BOWEL PREPARATION FOR COLONOSCOPY
Notes for medical and nursing staff
GENERAL COMMENTS
Poor preparation is the most common reason for failure of colonoscopy.
If a colonoscopic examination is incomplete, the patient is subjected to the risks and discomfort of
the procedure without its full benefits. The test will often have to be repeated. This is undesirable
for the patient and leads to inefficient use of the endoscopy facilities so that other patients will have
to wait longer for their test.
The instructions enclosed are designed for the “average” patient. Specific situations may require a
more individualised approach.
SPECIAL SITUATIONS


Patients with severe constipation may require regular laxatives, an increased fluid intake and
enemas for several days prior to commencement of bowel prep.
Patients with established or impending bowel obstruction should not receive stimulant
laxatives. If bowel prep is necessary this should be performed very carefully after consultation
with gastroenterology or surgical colleagues.
Patients who have had colonic surgery: You need to know details of the operation.






Colonic resection without stoma: standard oral bowel prep.
Sub-total colectomy (ileo-sigmoid or ileo-rectal anastomosis or ileal pouch): overnight fast
followed by enema prep (as for sigmoidoscopy).
Abdominoperineal resection (AP resection or APER): standard oral bowel prep.
Defunctioning colostomy (loop colostomy): standard oral bowel prep and a wash-out per
stoma (if the distal colon needs to be examined).
Hartmann’s procedure (colostomy with an oversewn rectal/ sigmoid stump): standard oral
bowel prep and an enema (as for sigmoidoscopy).
Defunctioning ileostomy: there is no point in giving oral bowel prep since the faecal stream is
diverted via the stoma. This sounds obvious but I have seen it done! Need colonic wash-out per
stoma +/- enemas – this will usually require admission to the surgical ward.
Any patient with a colostomy receiving oral bowel prep will need a special drainage colostomy bag
– contact stoma nurses.
PATIENTS REQUIRING ADMISSION
 Frail, disabled or elderly patients who may have difficulty getting to and from the toilet or who
are at risk of falls due to dehydration
 Some “brittle” or unsupported diabetics on insulin. (Most can manage at home – see protocol)
 Patients who require supervised bowel prep (eg where previous prep at home has failed)
 Patients who require colonic wash-out per stoma (see above)
IN-PATIENT BOWEL PREP




Keep a check to make sure everything is going to plan.
If no result within 3 hours of first dose of prep, give enema to start things off.
If severe pain, do not persevere with prep; contact Endoscopy Unit.
Check that rectal effluent is CLEAR, colourless fluid by the end of prep. If not, more may be
needed.
If you have any reason to suspect that bowel prep has been inadequate, PLEASE let the Endoscopy
Unit know in advance.
Morning appointment
BOWEL PREPARATION FOR COLONOSCOPY
Instructions for Patient
For colonoscopy (examination of the large bowel), the bowel must be empty so that
we can get good views. It is very important to follow the instructions below carefully
– otherwise your test may be unsuccessful and will have to be repeated.
If you are on treatment for diabetes (tablets or insulin) ask your GP or hospital
doctor for specific advice since prolonged fasting may be dangerous.
ONE WEEK BEFORE THE TEST

If you are taking iron tablets (anything with “Ferrous” in the name) or
constipating medications such as loperamide (Imodium) or codeine
phosphate, these should be stopped at least 5 days before the test.

If you are taking Warfarin tablets and have been given no specific advice about
whether to continue with them, please contact the Endoscopy Unit for guidance.

Continue with all other medications until your appointment.
TWO DAYS BEFORE THE TEST (i.e. Wednesday if your test if on a Friday)

From two days before the test you may eat only low residue foods.

Foods from the following list are acceptable: boiled or steamed white fish, boiled
chicken, potato (no skin), egg, cheese, white bread, butter (or margarine),
seedless jam, Marmite, honey, rich tea biscuits, chocolate, yoghurt, jelly (any
colour except red) and ice-cream.

Do not eat red meat, fruit, vegetables, nuts, pulses or cereals in any form.

You should aim to drink plenty of fluid during the day.
THE DAY BEFORE THE TEST

Have a good breakfast of foods taken from yesterday’s permitted list.

You are now ready to begin taking the bowel clearing medicine (please turn the
page for detailed instructions).

After breakfast you must eat no solid food but drink as much clear fluid as
possible.

Clear fluids include fruit juices (without pulp), fizzy drinks or tea and coffee
(without milk). Bovril or clear soup (watery without bits in it) can be taken to
keep your strength up and sugary drinks such as Lucozade provide energy.

