhalers with you. If you are taking any regular medication for diabetes, check with the nursing staff for specific instructions. We will send you a special leaflet that explains how to control Page 1 your blood sugar around the time of your procedure. Please bring your diabetic pills or insulin with you [it is important to maintain a blood sugar above 5 leading up to your procedure, check your glucose level and if necessary suck some glucose tablets ahead of your procedure to achieve this]. If you have a colostomy (external stool bag on a stoma from previous bowel surgery), the bowel preparation medicine will work in the same way. You are advised to put on a drainable appliance before taking the medicine until after the examination. If you do not have any drainable appliances (pouches), please contact your stoma care nurse at Wexham Park Hospital on 01753 633734 or bleep via the hospital switchboard on 01753 633000. Please let us know if you are pregnant or trying to conceive. Note: Patients taking the oral contraceptive pill should take alternative precautions during the week following taking bowel prep as rapid bowel transit may make the pill ineffective. If you are in poor health or very frail, this procedure may not be for you. Come to see us first in the outpatient clinic to decide if this indeed the best way to check your bowel. It may be better to check you using the alternative techniques discussed above. Page 2 BOWEL PREPARATION Seven days before your examination If you normally take any iron tablets, stop taking them now. Four days before your examination Stop taking any constipating agents, e.g., Lomotil, codeine phosphate etc, but continue with other medication and any laxatives. Avoid fibre supplements such as Fybogel. Two days before your examination EAT ONLY foods from the following list. Permitted foods: Chicken Cheese Eggs White bread Honey (but not jam or marmalade) Rich tea biscuits Plain yoghurt White fish Potatoes (without the skin) Chapattis Butter or margarine Yellow jelly (but not red) Ice cream Foods NOT permitted: High fibre foods Fruit Mushrooms Wholemeal bread Sweet corn Red meat Vegetables Salads Nuts Cereals or pulses in any form The day before your examination Have a good breakfast, and a light lunch, of foods taken from yesterday's permitted list. After this do not eat any solid food until after your examination but drink plenty of clear fluids (tea, coffee, squash, non-alcoholic drinks, carbonated drinks, water, clear soups, Bovril, Oxo, etc.). You may have small amounts of milk in tea and coffee. Clear jelly and ice cream are permitted. **If your admission time is at or after 3.00pm tomorrow, you may have a light evening meal today, from the list of permitted foods. Taking the laxative Follow the instructions here, not the manufacturer’s instructions. 10 senna tablets and two sachets of Citramag are enclosed. Please follow the instructions for taking this medication which begin overleaf. Please note that the time at which you must take the bowel prep varies depending on the time of your appointment. Please follow the instructions on the correct sheet. For comfort during the bowel preparation, you may wish to put some ointment on your bottom. Zinc and castor oil, Sudocrem and Vaseline are all suitable. Please bring a dressing gown, slippers and something to read. Do not bring valuable items such as credit cards and jewellery. Page 3 If your appointment is at 9.45 am or before The day before your examination Have a good breakfast and a light lunch at 12:00pm eating only foods from the Permitted foods list on page 3. After this, do not eat any solid food until after your examination but drink plenty of clear fluids only such as tea, coffee, squash, carbonated drinks, water, clear soups, Bovril and Oxo. You may have small amounts of milk in tea and coffee. Clear yellow jelly and ice cream are also permitted. Drink at least 1½ litres of clear liquids during the day. At 4:00 pm in the comfort of your home, take all 10 Senna tablets with a glass of water. At 5.00 pm dissolve the contents of 1 sachet of Citramag in 200mls (8 fluid ounces) of hot water in a measuring jug. Citramag fizzes and may spill if a large enough jug is not used. Allow the liquid to cool for at least half an hour before pouring it into a suitable glass and drinking it. At 7:00 pm, prepare and drink the second sachet of Citramag in the same way. Stay close to an available toilet since you should expect frequent, watery bowel movements, like diarrhoea, to start within 3 hours of taking Citramag. You may also experience stomach cramps, but you must drink all the Citramag to ensure the bowel is emptied completely. Remember: You MUST drink plenty of clear fluids, throughout the day and evening, to help avoid headaches and dehydration. On the day of your examination Take any prescribed tablets, other than those mentioned earlier, with a glass of water. You may have a light drink (water, squash, black tea) no later than 4 hours before your appointment. Page 4 If your appointment time is between 10am and 3pm inclusive The day before your examination Have a good breakfast and a light lunch at 12:00pm eating only foods from the Permitted foods list on page 3. After this, do not eat any solid food until after your examination but drink plenty of clear fluids only such as tea, coffee, squash, carbonated drinks, water, clear soups, Bovril and Oxo. You may have small amounts of milk in tea and coffee. Clear yellow jelly and ice cream are also permitted. Drink at least 1½ litres of clear liquids during the day. At 4:00 pm in the comfort of your home, take all 10 Senna tablets with a glass of water. At 5.00 pm dissolve the contents of one sachet of Citramag in 200mls (8 fluid ounces) of hot water in a measuring jug. Citramag fizzes and may spill if a large enough jug is not used. Allow the liquid to cool for at least half an hour before pouring it into a suitable glass and drinking it. Stay close to an available toilet since you should expect watery bowel movements, like diarrhoea, to start within 3 hours of taking Citramag. You may also experience stomach cramps. Remember: You MUST drink plenty of clear fluids throughout the day and evening to help avoid headaches and dehydration. On the day of your examination At 6:00 am, prepare and drink the second sachet of Citramag. Take any prescribed medications, other than those mentioned earlier, with a glass of water. You may have a light drink (water, squash, black tea) no later than 4 hours before your appointment. Page 5 If your appointment is after 3pm On the day of your examination Have a liquid breakfast before 8 am. This can include tea and coffee (without milk), Bovril, fruit squashes, Coke or clear soup. At 8:00 am, in the comfort of your home, take all 10 Senna tablets with a glass of water. Then, prepare and drink both sachets of Citramag. Dissolve the contents of one sachet of Citramag in 200mls (8 fluid ounces) of hot water in a measuring jug. Citramag fizzes and may spill if a large enough jug is not used. Allow the liquid to cool for at least half an hour before pouring it into a suitable glass and drinking it. Take any prescribed medications other than those mentioned earlier. You MUST drink plenty of clear fluids throughout the day to help avoid headaches and dehydration. You may have a light drink (water, squash, black tea) no later than 4 hours before your appointment. Stay close to an available toilet since you should expect watery bowel movements, like diarrhoea, to start within 3 hours of taking Citramag. You may also experience stomach cramps. By the time you have to leave for the hospital the bowel should be empty. Page 6 If you would like a copy of this leaflet on audiotape, in large print or translated, please telephone 01753 634398 Title of leaflet: How to take Bowel Preparation Medicine: Information for Patients having a Colonoscopy Reference No: H/030/1 Issue Date: September 2013 Review date: September 2015 Compiled by: Dr Sass Levi, Lady Sobell GI Unit Legal Notice Please remember that this leaflet is intended as general information only. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on any concerns you may have with your doctor. Heatherwood Hospital Wexham Park Hospital London Road Wexham Street Ascot Slough Berkshire SL5 8AA Berkshire SL2 4HL Tel 01344 623333 Tel 01753 633000 Web: http://www.heatherwoodandwexham.nhs.uk/information-leaflets Page 7