USE OF PREPARATION BEFORE COLONOSCOPY

USE OF PREPARATION BEFORE COLONOSCOPY.pdf

Colonoscopy examination allows the doctor to see the whole colon. This method helps to find potential problems, such as inflamed tissue, pathological growth, ulcers, bleeding, muscle spasm or other abnormalities.

For the examination to be successful and safe, the colon needs to be cleaned out properly before the examination.

Here is how you prepare for the procedure:

Talk with your doctor:

If you are taking blood-thinning medicines (anticoagulant and antiplatelet drugs, e.g. Anopyrin, Aspirin Protect, Brilique, Efient, Eliquis, Godasal, Ibustrin, Pradaxa, Stacyl, Tagren, Trombex, Vasopirin, Warfarin, Vessel Due F, Xarelto, Zyllt) and/or medicine for diabetes (including insulin), consult your doctor as they may need to be stopped or changed before the procedure.

7 days before the examination:

Stop taking tablets with iron - Ferretab Compositum, Ferro-Folgamma, Maltofer, Sorbifer Durules, Tardyferon (iron tends to turn the stool black and thicken consistency. It may also alter the visualisation of the colon).

3 days before examination:

Stop taking medicine for diarrhea like Imodium, Loperon, capsules containing codein.

Start eating a low-fiber diet: avoid whole grains, nuts, dried fruit, seeds, raw fruits or vegetables and meat

You can eat: dairy (yogurts, milk rice, puddings), white bread, pasta, eggs, well-cooked vegetables without skin, fruits without seeds and skin, potatoes (preferably mashed) and broth (without vegetables, and meat).

If you are diabetic, don’t forget to measure your blood sugar more often.

It is important to stay hydrated by drinking lots of clear liquids (cca 2 l a day), such as sports drinks, clear juice like apple and white grape, and clear broth. Coffee and tea is also possible, but without cream.

1 day before the examination:

Avoid coffee or tea with milk and dairy, pulpy juice, sparkling water and alcohol.

For breakfast: you can have e.g. tea, apple juice, water, white bread and yogurt.

For lunch and dinner: clear liquids only - broth (without vegetables, meat or pastas),tea, apple juice, still water. Avoid all colored drinks.

For dinner drink only tea or still water, avoid colored drinks.

On the day of the examination:

Arrive on an empty stomach. Don’t drink anything — even water — two to four hours before your procedure. This step is important to help prevent you from getting sick after your procedure.

Due to more frequent watery stools, the skin around the anus may become red and irritated. You can protect it by application of protection cream (e.g. Bepanthen cream, Infadolan, Sudocream)

If you are on hormonal contraception pill, your protection may be lowered by the diarrhoea. We recommend to use extra method of contraception, such as condom, for next 7 days. Ask your doctor whether you should continue to take any prescription medications during your preparation or if you should stop until after the procedure. Be sure to also ask about any vitamins, supplements, or OTC medications you use daily.

FOLLOW THE INSTRUCTIONS EXACTLY BEFORE THE EXAMINATION TO KEEP THE COLON COMPLETELY CLEAN SO THE DOCTOR CAN PROPERLY EXAMINE IT.

If you follow the preparation instructions exactly

your colon will be clean,
it is easier to find even small polyps,
the doctor can remove polyps immediately and
you won’t have to repeat the preparation or the whole examination again

If you don’t follow the preparation instruction exactly

your colon will not be clean,
the doctor may not see everything and polyps and lesions can be missed,
the whole process may need to be repeated or rescheduled, meaning another round of bowel prep
aration and
the colonoscopy may take longer

Laxatives

Your doctor will prescribe you laxatives to use before the colonoscopy. The timing and dosage of drinking the laxative solution must be adjusted to the time and date of the colonoscopy. The laxative can be ingested in a single dose or divided doses (first dose is ingested in the evening before the procedure and the other dose in the morning of the procedure.

You have to finish swallowing the solution at least 3 or 4 hours before the beginning of the procedure.

Single dose is suitable:

for morning colonoscopies, when the entire dose of the laxative is ingested in the evening before the procedure, or
for afternoon colonoscopies, when the entire dose of the laxative is ingested in the morning of the procedure.

