Colonoscopy Preparation

Preparing for a colonoscopy can be extremely difficult especially when friends and family eat in front of you and you just want a bite of their food.  Depending on your preparation choice (Picolax or MoviPrep) it influences when you have to start your preparation for the colonoscopy.  MoviPrep is the day before the procedure whilst Picolax is 3 days before the procedure.  For both preparations you can take your usual medications but avoid all iron medication and any other constipating drugs for one week before the procedure.

BOTH preparations cause diarrhoea!  And both may cause stomach cramps and vomiting.  These preparations are to clean the bowel out for the colonoscopy.  If you cannot handle the pain and cramps drink the preparations more slowly over 30mins to ease the side effects and if it still persists seek medical advice from the endoscopy unit or GP (if open).

To reduce irritation from wiping use soft or moist tissue paper and apply petroleum jelly (Vaseline) to your bum before and after each visit.

With Picolax you have to start a low residue diet Day 1 (3 days before the procedure).  So if your procedure is on the Monday you start your diet on the Friday.  See the below for the list of foods and drinks you are allowed and the ones you have to avoid when following a low residue diet.

Day 2 (2 days before the procedure) you must follow a clear liquid diet.  See below for the list of drinks allowed when following a clear liquid diet.

Day 3 (day before the procedure) you have to continue the clear fluids to prevent you from becoming dehydrated.  At 8am dissolve the powder containing one sachet of Picolax with 150ml of cold water and drink.  At 4pm dissolve the powder of the second sachet of Picolax and drink.

On the day of the procedure if you are only having a colonoscopy, keep drinking clear liquids up until your appointment time to satisfy your thirst.  After your procedure you can start eating and drinking as normal again.

With the MoviPrep the preparation starts the day before the procedure.  You have to have a low residue breakfast BEFORE 8am.  After 8am follow a clear fluid diet.  To prepare the MoviPrep take one of sachet A and one of sachet B and dissolve both in one litre of luke-warm water.  Start drinking at 1pm and finish at 2pm, drink one glass every 15mins.  And do the same with the second set of sachets and drink between 6pm and 7pm.  Drink each glass as quickly as possible instead of sipping it slowly.

A low residue diet can include any of the following:

• Boiled potatoes
• Cheese
• Chicken – grilled, roasted, boiled (not fried)
• Chocolate with NO fruit/nuts
• Clear strained soups – chicken, beef, vegetable (ensuring there are not bits left)
• Cornflakes
• Couscous
• Crisps
• Custard
• Eggs
• Fish – grilled or poached (not fried)
• Frosted flakes
• Ice cream
• Jelly
• Milk
• Peeled, well-cooked, soft/mashed vegetables
• Plain biscuits e.g. rich tea
• Potatoes (no skins)
• Rice Krispies
• Rice pudding
• Seedless jam
• Semolina
• Smooth yoghurts
• Soft/ripe, peeled fruit without pips or seeds e.g. tinned fruit, melon, ripe bananas, apples, pears
• Spices/pepper
• Sponge cakes with NO fruit/nuts
• Squash/fizzy juice
• Stock cubes
• Tea/coffee
• White bread/flour
• White pasta
• White rice

AVOID

• All cereals containing dried fruits/nuts
• All dried fruits
• All seeds, pips, tough skins
• All whole wheat cereals e.g. shreddies, Weetabix, etc.
• Avoid all nuts including coconut and almonds
• Baked beans
• Berries e.g. strawberries, raspberries
• Brown rice
• Celery
• Chocolate, toffee, fudge with dried fruits/nuts
• Citrus fruits
• Digestive biscuits
• Horseradish
• Lentils
• Marmalade with peel and jam with seeds
• Marzipan
• Pearl barley
• Peas
• Pickles/chutneys
• Pies/egg dishes containing vegetables as listed below
• Popcorn
• Porridge and muesli
• Potato skins
• Prunes
• Puddings/cakes/biscuits made with wholemeal flour, dried fruit or nuts e.g. mince pies, fruit crumbles etc.
• Quinoa
• Raw vegetables/salads
• Relish
• Skin and bones of fish
• Smoothies and fruit juices with bits
• Split peas/lentils
• Sweetcorn
• Tough, gristly meats
• Vegetable soups
• Wholemeal pasta
• Wholemeal/granary bread/flour
• Yoghurts and cheeses containing fruit/nuts

A clear liquid diet includes:

• 100% cranberry juice (not from concentrate or ones with dyes)
• Clear strained soups
• Flavoured waters
• Fruit cordial/squash ( not dark red or purple coloured)
• Fruit juices (strained if containing not bits) [also avoid cloudy apple juice]
• Jelly (not dark red or purple colours)
• Lucozade and fizzy drinks
• Oxo, Bovril, marmite drinks
• Sports energy drinks
• Tea and coffee with NO milk

Emotions and diagnosis of Crohn's Disease

Being diagnosed with Crohn’s disease may have come to you as a surprise if it does not run within your family.  Usually when you get diagnosed with a chronic illness it becomes the centre of your world.  Every day you have to plan everything around your condition.  When your Crohn’s is in an active flare your independency may become compromised, possibly your mobility and creating a variety of issues with family, friends and co-workers.

