BOWEL PREPARATION INSTRUCTIONS FOR COLONOSCOPY

A colonoscopy enables the doctor to see the inside lining of your large bowel(colon). In order to get a good view, it is important that the bowel is thoroughly emptied and clean on the inside - otherwise the bowel wall on the inside may be partially covered by faeces.

BEFORE THE COLONOSCOPY

1 week before colonscopy -

Discuss with your general practitioner & your cardiologist first about stopping these medications - aspirin, clopidrogel(eg. Plavix, Iscover), dipyridamole(eg Asasantin, Persantin), Prasugrel(Effient), Tigagrelor(Brilinta), Ticlopidine. (These medications increase the risk of bleeding especially if a polyp is excised during the colonoscopy) 

5 days before colonoscopy - If you are taking warfarin(Coumadin, Marevan), this is usually stopped then. Again it is important to discuss this with your usual doctor, cardiologist and your surgeon. For some low-risk patients on warfarin, that is all that needs to be done. For high-risk patients(risk of stopping the anticoagulant), daily injections with low-molecular weight heparin eg Clexane may need to be given until the day before the scope once INR is less than 2

Dabigatran(Praxada), Rivaxoxaban(Xarelto), Apixaban(Eliquis) - needs to be stopped 48 hours before the surgery, best to discuss this with the prescribing doctor. Clexane injections may also need to be given once these medications are stopped - eg for patients with mechanical heart valve or at high risk of blood clots

2 days before colonoscopy -

Take only low-residue foods eg white bread, white rice, eggs, potato without the skin. Do NOT eat vegetables, fruits or anything high in fibre

1 day before colonoscopy -

DRINK CLEAR FLUIDS ONLY after a light dinner(have this by 7pm). Clear fluids include - water, black tea WITHOUT milk, clear fruit juices without pulps, clear soup, soft drinks, mineral water and cordial.

Take the 3 sachets of PICOPREP(or Picolax) :

1. Mix the sachet of Picoprep with a glass of warm water

2. For a MORNING procedure, take the first sachet of Picoprep at 8pm, 10pm and the third sachet as late as possible(between midnight to 6 hours before the scope - studies have shown that the closer to the procedure the bowel prep is taken, the cleaner the bowel preparation will be) for a morning procedure the next day)

3. For an AFTERNOON procedure, take the Picoprep at 10pm and at 8 am & 10am

REMEMBER to continue drinking at least a glass of water/clear fluids every hour.

You may have clear fluids UP TO 2 HOURS BEFORE the procedure  - this is to help wash out any faeculent material in the bowel

Avoid coffee and alcohol as these can cause you to lose more fluids especially from your urine.

AFTER THE COLONOSCOPY

It is important to make arrangements ahead of time for someone to drive you home.

Do not drive or operate any machinery or sign any legal documents on the day of the colonoscopy/anaesthesia.

Immediately after the procedure, you may feel some addominal discomfort/cramps or bloating. You may also feel like passsing wind.(This is due to the air gently insufflated into your bowel during the colonoscopy)

The surgeon will discuss with you the findings before you go home or make arrangements to see you at a later date. A complete report will be forwarded to your doctor.

Should you have any bleeding, abdominal pain, black tarry stools or fever within 2 weeks after the procedure, you should contact your doctor immediately.

ALTERNATIVE REGIMEN TO PICOPREP alone:

1. Colocaps Balance tablets - From 8pm for a morning procedure, take 5 tablets every 15min until all 65 have been taken. For an afternooon procedure, take 5 tablets every 15min from 11pm until midnight; recommence taking the tablets from 8am in the morning

2. Glycoprep - 2 jugs of 1 Litre each

3. Picoprep, Glycoprep and Picoprep regimen - this is for a cleaner bowel preparation especially for those whose prep was suboptimal before

4. Fleet orally X3 instead of Picoprep

5. Fleet enema X2 alone 2 hours before - for a limited colonoscopy, usually can have reasonably good views up to transverse colon, but poor views of the right colon

Please see  www.colonoscopy.net.au for more bowel preparation information.