How to make your colonoscopy preparation easier

If you can, split the doses or ask for a low-volume laxative,
drink the laxative solution cold,
use a straw or
add flavouring (lemon or apple juice).

Frequently asked questions

Q: I have a heart/kidney condition and my doctor advised me to limit my fluid intake.

A: Bowel preparation before a colonoscopy does not burden the cardiovascular system or the kidneys^{^[1]}, however, consult your attending physician whether it is necessary to adjust the preparatory diet before the colonoscopy.

Q: I have diabetes and I am afraid that I will suffer from hypoglycemia.

A: You may need to adjust the dosage of your diabetes medications. If you are unsure or concerned about taking your diabetes medications, talk to your diabetologist. It is better to schedule the examination in the morning so that you can resume taking your medication as soon as possible.

The day before the examination, test your blood sugar before each meal, before going to bed, and whenever you feel symptoms of high or low blood sugar.

Even if you are diabetic, it is necessary to follow diet recommendations mentioned earlier, however, you should monitor sugar and lipid levels more carefully.

Q: Which medicines can I take?

A: Ask your doctor whether you should continue to take any prescription medications during your preparation or if you should stop until after the procedure. Be sure to also ask about any vitamins, supplements, or OTC medications you use daily.

Laxative medication

Fortrans

Each pack of Fortrans contains 4 sachets with powder for oral solution. Each sachet must be dissolved in one litre of water. Shake until the powder is completely dissolved. Once reconstituted, the solution should be drunk without delay.

Each litre of solution must be drank within 1 hour. The effect of the solution should occure during first two hours and continue for about 2-3 hours after last intake of Fortrans. The solution must be taken up slowly (approximately during 4 - 4.5 hours, one glass during 15 - 20 minutes, in several swallows. If you feel nauseous during consuption of FORTRANS® discontinue intake of the medication for half an hour. If you still do not manage to achieve sufficient preparation (excretion of clear liquid), inform the nurse and the doctor before the examination.

Adapt the start of bowel preparation to the date of the examination:

Divided doses:

The examination is at noon: drink 2 liters in the evening before and 2 liters early in the morning of the colonoscopy. Keep in mind you have to finish the preparation at least 4 hours before the examination.

Single dose:

The examination is in the morning: drink 4 liters of the solution in the afternoon/evening before the examination. If you are diabetic, start the preparation earlier - from 2 p.m.

The examination is in the afternoon: drink 4 liters of the solution in the morning of the examination. The preparation should be finished no later than 4 hours before the examination.

MOVIPREP

The package of Moviprep contains 4 sachets of powder - 2 larger sachets marked A and 2 smaller sachets marked B.

Preparation of the laxative: At the time instructed by your doctor, dissolve the contents of 1 bag A and 1 bag B together (until completely dissolved) with 1 liter of water = 1 dose. Every 15 minutes, drink at least 250 ml of the solution, until the full liter is consumed. In addition, drink 500 ml of the clear liquid of your choice (water, clear juice without pulp, broth). This is a necessary step to ensure adequate hydration and an effective prep.

The solution can be used in two ways:

Two-day split-dosing regimen:

Dose 1 – In the evening before the colonoscopy, approximately 10 to 12 hours before (1 litre of the laxative + 0,5 l of water)
Dose 2 – Take next morning, on the day of the colonoscopy, approximately 12 hours after the start of Dose 1 and at least 3 ½ hours prior to colonoscopy: (1 l of laxative + 0,5 l of water)

One-Day Evening Only Dosing Regimen: both doses of the laxative are used in the evening before the colonoscopy. Dose 1 – At least 3 ½ hours before bedtime the evening before the colonoscopy. Dose 2 – At least 1 ½ hours after starting Dose 1 on the evening before the colonoscopy.

PICOPREP

The package of Picoprep contains 2 sachets of powder.

Preparation of the laxative: dissolve the contents of 1 sachet in a cup of water (approx. 150 ml) and mix for 2 or 3 minutes until a white, cloudy liquid is formed and the powder is dissolved completely. If the solution warms up during preparation, wait until it cools down before drinking.

Unless your doctor has given you specific instruction, please follow these dosage instructions. Drink the contents of one dissolved sachet 10 to 18 hours before the examination and drink at least 1250 ml of clear liquids (water, fruit juices without pulp, tea). Drink the second dose 4 to 6 hours before the procedure and drink at least 750 ml of clear liquids.

