prep

PREPARING FOR PROCEDURES

IF YOU ARE HAVING A COLONOSCOPY

Colonoscopy is an examination of the large intestine/bowel by a flexible tube. It transmits pictures of the bowel lining to a TV-type monitor. It is done to investigate symptoms such as altered bowel habit, abdominal pain, low blood count, bleeding, or in those with history of bowel cancer or polyps. We can also remove polyps (polypectomy) which may prevent bowel cancer, take biopsies or inject blood vessels during colonoscopy. It will be a day procedure. You will be given sedation and cannot drive until the next day. The Colonoscopy preparation is designed to clear the bowel of faeces so that the best possible examination can be done. If the preparation is not adequate some abnormalities such as polyps or even bowel cancer can be missed. You can expect to have loose stools and then watery diarrhoea beginning a few hours after the prep.

 

WHAT PREPARATION OR PRECAUTIONS ARE REQUIRED?

Please follow the instructions for “COLONOSCOPY PREPARATION” (click here for more information). You will need to clear your bowel using laxatives bought from the chemist.

It is tempting to think that if you have diarrhoea the bowel must be clear and that it is ok not to take all the prep. This will result in a poor result and the procedure may need to be repeated, as polyps or cancers can be missed with poor preparation.

It is very important to follow these instructions below carefully and not the instructions on the Picosalax sachets. Picosalax causes diarrhoea so make sure that you are not away from your home or in a vehicle when this is taken. At the conclusion of the preparation bowel motions should be liquid, slightly yellow in colour and contain no visible sediment. If this is not the case advise the nurse on admission. For your comfort you may wish to apply a barrier cream to the anal area prior to commencing the bowel preparation.

NO SEEDS OR NUTS FOR TWO DAYS PRIOR TO YOUR PROCEDURE e.g. Multigrain bread, kiwi fruit, almonds.

You will need to buy 4 sachets of Picosalax from the chemist/ or WCEC:

Immediately before use, mix the contents of each sachet in approximately 150ml (about 2/3 cup) of water.  Stir for 2-3 minutes.  The solution should now become a off-white, cloudy liquid with a faint odour of orange.  Sometimes the solution becomes hot as the powder dissolves.  If this happens, wait until it cools sufficiently before drinking.

THE DAY BEFORE THE PROCEDURE TAKE CLEAR FLUIDS ONLY. You must drink at least 2-3 litres of fluid

  1. You may have jelly (not red or purple), clear strained soup, strained fruit juice, tea or coffee black and plenty of water.
  2. Drink the bottle of sports drink not red or purple as this can look like blood.

FOR A MORNING PROCEDURE, THE NIGHT BEFORE YOU WILL NEED TO:

  1. At 6.00 pm Drink one glass of the Picosalax over 5 to 10 minutes followed by a minimum of 750mls of water.
  2. At 7.00 pm Drink the 2nd glass of Picosalax over 5 to 10 minutes followed by a minimum of 750mls of water.
  3. At 8.00 pm Drink the 3rd glass of Picosalax over 5 to 10 minutes followed by a minimum of 750mls of water.
  4. At 9.00 pm Drink a bottle of sports drink e.g. "Gatorade" or "Powerade" (not red or purple)
  5. At 5.00 am the morning of your procedure - Drink the 4th glass of Picosalax over 5 – 10 minutes followed by 2 glasses of water. Nothing after 5.30 am.

FOR AN AFTERNOON PROCEDURE, THE NIGHT BEFORE YOU WILL NEED TO:

  1. At 7.00 pm Drink one glass of the Picosalax over 5 to 10 minutes followed by a minimum of 750mls of water.
  2. At 8.00 pm Drink the 2nd glass of Picosalax over 5 to 10 minutes followed by 750mls of water.
  3. At 9.00 pm Drink a bottle of sports drink e.g. "Gatorade" or "Powerade" (not red or purple
  4. At 5.00 am the morning of your procedure - Drink the 3rd glass of Picosalax over 5 to 10 minutes followed by a minimum of 750mls of water.
  5. At 6.00 am the morning of your procedure - Drink the 4th glass of Picosalax over 5 to 10 minutes followed by 1 large glass of water.

You must fast completely (no food at all), except that you may drink water up to 3 hours before your procedure.

