Having a Sigmoidoscopy / Colonoscopy with Picolax

In order to do this a flexible tube the thickness of a finger, is carefully passed through the anus into the rectum and into the large bowel. This can be uncomfortable as bends in the colon are negotiated and air is used to inflate the colon. The Sigmoidoscope/Colonoscope has a small camera attached which is connected to a monitor system where images can be seen. In order for the test to be successful, it is important that you take the Picolax bowel preparation as directed. This will assist in cleaning your bowel, enabling us to make a correct diagnosis.

By examining your bowel the cause of your symptoms may be found, sometimes we are able to treat them there and then. Images and samples (biopsies) may be taken and sometimes polyps (small growths in the bowel) can be removed at the time or other treatments performed. These will be discussed with you as necessary.

A Sigmoidoscopy or Colonoscopy is a safe examination but rarely, a complication such as bleeding or perforation may occur (1 in 1500, or if polyps removed 1 in 200). Other risks are discomfort, bloating and pain. Entonox (gas and air) may cause nausea, dizziness and euphoria. Sedation may cause nausea and vomiting, and rarely you may become over sedated which can reduce your breathing rate.

There may be alternatives to a Sigmoidoscopy or Colonoscopy but your physician has advised that this is the most appropriate procedure available to you. If you would like to discuss alternatives further please speak to your referring physician.

If you are unable to make your appointment or need to change your appointment time, please do telephone via the numbers on the back of this leaflet.

Your appointment time takes into account the time required to admit you onto the unit. You should therefore not expect to immediately go through for the test when called. You will be in the department for up to 4 hours. Please note we usually have 6 different lists running consecutively, this may mean some people will have to wait longer than others, even with the same appointment time.

Please note that the time of day that you will need to start taking the Picolax solution differs between a morning and afternoon appointment. Please follow the instructions carefully.

Please be aware we are a Teaching Hospital and may have trainees in any areas of your pathway. They will always be supervised and they will always be working at an appropriate level for their training stage. If you would rather not have a trainee involved in your care please let the staff know your wishes. This will not affect your care.

Please make sure you follow the instructions in this leaflet and on your appointment letter.

Take any medication you are on up to 2 hours before your appointment with water. If you are taking medication for DIABETES please refer to the specific diabetic instructions towards the end of this leaflet.

Please bring a list of your medication with you on the day.

Please leave valuables and jewellery at home where possible as we are unfortunately unable to look after these.

In order to examine the whole of the bowel it must be clear of all waste materials. This is achieved by using a combination of changing what you eat and taking laxative medicines.

Picolax (bowel preparation) works by loosening your stools. This is unpleasant but necessary and may last up until your appointment. Easy access to a toilet will be required for the most of the day.

You might like to use a barrier cream to prevent a ‘sore bottom’. A product such as petroleum jelly can be effective.

7 days before your Colonoscopy appointment please stop taking iron tablets.

2 days before your Colonoscopy appointment please stop taking medication that might constipate you for example Co-Codamol, Codeine, Co-phenotrope (Lomotil®), Loperamide (Imodium®) or Kaolin & Morphine mixture.

Taking other medication. If you are taking other medication,

please take it at least one hour before or at least one hour after taking Picolax, otherwise they may be flushed through your digestive system and not work so well.

DO NOT TAKE PICOLAX IF

• You are allergic to any of the ingredients.

• You are pregnant.

• You are on dialysis.

• You are taking medication for an organ transplant.

• You have not passed wind or opened your bowels in the last five days leading up to your bowel preparation time.

Please contact the Endoscopy Booking Assessment Nurse if any of these cautions apply to you via the phone number on the back of this leaflet.

Some Possible side effects of Picolax

Picolax may cause headaches, tiredness, nausea, griping and anal pain. Isolated cases of allergic reactions and vomiting and severe diarrhoea with related symptoms have been reported. Rarely are people allergic to Picolax. They may experience a rash or itching, swelling of the face or ankles, palpitations or shortness of breath. If any of the side effects become serious, stop taking Picolax and seek medical advice.

Oral Contraception

If you are taking an oral contraceptive pill, diarrhoea can make it less effective. Continue taking the pill but use other precautions for the rest of that cycle.

Important: No alcohol should be consumed on the day before and the day of the procedure.

Two days before your test please follow a low residue diet, which consists of the following:

Fats (use sparingly) Butter or margarine.

Rice Plain boiled white rice.

Eggs Boiled or poached.

Meat/fish well cooked meat, lean beef, lamb, ham, veal, pork, poultry, fish, shellfish.

Cheese Cream, cottage or cheese sauce.

Bread White bread or toast.

Cereals Crisped rice cereal Cornflakes (no bran).

Pasta Plain macaroni, spaghetti, noodles.

Potatoes Boiled, creamed, mashed or baked (no skins).

Dessert Clear jelly (not red jelly).

Foods to avoid: Red/rare meat, sausage, pies, any fruit or salads, most vegetables, potato skins, chips, wholemeal or brown bread, nuts, pulses, baked beans, wholemeal pasta, brown rice, puddings containing fruit and nuts, cakes, biscuits and yoghurts.

On The Day Before The Examination

1am (at night) – From now on keep to a LIQUID diet: Water, clear soup, Bovril, Oxo, lemonade, fizzy drinks, sieved fruit juices, tea or coffee without milk (no red liquids). Do not eat any solid food.

Note: You should continue to take any prescribed medication.

8am – Take the first sachet of Picolax:

Mix one sachet in 3-4 dessert spoonfuls of cold water. Stir for 2-3 minutes – the mixture will become hot. Wait 5 minutes then dilute the solution with cold water to make half a tumbler (150ml), stir and drink the mixture.

