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Patient Information

Bowel preparation before endoscopy (Picolax and a prolonged low residue diet)

https://kingstonhospital.nhs.uk/information/bowel-preparation-before-endoscopy-picolax-and-a-prolonged-low-residue-diet

A colonoscopy or sigmoidoscopy is done to have a look inside the bowel. Both are a type of endoscopy. For this, the bowel must be completely empty.

You must prepare properly



7 days before
• Low-fibre food only
• Drink one large cup of fluids every hour during the day


2 days before
• Stop solid food
• Continue drinking plenty, but only clear fluids


1 day before
• Begin bowel prep


Day of morning appointment
• Stop fluids



Day of afternoon appointment
• Finish bowel prep
• Then stop fluids

What is bowel preparation?

Red warning circle saying no bowel preparation means no procedure

Seven days before the procedure, you will need to start ‘bowel preparation’ (called ‘bowel prep’ for short). This will empty the bowel.

Bowel prep involves: 

  • taking the medicines Picolax and senna (both laxatives) to make you poo 
  • cutting down on how much fibre you eat  
  • stopping all food in the last few hours beforehand. 
The instructions given below are very important. If you do not stick to them, we will probably have to cancel the procedure because we will not be able to see inside your bowel clearly.

Contact the endoscopy nurse helpline if you have any questions.

What effect does it have?

The laxatives will cause repeated bowel movements and eventually diarrhoea.

These effects can start at any time after taking the laxatives. The urge to open your bowels can be sudden, giving you little time to reach a toilet. So, it is a good idea to stay within easy reach of a toilet.

The laxatives may also cause nausea, stomach cramps and bloating.

Very rarely, patient have a severe reaction to the laxatives.

Contact your GP or go your nearest emergency department (A&E) if you feel significantly unwell, collapse or faint. Take this information sheet with you.

Before starting the laxatives, it is sensible to have a supply of the drinks you will need (see box A, below).

7 days before the endoscopy

Begin preparation for your endoscopy seven days before your appointment, when you wake up that morning.

Increase how much fluids you drink to 200 mls (one large cup) every hour. This is to make the laxatives work better.

Start eating only low-fibre food (see box B).

Cut down alcohol to no more than one small glass of wine or one small bottle of beer per day.

2 days before the endoscopy

Stop solid foods 24 hours before you start taking the laxatives. Instead, drink only clear fluids (see box A). Continue to drink 200 mls (one large cup) every hour. Do not eat any solid food until after the endoscopy.

Do not drink just water. It is important you drink sugary drinks for the energy and savoury drinks for the salt. Otherwise, you may feel weak or dizzy and you may even faint.

1 day before the endoscopy

The day before your appointment you must begin taking the laxatives.

When you start this depends on what time your endoscopy is booked for. The tables, below, set out the details.

Continue to avoid any solid food and drink plenty of clear fluids (see box A).

Morning endoscopy (8am to 12.45 appointments)

Day before appointment
middayTake all 10 senna tablets.

Drink at least one additional litre of clear fluids (see box A).
2pm Take the first dose of Picolax laxative. See box C.
8pm Take the second dose of Picolax laxative.
Day of appointment
4 hours beforeStop all fluids apart from sips of water.
2 hours before Stop drinking water until after endoscopy.

Afternoon endoscopy (1pm to 5.30pm appointments)

Day before appointment
3pmTake all 10 senna tablets.

Drink at least one additional litre of clear fluids (see box A).
7pm Take the first dose of Picolax laxative. See box C.
Day of appointment
7am Take the second dose of Picolax laxative.
4 hours beforeStop all fluids apart from sips of water.
2 hours before Stop drinking water until after endoscopy.

Box A


Clear fluidsAvoid
water squash, fizzy drinks, apple juice, orange juice, black tea or coffee (sugar is allowed), Oxo/Bovril/Marmite, Horlicks (made with water), Ovaltine (made with water), hot chocolate (made with water), consommé, lemon or lime jelly, sorbet (no fruit bits)milk, milkshakes, smoothies, red-coloured drinks, fruit juice with ‘bits’, alcohol, soup, ice cream

Box B

Low fibre food you can eatFoods to avoid  
Cereals 
Rice KrispiesAll breakfast cereals except Rice Krispies
Dairy 
milk, cream
butter or spread
cheese
smooth yogurts (no bits)
 
Soup 
clear soups 
Protein 
tender meat
white fish
eggs
tofu, Quorn
nuts, including coconut
seeds
nut roast
Fruit and vegetables 
boiled or mashed potatoes (peeled), courgettes (peeled), cucumber (peeled), cauliflower florets, marrow flesh, parsnips (peeled), radish, apples, bananas, pears, lychees (all fruit must be peeled), grapefruit (avoid pith)jacket potatoes
All fruit and vegetables not mentioned on the ‘food you can eat’ list,
juice with ‘bits’, beans and pulses
Bread and starchy food 
white bread
cream crackers
white rice
white pasta
Yorkshire puddings
Avoid all bread except for white bread
oatmeal, oat bran and oat germ
rye flour, bran
Jams, pickles 
marmalade (no shred), honey, marmitejams, pickles, chutney
Snacks and puddings 
crisps
plain biscuits, such as Rich Tea, shortbread, malted milk or Nice biscuits
plain madeira cake
ice lollies
ice cream
plain or milk chocolate (no nuts/fruits)
digestive biscuits
biscuits containing bran

Box C


How to take laxatives
• Empty one packet of Picolax into 150ml cold water. Stir until dissolved. The Picolax may become hot when mixed with water. Allow it to cool before drinking it.

• You may add squash (without ‘bits’) or ice if you wish.

Bowel preparation before endoscopy (Picolax and a prolonged low residue diet) - Kingston Hospital Download PDF


Contacts

Endoscopy nurses helpline 020 8934 6614 (2pm to 4pm only)

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For information accessibility please visit Kingston Hospital AccessAble www.accessable.co.uk/kingston-hospital-nhs-foundation-trust
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For detailed information on accessibility at Kingston Hospital visit Kingston Hospital AccessAble (https://www.accessable.co.uk/kingston-hospital-nhs-foundation-trust).


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