The more you drink, the better your bowel preparation will be.
Afternoon appointment
BOWEL PREPARATION FOR COLONOSCOPY
Instructions for Patient
For colonoscopy (examination of the large bowel), the bowel must be empty so that
we can get good views. It is very important to follow the instructions below carefully
– otherwise your test may be unsuccessful and will have to be repeated.
If you are on treatment for diabetes (tablets or insulin) ask your GP or hospital
doctor for specific advice since prolonged fasting may be dangerous.
ONE WEEK BEFORE THE TEST

If you are taking iron tablets (anything with “Ferrous” in the name) or
constipating medications such as loperamide (Imodium) or codeine
phosphate, these should be stopped at least 5 days before the test.

If you are taking Warfarin tablets and have been given no specific advice about
whether to continue with them, please contact the Endoscopy Unit for guidance.

Continue with all other medications until your appointment.
TWO DAYS BEFORE THE TEST (i.e. Wednesday if your test if on a Friday)

From two days before the test you may eat only low residue foods.

Foods from the following list are acceptable: boiled or steamed white fish, boiled
chicken, potato (no skin), egg, cheese, white bread, butter (or margarine),
seedless jam, Marmite, honey, rich tea biscuits, chocolate, yoghurt, jelly (any
colour except red) and ice-cream.

Do not eat red meat, fruit, vegetables, nuts, pulses or cereals in any form.

You should aim to drink plenty of fluid during the day.
THE DAY BEFORE THE TEST

Have a breakfast of foods taken from yesterday’s permitted list.

At 12 o’clock (midday) have a light lunch of foods taken from yesterday’s
permitted list.

You are now ready to begin taking the bowel clearing medicine (please turn the
page for detailed instructions).

After lunch you must eat no solid food but drink as much clear fluid as
possible.

Clear fluids include fruit juices (without pulp), fizzy drinks or tea and coffee
(without milk). Bovril or clear soup (watery without bits in it) can be taken to
keep your strength up and sugary drinks such as Lucozade provide energy.

The more you drink, the better your bowel preparation will be.
Morning appointment
PICOLAX PREP - MORNING APPOINTMENT
You will have been given three sachets of Picolax. These must be taken on the
day before the test according to the following instructions.
ON THE DAY BEFORE THE TEST
At 10 o’clock in the morning empty one sachet of Picolax into a glass and mix with
4 dessert spoonfuls of water. Warning: the solution will become hot. Wait 5
minutes until the reaction is complete and then fill the glass with cold water, making
it up to about 150ml (1/4 pint) of liquid. Drink the solution.
NB
The medication will clear out the bowel resulting in diarrhoea within
three hours of the first dose, so stay near a toilet!
Over the next 4 hours drink a least 2 pints of clear fluid.
******
At 2 o’clock in the afternoon dissolve the second sachet of Picolax as described
above and drink.
During the afternoon aim to drink a further 2 pints of clear fluid.
******
At 6 o’clock in the evening dissolve the final sachet of Picolax as described above
and drink.
During the evening aim to drink a further 2 pints of clear fluid.
******

Some intestinal cramping is normal.

Applying a barrier cream (such as zinc & castor oil or Sudocrem) to the skin
around your bottom will prevent soreness.
******
ON THE DAY OF THE TEST

Take no solid food.

Take your regular medication with a small amount of water (except diabetes
tablets – see above)

You should continue to drink clear fluid (preferably water) until two hours before
the appointment time for your colonoscopy.

You must not eat or drink for 2 hours before the test.

You will usually be allowed to eat and drink again one hour after the test.
******
If you vomit the Picolax or have any other concerns please contact the Endoscopy
Unit on 0151 706 *******: A member of the nursing staff will be happy to assist you.
Afternoon appointment
PICOLAX
-
AFTERNOON APPOINTMENT
You will have been given three sachets of Picolax. You must start taking these on
the day before the test according to the following instructions.
ON THE DAY BEFORE THE TEST
At 2 o’clock in the afternoon empty one sachet of Picolax into a glass and mix with
4 dessert spoonfuls of water. Warning: the solution will become hot. Wait 5
minutes until the reaction is complete and then fill the glass with cold water, making
it up to about 150ml (1/4 pint) of liquid. Drink the solution.
NB
The medication will clear out the bowel resulting in diarrhoea within
three hours of the first dose, so stay near a toilet!
Over the next 4 hours drink a least 2 pints of clear fluid.
******
At 6 o’clock in the evening dissolve the second sachet of Picolax as described
above and drink.
During the evening aim to drink a further 2 pints of clear fluid.
******

Some intestinal cramping is normal.

