Bowel Preparation

There are several approaches to bowel preparation:

  1. Electrolyte oral bowel preparation

  2. Saline oral bowel preparation (e.g. Phospho-soda bowel prep)

  3. Magnesium citrate laxative

Electrolyte Oral Bowel Preparation

Composition:
  • Lyte prep Peglyte, Colyte
  • Polythelene glycol 3500
  • Sodium Bicarbonate
  • Potassium Chloride
  • Sodium Sulfate
  • Sodium Chloride


Clinical Pharmacology:

  • Induces a diarrhea usually within four hours.
     
  • Combination of osmotic activity of Polythelene glycol 3350 & electrolyte concentration
     
  • Results in no net absorption or secretion of ions or water.


Contraindications and Precautions:

  • Gastrointestinal obstruction, gastric retention, bowel perforation, toxic colitis or megacolon.


NOTE: Bowel preps with PHENOLPHTHALEIN have been withdrawn due to their carcinogenic effect in experimental animals.

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Saline Oral Bowel Preparation

PHOSPHATES SOLUTION (Fleet Phospho, etc.)

Composition:

  • Phosphates solution consists of monobasic sodium phosphate and dibasic sodium phosphate in an aqueous solution.
     

Pharmacology:

  • Phosphate containing saline laxatives may be absorbed by an active process. It is versatile in action as a gentle laxative or purgative, according to dosage.


Contraindications/Warnings:

  • Do not use Phosphates Solution in patients with kidney disease or in patients who are on a sodium restrictive diet unless directed by a physician.
     
  • Do not use Phosphates Solution in patients with congenital megacolon or congestive heart failure, as hypernatremic dehydration may occur.



Pearls:

  • May be used on patients with previous poor bowel prep
     
  • The above bowel preps leave the bowel wet, precluding good mucosal coating.
     
  • Suggest giving oral 20 mg of Dulcolax 2 hours before starting the bowel prep.
     
  • Expensive and the large volume ingested sometimes not possible

PATIENT INFORMATION SHEET

Fleet® Phospho-soda®

 READ CAREFULLY.  DO NOT EXCEED RECOMMENDED DOSAGE AS SERIOUS SIDE EFFECTS MAY OCCUR. (SEE PACKAGE FOR OTHER IMPORTANT WARNINGS.)

 ·          Purchase 3 oz. of Fleet Phospho-soda from your pharmacy. 

A)      Day Before Exam

Breakfast , Lunch and Dinner :Follow diet sheet overleaf

 ·          At 4.00 PM: Take the first  1.5 oz dose of Fleet Phospho-soda (See right for instructions)

·          At 6.00PM Take the second 1.5-oz dose of Fleet Phospho-soda 

·         (FOLLOW INSTRUCTIONS ON BOTTLE)

B) On day of exam do not eat or drink any food.


 IMPORTANT INFORMATION ON MAKING  BOWEL PREPARATION COMFORTABLE

·          The taste is improved by mixing the laxative with ginger ale, apple juice or lemon-lime type drinks.

·          This prep often works within 30 minutes but may take as long as 3 hours. Remain close to a toilet, as multiple bowel movements will occur.

·          Can apply Vaseline over anal area after each bowel movement (to prevent severe irritation)

·         On day of exam, you can drink some liquids as per Diet Sheet

 

DIET INSTRUCTIONS

 Light Breakfast

  Breakfast may include any of the following items:

·          Any items from the "Clear Liquids Diet List" below

·          One boiled or poached egg or small portion of skinless chicken/turkey or fish

·          White toast - no butter

·          One 8 oz. can Ensure (Do not take Ensure Plus)

 

 Clear Liquids Diet List

 A) Beverages:

·          Soft drinks (orange, ginger ale, cola, Sprite, 7-Up, etc.), Gatorade, Kool-Aid

·          Strained fruit juices without pulp (apple, white grape, orange, lemonade, etc.)

·          Water, tea, or coffee (no milk or non-dairy creamer)  

 B) Soups:

·          Low sodium chicken or beef bouillon/broth

  C) Desserts:

·          Hard candies

·          Jell-O (lemon, lime or orange; no fruit or toppings)

·         Popsicles (no sherbets or fruit bars)

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Magnesium Citrate Laxative

Sample patient information sheet:

MAGNESIUM CITRATE LAXATIVE

READ CAREFULLY. DO NOT EXCEED RECOMMENDED DOSAGE AS SERIOUS SIDE EFFECTS MAY OCCUR. (SEE PACKAGE FOR OTHER IMPORTANT WARNINGS.)

Purchase Magnesium Citrate and Dulcolax tablets from your pharmacy.

If you have any medical problems, such as insulin dependent diabetes, heart disease, please consult your Family Doctor, for additional instructions before beginning this procedure.

A) Day Before Exam:

Breakfast:
Have a Light Breakfast

Lunch and Dinner
Drink all the Clear Liquids you like

At 2.00 PM
Take the 4 tablets of Dulcolax tablets with water

At 4.00PM
Take the entire bottle of Magnesium Citrate

Drink lots of liquids or water

B) On Day of Exam:

You can drink some liquids as per Diet Sheet (if you are NOT undergoing colonoscopy)

PEARLS OF BOWEL PREPARATION:

· The taste is improved by mixing the laxative with ginger ale, apple juice or lemon-lime type drinks.
· This prep often works within 30 minutes but may take as long as 3 hours. Remain close to a toilet, as multiple bowel movements will occur.
· Can apply Vaseline over anal area after each bowel movement (to prevent severe irritation)

 
DIET INFORMATION

Light Breakfast

Breakfast may include any of the following items:

· Any items from the "Clear Liquids Diet List" below
· One boiled/poached egg or small portion of skinless chicken/turkey or fish
· White toast - no butter
· One 8 oz. can Ensure (Do not take Ensure Plus)
Clear Liquids Diet List

A) Beverages:
· Soft drinks (orange, ginger ale, cola, Sprite, etc.), Gatorade, Kool-Aid
· Strained fruit juices without pulp (apple, orange, lemonade, etc.)
· Water, tea, or coffee (no milk or non-dairy creamer)

B) Soups:

· Low sodium chicken or beef bouillon/broth

C) Desserts:

· Hard candies
· Jell-O (lemon, lime or orange; no fruit or toppings)
· Popsicles (no sherbets or fruit bars)

IMPORTANT: If you have any problems with preparation or have any questions you can call your Family Doctor or us during regular office hours.

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