Extended Bowel Preparation Afternoon Appointment Plenvu and Picolax

Gastroenterology Department - Royal Liverpool and Broadgreen Hospitals

Your clinician would like you to have extended bowel preparation over four days for your colonoscopy test. The instructions are given below and should be followed carefully.

What are the benefits of bowel preparation?

Bowel preparation will clear your bowel of all waste material. This will allow the endoscopist to view your bowel properly during your procedure.

Are there any risks/side effects?

• The medication will clear out of the bowel resulting in diarrhoea within approximately one to two hours of the first dose. It is advised that you stay within easy reach of a toilet once you start to take the medication.
• Some patients experience nausea, vomiting, or abdominal pain. This can be associated with dizziness. If any of these symptoms occur, please lie down until they pass.
• You might like to use a barrier cream to prevent a sore bottom. A product such as petroleum jelly can also be effective.
• Some stomach cramping is normal.
• If you vomit up the bowel preparation at any time or have any other concerns regarding side effects please contact us directly – see end of leaflet for contact details.
• Female patients If you are taking an oral contraceptive pill, diarrhoea can make it less effective.

Are there any alternatives to this procedure?

This procedure has been considered the best test to investigate your symptoms. If you are unsure about having this procedure, then please discuss alternative tests with the clinician who referred you.

You can eat foods from the low residue diet list from day one (four days before the test) but you must not eat any solid food for a day and a half before the test

An example of a low residue diet is shown further on in this leaflet

• Day one: Date....................................................................... Low residue diet.
• Day two: Date........................................................................ Low residue diet.
• Day three: Date..................................................................... Low residue diet until 4pm.

You can have a light breakfast and lunch from the low residue diet list and then no further solids from 4pm.

An example of clear fluid drinks is shown further on in this leaflet When do I take my first sachet of Picolax?

• Day three: Date:....................................................................... at 6pm

Over the next four hours drink at least two pints of fluid from the clear fluid drinks list.

When do I take my second sachet of Picolax?

• Day four: Date:......................................................................... at 10am

You should continue to drink fluids from the clear fluid drinks list. Instructions on how to mix Picolax are attached

Important: The medication will clear out your bowel resulting in diarrhoea within approximately one to three hours of the first dose. It is advised that you stay close to a toilet.

It is advised not to drink alcohol with Picolax. When do I take Plenvu?

• Dose one: Day Four Date....................................................................... at 7pm
• Dose two (Sachet A + B): Day Five Date............................................ at 7am

Instructions on how to mix and take Plenvu are attached

Important: The medication will clear out your bowel resulting in diarrhoea within approximately one to three hours of the first dose. It is advised that you stay close to a toilet.

It is advised not to drink alcohol with Plenvu

Day five: Colonoscopy date ………………………………………………………………

Summary

What do I do on the day of the Colonoscopy?

Remember you are not allowed to eat anything until after your test.

• • You may continue to take all your other usual medications as normal.
  • Do not take your medication one hour either side of drinking your dose of Plenvu.
• • Avoid taking medications such as tetracycline, ciprofloxacin, iron, digoxin, chlorpromazine and pencilliamine two hours before or six hours after taking Picolax
• • Do not take tablets for diabetes on the day of your colonoscopy but bring your medication with you.
  • If you take insulin, please take this as instructed by your diabetes nurse.
• • If you normally monitor your blood sugar then please check it every two hours

·  If you feel dizzy, sweaty or irritable (hypo) take two to three teaspoons of sugar or six glucose tablets or one glass of Lucozade.

·  You should feel better almost immediately, if not repeat the above treatment. If symptoms persist, contact your doctor.

• • If you take blood thinning tablets, please take these as advised by the anticoagulation team who will contact you before your procedure.
  • If you take antiplatelet therapy e.g. Clopidogrel, Prasugrel, Aspirin etc. you will be advised if/ when to stop this by the gastroenterology staff.

You should continue to drink clear fluids up until two hours before your appointment time.

Attend the gastroenterology department at your appointment time.

How to make up Picolax sachets

• • Empty the sachet into a glass.
  • Add one cup of water (approximately 150mL).
  • Stir for two – three minutes – the solution should become off-white, cloudy liquid with a faint odour of orange.
  • If the solution becomes warm, wait until it cools sufficiently to drink.
  • Drink the solution.
  • Ensure adequate clear fluid intake.