Applying a barrier cream (such as zinc & castor oil or Sudocrem) to the skin
around your bottom will prevent soreness.
******
ON THE DAY OF THE TEST
Take no solid food
Take your regular medication with a small amount of water (except diabetes tablets
– see above)
At 8 o’clock in the morning dissolve the final sachet of Picolax as described above
and drink.
During the morning aim to drink a further 2 - 3 pints of clear fluid.

******
You should continue to drink clear fluid (preferably water) until two hours before
the appointment time for your colonoscopy.

You must not eat or drink for 2 hours before the test.

You will usually be allowed to eat and drink again one hour after the test.
******
If you vomit the Picolax or have any other concerns please contact the Endoscopy
Unit on 0151 706 *******: A member of the nursing staff will be happy to assist you.
Morning appointment
KLEAN-PREP - MORNING APPOINTMENT
You will have been given four sachets of Klean-Prep. These must be taken on
the day before the test according to the following instructions.
ON THE DAY BEFORE THE TEST
At 2 o’clock in the afternoon, fill a jug or bowl with 1 litre (1 ¾ pints) of water.
Empty the contents of one Klean-Prep sachet into it and stir until the powder is
completely dissolved. Drink one glassful of this solution about every 15 minutes
until you have drunk it all. Take your time – there is no need to rush. It should take
about 1 hour to drink a litre of solution.

Some people find Klean Prep easier to drink if they add a flavour such as lime
cordial.
At 4 o’clock in the afternoon, make up the next sachet as above and drink it over
about an hour.
NB: The medicine will clear out the bowel resulting in diarrhoea within
three hours of the first dose, so stay near a toilet!

If you have not had a bowel movement by 6 pm, do not take any more KleanPrep but wait until you have a bowel movement and then start taking KleanPrep again.
At 6 o’clock in the evening make up the next sachet and drink the liquid as before.
At 8 o’clock in the evening make up the last sachet and drink it.

Throughout the day, you can continue to drink as much additional clear fluid as
you like.
******
ON THE DAY OF THE TEST

Take no solid food.

Take your regular medication with a small amount of water (except diabetes
tablets – see above)

You should continue to drink clear fluid (preferably water) until two hours before
the appointment time for your colonoscopy.

You must not eat or drink for 2 hours before the test.

You will usually be allowed to eat and drink again one hour after the test.
******
If you vomit the Klean-prep or have any other concerns please contact the
Endoscopy Unit on 0151 706 *******: A member of the nursing staff will be happy to
assist you.
Afternoon appointment
KLEAN-PREP - AFTERNOON APPOINTMENT
You will have been given four sachets of Klean-Prep. You must start taking these
on the day before the test according to the following instructions.
ON THE DAY BEFORE THE TEST
At 4 o’clock in the afternoon, fill a jug or bowl with 1 litre (1 ¾ pints) of water.
Empty the contents of one Klean-Prep sachet into it and stir until the powder is
completely dissolved. Drink one glassful of this solution about every 15 minutes
until you have drunk it all. Take your time – there is no need to rush. It should take
about 1 hour to drink a litre of solution.

Some people find Klean Prep easier to drink if they add a flavour such as lime
cordial.
At 6 o’clock in the evening, make up the next sachet as above and drink it over
about an hour.
NB: The medicine will clear out the bowel resulting in diarrhoea within
three hours of the first dose, so stay near a toilet!

Throughout the day, you can continue to drink as much additional clear fluid as
you like.

If you have not had a bowel movement by the next morning, do not take any
more Klean-Prep but contact the Endoscopy Unit for further advice.
******
ON THE DAY OF THE TEST
Take no solid food
Take your regular medication with a small amount of water (except diabetes tablets
– see above)
At 8 o’clock in the morning make up the next sachet and drink the liquid as before
At 10 o’clock in the morning make up the final sachet and drink the liquid as before

******
You should continue to drink clear fluid (preferably water) until two hours before
the appointment time for your colonoscopy.

You must not eat or drink for 2 hours before the test.

You will usually be allowed to eat and drink again one hour after the test.
******
If you vomit the Klean-prep or have any other concerns please contact the
Endoscopy Unit on 0151 706******: A member of the nursing staff will be happy to
assist you.