CLENSIA

The package contains 8 sachets with powder (4 large sachets marked A + 4 small sachets marked B).

How to prepare the laxative: Empty the contents of 2 sachets A and 2 sachets B into a suitable container. Add 1 liter of water and stir until the powder is completely dissolved. You can prepare the solution and put it in the fridge to cool it down before the the start of bowel preparation.

The solution can be used in two ways:

Divided doses : drink one liter of the solution in the evening before the examination and the second liter of the solution early in the morning of the examination. Drink the solution over 1 to 1.5 hours. Try to drink 250 ml every 15-20 minutes. While drinking laxative solutions, drink at least 1 liter of clear liquids (= i.e. at least 500 ml of water for each liter of laxative solution). You should finish the preparation at least 4 hours before examination.
Single dose: drink 2 liters of the solution in the evening before the examination. Slowly drink the solution, cca 250 ml every 15-20 minutes. Keep in mind, there should be a 1-2 hour rest between the doses. In the meantime, drink clear liquids (at least 500 ml of water for each liter of laxative solution).

EZICLENE

The package of Eziclen contains 2 bottles of liquid.

How to prepare the laxative: Pour a bottle of Eziclen into the measuring cup provided. Add water to the medicine until the liquid reaches the line marked on the measuring cup. Slowly drink the entire contents of the measuring cup over the next 30 to 60 minutes. In the following hour, please drink two more measuring cups full of water or clear liquid over the next hour.

The solution can be used in two ways:

Divided doses: In the evening before the procedure, prepare the first dose as described above. In the morning of colonoscopy - approximately 10-12 hours after starting the preparation, repeat the process with a second bottle. You should complete the preparation at least 4 hours before the examination.
Single dose: Start the first dose In the evening before the procedure (e.g. 6 p.m.), prepare the first dose (1 cup of solution + 2 cups of clear liquids). Approximately 2 hours after the start of the first dose (e.g. 8:00 p.m.), the procedure is repeated. Preparation is described above.

CITRAFLEET

The package of Citrafleet contains 2 sachets. To prepare the solution, dissolve the contents of 1 sachet in a cup of water (approx. 150 ml) and stir for 2 to 3 minutes. The resulting solution appears turbid (cloudy). If it becomes hot, wait until it cools sufficiently to drink.

The solution can be used in two ways:

Divided doses: First dose is in the evening before the procedure. The second dose should be administered early in the morning of the procedure (so that the preparation is finished no later than 4 hours before the examination). After a period of ten minutes following the administration of each reconstituted sachet, it is recommended to drink approximately 1.5-2 litres of a variety of clear fluids at a rate of approximately 250-400 ml/h.
Single dose:
1. One sachet in the afternoon and the second sachet in the evening prior to the procedure. This schedule is recommended when the procedure is planned for early in the morning, or
2. Both sachets in the morning of the day of the procedure. This regimen is only suitable when the procedure is planned in the afternoon/evening.
3. The time elapsed between the two sachets should be at least 5 hours.

SOLUTION OF PHOSPHATE SALT

The solution, individually prepared in the pharmacy, is usually divided into 2 bottles. It is stored at a room temperature of 15-25°C and has a shelf life of 30 days .

The solution can be used in two ways:

Divided doses: In the evening before the procedure, drink the first bottle of laxative solution and drink approximately 1-2 liters of clear liquids. Early in the morning (5 hours before the scheduled examination) drink the second bottle of laxative solution and then drink 1-2 liters of clear liquids.
Single dose: drink both bottles in the evening before the procedure so that they are separated by at least 5 hours. For each bottle, drink 1.5 - 2 liters of clear liquids (approximately 250-400 ml/h).

After the exam

After the exam, it takes about an hour to begin recovery from the sedative. You'll need someone to take you home because it can take up to a day for the effects of the sedative to wear off fully. Don't drive or make important decisions or go back to work for the rest of the day.

^{^[1]} With the exception of patients suffering from heart failure (NYHA III – IV) or those who have very limited kidney function. These patients should undergo the preparation for colonoscopy under medical supervision