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

The Recovery....

My recovery all began after the endoscopy and colonoscopy on April 12th. I was told what would happen once I got back up to the ward. However, I was to groggy with the sedation and I had fallen asleep when the consultant was speaking to me so I could not remember much. When I had came round fully on the ward, which I had no recollection of coming back to after the procedures, a nurse had told me what exactly was happening with my treatment. I was to be put on azathioprine tablets at 100mg a day as well as hydrocortisone injection and an antibiotic drip for five days and then change over onto prednisolone and antibiotic tablets. The azathioprine was the consultants choice of immunosuppressant to manage my Crohn's disease and hopefully lead me into remission. I then spent another two weeks waiting for a MRI scan to see how bad the Crohn's Disease was to see if I really needed to start using the Humira as well. When I eventually got the scan it came back saying that the Crohn's was severe in the large bowel but had not touched the small bowel which was good as I did not need to start using the Humira unless the azathioprine was not working on its own in the future after I came off the steriods. 

The Diagnosis....

Just before March 2013 all I could stomach was soups, liquids and Super Noodles. Just before I went home for a week I had went to the doctors as I was not feeling well, this time it was a Urinary Tract Infection (UTI) but they thought it was so bad that it was near my kidneys. So I was put on a course of antibiotics. When I went home to see my family and friends during the first week of March all I got was are you eating properly or are you taking laxatives. The answer was no to both.

My food for the majority of 6months before my diagnosis.

I had lost just under 4 stone at the time. When I came back I still had the UTI but was feeling dizzy and faint. Within a space of two weeks I had visited the Accident and Emergency 3 times. The first time I was put on a fluid drip and send home with yet more antibiotics. The second time I was hooked up to an ECG machine and sent home with nothing but told to rest up and take it easy. On the third time it was a student doctor that had said that I was at all not well and should not be sent home like the previous times, as I had hardly any strength to even stand up on my own and I was being sick.

At this stage I had lost just under 4.5 stone and the student doctor said either ulcerative colitis or Crohn's disease. I am glad he was there that day or I would probably have still not been diagnosed or either no longer here as I had been getting heart palpitations and he had said it was a sign my body was either shutting down or could not cope no more with the rapid weight loss. The third time of being in A&E I was transferred up to the Acute Medical short stay ward. In the morning I was moved to the Acute Medical Ward for Gastro and Liver care as there was a bed free for me.

In the Gastro and Liver ward I was poked and prodded for 4 weeks. Within the first two weeks I had lost more weight just bringing it to just under 5 stone in total. My consultant and his junior doctors had helped to gather all the information from me and came to a conclusion it was more like Crohn's disease than ulcerative colitis. The only reason which lead to make their decision was the numerous blood tests they had done and all of them showed different vitamin and mineral deficiencies. I was put on a number of different IV drips to boost my vitamins and minerals which I was deficient in. During my stay in the hospital I had a number of tests done to try and see what was wrong with me such as, ultrasound of my liver, kidneys and stomach, endoscopy, colonoscopy and MRI.

My home for just over 4weeks.

For the Ultrasound I was not allowed to eat anything for 6hours before the scan so, they could get a better picture of what was going on. The endoscopy, colonoscopy and MRI I had to drink a disgusting laxative which had made me sick. But because I could not keep it down they had it changed to another one which went down a bit easier but closer to the test times I was really sick so they had to give me fluid through a drip and a paracetamol drip as I was in so much pain.

When they were carrying out the endoscopy they could only find mouth ulcers and ulcers at the back of my throat which was what was causing it painful to swallow anything. In the colonoscopy they had found a lot of ulceration and inflammation in my large bowel. But the consultant said where I was getting my pain in my stomach would not be caused by where they found the Crohn's disease so he ordered a MRI scan to see if it was in my small bowel. After these procedures he had said it was definitely Crohn's disease but he wanted to see how far it had spread. He had also said something about getting put on a drip when I returned to the ward but I was not paying much attention as I had been heavily sedated and was drifting in and out. I cannot even remember getting back into my bed on the ward but I was told that I was helped back into bed as I was near enough fast asleep. I was woken up to be told my dinner had arrived but I fell back to sleep as the sedation had not worn off by that time. It was near midnight I had woken up again but because I was slightly hungry and extremely weak so, I asked for some toast and butter and Lucozade. One of the nurses actually went to the canteen to get me the Lucozade as I could just about make it to the toilet without any assistance so, they did not want to risk letting me go on my own to the canteen. Once I got some food into me I felt a bit better. The next morning I was put on antibiotic and steroid drips for 4days. On the fourth day the plaster over the cannula made my skin come out in an allergic rash so, the nurse asked the doctor could it be taken out and be put on my course of tablet antibiotics and steroids a day early. Thankfully they said yes cause no matter who puts the cannulas in makes me come out in massive bruises. I had also been started on azathioprine as well at 100mg as the dosage goes by the weight of the patient. Also my consultant was unsure of whether or not to start me on humira but would make the definite decision when he got the results back from the MRI scan.
 
A week after my endoscopy and colonoscopy procedures I got disturbed eating my breakfast which I had stolen off the breakfast cart before they started doing the rounds at 8.15am, I was rushed down to the MRI scan. It was a complete waste of time eating my breakfast as I was given more of the disgusting laxatives which I was to drink within an hour before my slot. A few days later I was told that the Crohn's had not yet spread to the small bowel. This was a good thing as he had decided not to start the humira just yet.