Patiëntenfolder

Bowel preparation with Picoprep

For a colonoscopy, your bowel must be thoroughly clean. This allows the doctor to clearly examine the intestinal wall and detect any abnormalities. If your colon is not clean (enough) on the day of the procedure, the colonoscopy may have to be canceled. It is therefore important that you carefully read and follow the instructions below to ensure you are well-prepared. 

Endoscopy department for gastrointestinal and liver diseases

The preparation for the procedure consists of: 

• Taking Bisacodyl® and PICOPREP® (laxatives). 

• Following a low-fiber diet starting one day before the procedure. 

• Drinking plenty of water or clear fluids. 

Unless otherwise instructed by the doctor/nurse, you will use Bisacodyl® and PICOPREP® to clean out your bowels (laxative preparation). Please follow the schedule provided below, and not the one mentioned in the laxative package insert. 

If you have also received a prescription for Macrogol, you should start using it 7 days prior to the colonoscopy. Macrogol softens your stool, which makes it easier for your bowels to be cleansed with PICOPREP® before the colonoscopy. 

Low-fiber diet  

The day before the scheduled procedure, you will start the low-fiber diet. This means you are not allowed to eat certain fiber-rich foods. 

What you should NOT eat: 

• Whole grain products such as:  

Bread with seeds and whole grain bread. Whole grain and multigrain pasta, and brown rice.  

• Fibrous vegetables such as:  

Asparagus, celery, sauerkraut, runner beans, green beans, leeks, peas, legumes, bean sprouts,  

corn, mushrooms, tomatoes, onions, garlic, spinach, endive, bell peppers, and raw vegetables.  

• Fruits with fibers and/or seeds such as:  

Oranges, grapefruit, tangerines, kiwis, blackberries, grapes, strawberries, and dried fruits. 

What you CAN eat: 

• Bread-based meals such as:  

Rusk, white or light brown bread with margarine or butter.  

Lean cold cuts, cheese, a boiled egg, chocolate sprinkles, chocolate spread, honey, syrup, and seedless jam.  

• Fruits such as:  

Soft, ripe fruit or canned fruit without seeds, fibers, or peel. Applesauce, fruit puree.  

• Hot meal options such as:  

Soup with small pieces of meat, vermicelli, and/or meatballs (but no vegetables).  

Potatoes, white rice, pasta, macaroni. Lightly roasted lean meat, fish, or chicken (without skin).  

• Well-cooked vegetables such as:  

Beets, cauliflower, broccoli, carrots.  

• Desserts such as:  

Custard, pudding, quark or yogurt.

                                                                                                          

Preparing PICOPREP  

Instructions for preparing Picoprep®: 

- Picoprep® is a laxative with an orange flavor. You will receive 1 package of Picoprep®, which contains 2 sachets. 

- Dose 1: Dissolve one sachet of Picoprep® in 150 ml of water. Stir for 2-3 minutes until the solution stops fizzing and is completely dissolved.  

- Dose 2: Repeat the preparation method as described for dose 1.                                     

Preparing and taking Macrogol 

Dissolve one sachet of Macrogol in a glass of water and take it in the morning and, if needed, in the evening, to soften your stool. By softening your stool, your bowel can be more easily cleansed with PICOPREP® before the colonoscopy.

Laxative Schedule

For laxative preparation with PICOPREP®, follow the schedule below. It is important that you drink the prescribed amount of fluid completely. 

7 days before the procedure:

  • If you are taking iron tablets, stop taking them now. 
  • Do not eat any seeds, nuts or grains until the procedure (e.g., bread with seeds/nuts or fruit with small seeds such as kiwis, grapes, berries, strawberries, blackberries etc.). 
  • If needed, start taking Macrogol at breakfast and dinner until you start with PICOPREP®. 

2 days before the procedure:

  • During dinner, take 2 Bisacodyl® tablets with a glass of water. 

1 day before the procedure:

  • Start the low-fiber diet today. After 3:00 PM, you are not allowed to eat anything, and you may only drink clear fluids*. 
  • Between 6:00 PM and 8:00 PM, drink 1 glass (150ml) PICOPREP® dose 1 and at least 2 liters of clear fluids. 
  • - Starting from 8:00 PM, you are in the rest period — you may drink as much clear fluid as you like: the more you drink, the cleaner your bowel will be. 

On the day of the procedure: 

  • Four hours before the procedure, drink 1 glass (150ml) PICOPREP® dose 2 and 2 liter of clear fluids within two hours.
  • Stop drinking two hours before the procedure.

* The following clear fluids are allowed: water, clear apple juice, lemonade, tea, and strained broth. 

Tips for taking PICOPREP®: 

It is important that you drink the prescribed amount of liquid completely. Below are some tips to make drinking the laxative a bit easier:  

  • Drink the glass of PICOPREP® in one go.  
  • Keep moving to help stimulate your bowels.  
  • If needed, chew gum (without sorbitol) or suck on a yellow-colored lollipop (without biting or chewing) to reduce any unpleasant taste.  

Effect of PICOPREP® 

PICOPREP® ensures that you will lose a significant amount of stool within two hours of drinking it. Afterward, the effect decreases somewhat. Often, there will still be a lot of stool in the morning after the laxative. When taking the laxative, the stool will become thinner and eventually resemble a watery and clear fluid. It is important to know that you will not completely lose control over your stool, which helps prevent accidents, and you should be able to reach the toilet in time. 

Do you have any questions? 

If you have any general questions about your bowel examination or problems with taking the laxatives, please contact the Endoscopy Department at telephone number 071-5296754 between 8:00 AM and 12:00 PM. General questions may include nausea/vomiting during the laxative process or doubts about whether your bowel is sufficiently clean. If your question cannot wait until the next working day, please contact the same number by 4:00 PM at the latest. 

In case of (medical) problems, you can contact the LUMC outside office hours via 071-5269111 and ask for the on-duty gastroenterologist. Medical problems may include severe abdominal pain or bright red blood loss through the anus after the colonoscopy. 

Recommended timing for taking laxatives on the day of the colonoscopy 

Time of your procedure 

Time to take the laxative on the day of the colonoscopy 

8.30 AM 

4.30 AM 

9.00 AM 

5.00  AM 

9.30 AM 

5.30 AM 

10.00 AM 

6.00 AM 

10.30 AM 

6.30 AM 

11.00 AM 

7.00 AM 

11.30 AM 

7.30 AM 

1.30 PM 

9.30 AM 

2.00 PM 

10.00 AM 

2.30 PM 

10.30 AM 

3.00 PM 

11.00 AM