It is not uncommon to experience a period of grief after being diagnosed.  There are five stages of grief which can be applied to emotional trauma like being diagnosed with a chronic illness.

There five stages of grief are:

1. Denial – unless Crohn’s disease runs in your family, the diagnosis may be a surprise, which may lead to you rejecting it especially if you have been living a healthy, active life.
2. Anger – having to restrict your way of life to accommodate the current reality based on the chronic illness can have powerful, negative feelings.  You may be angry without yourself, your loved ones or others who do not have the same condition.
3. Bargaining – the transition from your old way of life to living with Crohn’s is a challenging process and you could be tempted to make compromises that will not serve your new health requirements; such as continuing to eat foods that cause flare-ups.
4. Depression – there are a lot of facets of Crohn’s disease that can cause complications such as, the inability to control your bowels; frequent absences from work or school; depending on other people and many more.  With these as well as unexpected flare ups, can make you uncertain about your future and can lead to isolation and a loss in confidence which can lead to depression.
5. Acceptance – arriving at this stage is necessary for anyone adjusting to living with Crohn’s as it signals the detachments from negative emotions.  You have learned that you do not have to let your condition define you.

Researchers have found no direct relationship between emotions and Crohn’s disease; however patients who have negative emotional reactions to their diagnosis may take longer to find effective treatment to control their Crohn’s.

Teenagers are at a particular risk of encountering difficulty in adapting to their illness.  This is due to their inexperience at dealing with ups and downs within everyday life as they have not developed that coping skill yet.

Every patient has different coping mechanisms.  Patients with an optimistic attitude find it easier as they know that there are many effective treatments available.  Some patients respond to their symptoms with acceptance, while others become so upset to the point of worsening their flare ups due to stress.

Patients who see themselves as a burden on their friends and family may irrationally blame themselves for attracting the disease.  Patients with Crohn’s disease can thrive if they accept their condition and find practical ways to adjust to their reality and take everything in stride.  There are ways to take charge and below is just a few:

1. Always be prepared
Always carry a survival kit containing prescription medications, over the counter antidiarrheal medication, toilet paper, baby wipes, an extra pair of underwear and a change of clothes.  If you are going away from home or your workplace do research into the location of public bathrooms beforehand.

2. Get support
Support can be from family members or a trusted friend to help with support and offer reality checks if needed.  Always maintain regular contact with your doctor and consider talking to a specialist such as a therapist or counsellor.  There is also support available online in Crohn’s and Colitis forums and groups on social media.

Even check your national Crohn’s and Colitis websites to see if there are any forums or support groups.

UK – www.crohnsandcolitis.org.uk

USA – www.ccfa.org

3. Empower yourself

There are a few ways to do this.  Reading up on your illness can help you be able to grasp how the disease affects your body and mind and the better equipped you are the better you can handle it.  Even if your Crohn’s is in remission do not be shy to read up on what measures to take if and when it worsens e.g. surgery.  Knowing what you may have to face at some point in the future (not everyone faces surgery but it could be a change in medication) can dispel fearful thinking and help you feel in control of your ongoing symptoms and your reactions to them.

Take note of which foods trigger your flare ups as everyone is completely different and has different triggers and also know what you can do to soothe the symptoms if you eat a trigger food.  This can help reassure yourself about how much control you have over your condition.

Exercise is powerful and can help improve your symptoms.  If you are feeling down exercise can help by elevating your mood.  Also if your emotions continue to overwhelm you do not be afraid to consult with a doctor about other measures such as, anti-anxiety or anti-depressant medications.

When I was first diagnosed I refused to accept my condition until I had the support of my family and my boyfriend at the time.  Without their support it would have taken me longer to accept my condition and help myself by taking my medication.  Do not be afraid to accept your condition as there is plenty of support out there for you no matter where you live.  Nowadays I get the majority of mine from Facebook groups as they are all very understanding and know what I am going through so they can be of better help than my family and friends at most times.  I also take my daughter out on a walk to help with my mood which helps me a lot and then I have a bit more energy as well to do things before the fatigue kicks in again.