PATIENT
INFO

Instructions for Colon Preparation with PICOPREP

Morning Procedure

• Please follow instructions carefully. The success of your examination depends on the bowel being as clear as possible. The examination may need to be postponed and the preparation repeated.
• Bowel movements start within 2-3 hours after taking the first PicoPrep dose, and may continue intermittently for up to three hours after the last dose.
• PicoPrep produces watery stools up to the point where they will become colourless with no solid matter.
• It is advisable to remain near a toilet and apply Vaseline around the anus after each loose stool.

MEDICATION:

1. Diabetics, if possible, please check your sugar levels in the evening and morning; omit medication the morning of the procedure.
2. WARFARIN-stop 4 days prior to the procedure. If unsure whether you are allowed to stop medication, please check with your physician or cardiologist.
3. IRON TABLETS must be stopped one week prior to the procedure.
4. ALL ROUTINE MEDICATION CAN BE TAKEN.

THE DAY BEFORE THE COLONOSCOPY

Have a light meal of egg, toast and tea or coffee before 12:00, no milk or dairy products. Thereafter, CLEAR FLUIDS ONLY-drink at least one glass per hour from 12:00 until bedtime. Recommended fluids: Water, black tea/coffee, clear strained chicken noodle soup, Bovril drinks, clear fruit juice, e.g. Apple, litchi, grape juice, Isotonic drinks (Energade, Powerade-only yellow), Sprite, Ginger ale, green/yellow jelly without topping.

No milk or dairy products.
You have 4 sachets of PicoPrep.
At 11h00: Mix the 1st sachet in a glass of warm water, cool with ice and drink, followed by another glass of water.
At 13h00: Mix the 2nd sachet in the same way and drink, followed by a glass of water.
At 16h00: Mix the 3rd sachet in the same way and drink, followed by a glass of water.
At 18h00: Mix the 4th sachet in the same way and drink, followed by a glass of water.

Morning of the Procedure

Sedation is given-please ensure there will be someone to drive you home. Please obtain authorisation from your medical aid prior to the procedure (code 1653)

Colonoscopy Overview and Additional Procedure Information

Please read prior to the procedure.

What is a colonoscopy?

A colonoscopy is a day-case procedure in which the inside of the large intestine (colon and rectum) is examined. A colonoscopy is commonly used to evaluate gastrointestinal symptoms, such as rectal and intestinal bleeding, or changes in bowel habit. Colonoscopy is also advised in individuals without symptoms to check for colorectal polyps or cancer. A screening colonoscopy is recommended for anyone aged 50 years or older, and persons with a family history of colon polyps or cancer should be screened at an age 10 years younger than the age at which it was diagnosed in a family member.

What happens before a colonoscopy?

To complete a successful colonoscopy, the bowel must be cleaned so that the physician can clearly view the inside of the colon. It is very important that you read and follow all the instructions for your bowel preparation well before the procedure. Without proper preparation, the colonoscopy will not be successful and may have to be repeated. You may experience some irritation of the skin around the anus due to the passage of liquid stools.

This can be eased by:

• Applying a thin layer of Vaseline around the anus before drinking the PicoPrep, and after each bowel movement.
• Wiping with cotton wool soaked in warm water, rather than using toilet paper. Non-scented disposable wet wipes can also be used. Dry by dabbing with a soft towel or cloth.
• Sit in a bath filled with warm water, dab dry with a towel and apply Vaseline.

What happens during a colonoscopy?

The doctor will insert a long, flexible instrument into the rectum and advance it to the caecum (beginning of the colon). If necessary, pieces of tissue (biopsy) can be removed for testing, and polyps can be identified and removed. The colonoscopy may allow accurate diagnosis and treatment of colorectal problems, without the need for a major operation. The colonoscope is disinfected between procedures. You will have an intravenous line inserted (a “drip”) and will be lying on your left side. A sedative and pain-relieving drug will be administered to make you more relaxed during the procedure. Your vital signs are monitored, and you will be breathing oxygen to maintain a normal blood oxygen concentration. The procedure lasts between 20 and 40 minutes on average, and you will be allowed to rest until fully awake. You may feel slightly bloated and uncomfortable after the procedure, due to air inserted into your colon to improve visualisation.

What happens after a colonoscopy?

You will remain in the recovery room for observation until you are ready for discharge. You may feel some cramping or a sensation of having gas, but this soon passes. A responsible adult must drive you home. Avoid driving and operating machinery for 24 hours. Avoid alcohol and take a course of QuatroFlora capsules to restore intestinal flora.
Unless otherwise directed, you may resume your normal diet after a colonoscopy. Wait until the day after the procedure before resuming normal activities, e.g. exercise. If polyps were removed or biopsies taken, avoid using aspirin and anti-inflammatory drugs for 2 weeks. Paracetamol, e.g. Panado, Tylenol, etc., may be used.
If you are on any anticoagulants, e.g. Warfarin or Plavix, your physician will advise when it is safe for you to restart the medication.
If a biopsy was taken or a polyp removed, mild rectal bleeding may be noted for 1-2 days after the procedure. If heavier bleeding is encountered, e.g. clots of blood, or if you have severe abdominal pain, this must be reported immediately. If you are unable to contact the physician, report to the emergency department of the clinic or hospital where the procedure was performed.