How to make up Plenvu sachets Dose one

• • Pour the contents of the single sachet for dose one into a jug.
  • Make the solution up to 500mL with water.
  • Stir the solution well.
  • Drink the solution over a period of 60 minutes.
  • Alternate sips of the solution with sips of clear fluids as outlined below.
  • Aim to drink an additional 500mL of clear fluids in between sips of the Plenvu solution.

Dose two (Sachet A and B)

• • Pour the contents of the two sachets (sachet A and B) together in a jug.
  • Make the solution up to 500mL with water.
  • Stir the solution well.
  • Drink the solution over a period of 60 minutes.
  • Alternate sips of the solution with sips of clear fluids as outlined below.
  • Aim to drink an additional 500mL clear fluids in between sips of the Plenvu solution.

Which foods can I eat? (Low residue foods)

• • White meat, skinless chicken, grilled/boiled/poached or steamed white fish.
  • Potato without skin boiled/mashed/chips.
  • Eggs, cheese, tofu.
  • White - bread, croissants, pasta, rice, cous cous, pastry (white flour)
  • Cornflakes, Rice Krispies, Frosted Flakes
  • Milk, smooth yoghurts
  • Crisps
  • Butter/margarine.
  • Seedless/shredless marmalade or jam.
  • Marmite, honey, rich tea biscuits, chocolate, yoghurt.
  • Plain ice-cream, custard, clear jelly (no red or blackcurrant jelly), boiled sweets.
  • Sponge cakes without fruit or nuts, rice pudding/semolina
  • Do not eat red meat, fruit, vegetables, nuts or pulses, brown bread or bran.

Which foods should I avoid?

• • Wholemeal or granary bread, wholemeal flour, wholemeal pasta, brown rice, pearl barley, quinoa.
  • All whole-wheat cereals e.g Branflakes, Weetabix, Shreddies etc.
  • Porridge and museli- (all containing dried fruit and nuts).
  • Yogurts or cheese containing fruit or nut pieces.
• • Red meat or fish that is tough or gristly, skin and bones of fish and chicken, pies, egg dishes containing vegetables.
  • Vegetables, salad, baked beans, split peas, lentils, peas, sweet corn, celery, All seeds, tough skins, potato skins.
  • All fruit including dried fruit, citrus fruit and berries, prunes, smoothies, fruit juices with bits.
  • Avoid all nuts including coconut and almond
  • Puddings, cakes and biscuits made with wholemeal flour, dried fruits or nuts.
  • Chocolate or toffee with dried fruits or nuts, Popcorn, Marzipan, Digestive biscuits.
  • Marmalade with peel or jam with seeds.
  • Lentil and vegetable soups, Pickles and chutneys, Horseradish, Relish.

What can I drink?

• • Water, mineral/fizzy, fizzy drinks (including Lucozade), fruit squash (not blackcurrant), chicken stock cubes, clear soup, tea/coffee (to be taken black the day before procedure).
  • Sweetener may be added to food/drinks.

Breakfast

• • One boiled or poached egg.
  • One to two slices of white bread, butter or margarine or honey.
  • Tea or coffee (Small amount of milk optional).

Midday

• • Steamed or grilled white fish or chicken
  • One medium boiled potato (no skin) or two tablespoons of boiled white rice.
  • Small plain vanilla ice-cream and plain jelly.

Evening

• • As midday, or other foods from the low residue foods list.
  • Small plain vanilla ice-cream and plain jelly.

It is important to drink plenty of fluids in-between mealtimes

Feedback

Your feedback is important to us and helps us influence care in the future.

Following your discharge from hospital or attendance at your outpatient appointment you will receive a text asking if you would recommend our service to others. Please take the time to text back, you will not be charged for the text and can opt out at any point. Your co-operation is greatly appreciated.

Further information:

Contact the Gastroenterology Unit at the Royal Liverpool Hospital Monday – Sunday: 8am – 6pm

Telephone: 0151 706 2819 / 2726 / 2656

Text phone number: 18001 0151 706 2819 / 2726 / 2656

Author: Gastroenterology

Review date: May 2029

PI 2166 V2