To avoid becoming dehydrated – try to drink at least a cup every hour all day and evening. Aim to drink between 2 to 3 litres (3½ to 5 pints) of fluid during this time.

Be prepared for frequent, loose bowel movements – these may not begin until several hours after you’ve taken the first sachet of Picolax. The aim is to achieve clear watery motions.

3pm – Take the second sachet of Picolax (mixed as before). Continue drinking clear liquids.

On The Day Of The Examination

Continue drinking clear liquids until 2 hours before your examination.

The Day Before the Examination

12 Noon – Have a light lunch avoiding all foods containing roughage, including wholemeal bread, vegetables.

1pm – Take the first sachet of Picolax: Mix one sachet in 3-4 dessert spoonfuls of cold water. Stir for 2-3 minutes – the mixture will become hot. Wait 5 minutes then dilute the solution with cold water to make half a tumbler (150ml), stir & drink the mixture.

From now on keep to a LIQUID diet: Clear soup, Bovril, Oxo, fizzy drinks, sieved fruit juices, black tea or coffee (no red liquids).

You should continue to take any prescribed medication.

To avoid becoming dehydrated – try to drink at least a cup every hour all day and evening. Aim to drink between 2 to 3 litres (3½ to 5 pints) of fluid during this time.

Be prepared for frequent, loose bowel movements – these may not begin until several hours after you’ve taken the first sachet of Picolax. The aim is to achieve clear watery motions.

7pm – Take the second sachet of Picolax (mixed as before). Continue drinking of clear liquids.

On the Day of the Examination

Continue drinking clear liquids until 2 hours before your examination.

If you have diabetes, please read the ‘extra’ leaflet sent alongside this leaflet.

This leaflet is specific to controlling your diabetes through the various procedures available within our unit and you will have been sent the following leaflet:

• Guidance for Managing Diabetes for Sigmoidoscopy / Colonoscopy

This will give you clear instructions on what to do with your medication (including insulin) during the preparation for your test.

If you have not received a copy of this leaflet, could you please contact us via the phone numbers listed on the back of this leaflet.

A Sigmoidoscopy or Colonoscopy can be uncomfortable. A Sigmoidoscopy tests is usually undertaken with Entonox (gas and air). A Colonoscopy is usually undertaken with Entonox (gas and air) or mild sedation to relieve any pain.

Before Sigmoidoscopy or Colonoscopy the nursing staff will admit you to the unit and fully explain the tests to you whilst answering any questions or concerns you may have. You will be given paper dignity shorts to wear.

You will need to sign a consent form for the Sigmodoscopy or Colonoscopy. You will then be taken to another area where you will wait to be called into the room for your procedures.

You may have a cannula inserted into your hand or arm.

In the endoscopy room you will have your procedure whilst lying on your left side on a trolley.

A Sigmoidoscopy lasts approximately 15-20 minutes and a Colonoscopy lasts between 30-45 minutes depending on the position of your colon and the procedures that need to be done (for example removal of polyps will take longer).

If you are having Entonox (gas and air) instructions will be given on how to self administer this before your procedure starts.

Entonox is inhaled through a mouthpiece to relieve pain.

After the procedure you will be transferred to our recovery area for about half an hour where you will be given a drink and some biscuits.

Recovery from the effects of Entonox is rapid and you will be able to drive after half an hour from stopping Entonox, providing you have had a straightforward procedure.

You may feel bloated with wind-like discomfort. This is normal and usually settles quickly. If you have a biopsy taken or a polyp removed it is common to pass small spots of blood from your bottom for a day or two following the procedure.

Details of your results and discharge advice will be given before leaving the unit. Biopsy results will be communicated by the referring clinician at a later date.

You will need a cannula (small plastic tube) in your hand or arm through which a mild sedation and analgesia (pain relief) is given.

This should relax you but will not put you to sleep, it is not a general anaesthetic.

You will be awake and aware during the procedure with sedation.

Sedation may cause loss of memory and judgement for 24 hours after the test. You must not:

• Drive

• Drink alcohol

• Operate machinery

• Sign legal documents

If your job involves any of the above you will need to take the day off work following the sedation.

After the Colonoscopy you will have a rest for about half an hour and will then be offered a drink and biscuits.

After about an hour you will be discharged with your Colonoscopy results.

You may experience some bloating with wind like discomfort after your procedures. If you have a biopsy taken or a polyp removed it is common to pass small spots of blood from your bottom for a day or two following your colonoscopy.

You will need a responsible adult to accompany you from the unit because of the effects of the sedation and also have someone at home overnight after having sedation.

Following the procedures you will be transferred to our recovery area for a rest before being discharged home.

Details of your results and discharge advice will be given before leaving the unit. Biopsy results will be communicated by the referring clinician at a later date.

If you have any issues or need advice please contact the Gastroenterology & Endoscopy Unit within working hours (7:45am to 6pm) and ask to speak to the nurse in charge. See contact phone numbers on the back of this leaflet.

If urgent out of hours advice required please contact Ward 2 on 01253 953402.

Access from the main hospital multistorey car park

We are located in Area 6 - Gastroenterology & Endoscopy Unit, highlighted in orange on the main hospital map. Follow the signs for the Main Hospital up the escalator/lift towards Area 6, second corridor on the left. Follow the signs down the link corridor, exit to the right via the side door (external) which is signposted for Patient Entrance to Reception.

Access for drop off/collection only & disability parking

Enter via East Park Drive and follow the road up the hill, take the second left signposted for Gastroenterology & Endoscopy Unit Drop Off Only, follow the road round to the right.