IF YOU ARE HAVING AN ENDOSCOPY/GASTROSCOPY

FASTING REQUIREMENTS - You must fast for six hours before the procedure; this includes lollies and chewing gum. You may drink water only, up to 3 hours before your procedure. We strongly advise against smoking for at least 24 hours prior your procedure.

If for personal or religious reasons you cannot have a blood product or blood transfusion it is your responsibility to seek advice from your GP about alternative options prior to your procedure. Heart, lung or brain problems due to the sedation or blood pressure changes are possible, but very rare. Please inform your doctor of any other medical problems you may have. Allergic reactions or side effects to medications, including the bowel preparation are possible and unpredictable, but this is extremely rare.

Endoscopy Information

IF YOU ARE HAVING A FLEXIBLE SIGMOIDOSCOPY

This is a limited examination in which a flexible tube examines the lining of the last 1/3 of the large intestine, i.e. it doesn’t examine the whole of the large bowel. It may be done for symptoms of bleeding and diarrhoea and is usually reserved for those in whom more invasive examination may pose greater risk, or in the very young who only have minor bleeding. Sometimes it is used after a Barium enema to examine the very last part of the large bowel. Polyps within the reach of the instrument can be removed, however, if a polyp is seen a full examination of the bowel is required (Colonoscopy) to check for any other abnormalities. Flexible Sigmoidoscopy is a day procedure and lasts only about 5 to 10 minutes and is usually done with sedation. Because sedation is given, you cannot drive home, or drive until the next day.

FLEXIBLE SIGMOIDOSCOPY PREPARATION INSTRUCTIONS

If your procedure is in the morning: At 8.00 pm the night before your procedure – dissolve one sachet of Picosalax in a glass of warm water and chill in the fridge. When chilled, drink it over 5 to 10 minutes followed by 150 mls of water.

Then you must fast completely (nil by mouth), except that you may drink water up to 3 hours before your procedure.

If your procedure is in the afternoon: At 6.00 am the day of your procedure – dissolve one sachet of Picosalax in a glass of warm water and chill in the fridge. When chilled, drink it over 5 to 10 minutes followed by 150 mls of water.

Then you must fast completely (nil by mouth), except that you may drink water up to 3 hours before your procedure.

An enema will be given on arrival to clear the lower part of the bowel of stools.

Flexible Sigmoidoscopy Information

Flexible Sigmoidoscopy Admission Form

 

ADDITIONAL INFORMATION

DIABETICS

As a general guide, you may follow these instructions.

Tablets: Do not take your diabetic medication the night before and the day of your procedure.

Insulin: Take half your normal dose the night before, check levels in the morning, if TOO LOW- drink apple juice, if TOO HIGH – take half your insulin.

Take your insulin or tablets to the hospital with you. If you have concerns, discuss this with your doctor.

HISTORY OF HEART DISEASE OR STROKE

If you have a heart disease or have had previous strokes, these can be made worse by adjusting your blood thinners. The risk of a major coronary event after a coronary artery stent has been in place for more than 12 months is around 5%. If you are concerned about any known heart disease or previous strokes you must discuss this with the Gastroenterologist in consultation and the doctor in charge of your other illness e.g., cardiologist neurologist or GP.

SPECIFIC MEDICATION AND BLOOD THINNERS

The following medications MUST be discussed with your GP or Specialist (Cardiologist or Neurologist) at before your procedure is to go ahead. If you are taking:

  • Warfarin (Marevan, Coumadin)
  • Clopidogrel (Plavix, Iscover, Clovix, Piax)
  • Prasugrel (Effient)
  • Dipyridamole (Persantin and Asasantin)
  • Heparin
  • Clexane (Enoxaparin)
  • Pradaxa (Dabigatran)
  • Apixaban (Eliquis)
  • Rivaroxaban (Xarelto)
  • Ticagrelor (Brilinta)

You must make arrangements with your GP or Specialist (at least one week prior to your booking date) to discuss the management of your medication.

Aspirin should be continued.
Anti-inflammatories can be continued.
Iron liquid or tablets to be stopped 7 to 10 days before Colonscopy.

MEDICATIONS IN GENERAL

All medications should be taken, including blood pressure medications. Only stop these if you have been advised to stop.