MoviPrep Cleansing Procedure for Colonoscopy

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Movi Prep for Colonoscopy

PAUL E. SAVOCA, MD, FACS, FASCRS

PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE YOUR PROCEDURE:
All PATIENTS MUST FOLLOW A CLEAR LIQUID DIET ONLY ALL DAY THE DAY PRIOR TO COLONOSCOPY.
DO NOT EAT OR DRINK ANYTHING OTHER THAN YOUR PREP AFTER MIDNIGHT THE NIGHT BEFORE

  • DO NOT eat foods containing seeds for five days prior to your procedure such as sesame or poppy seeds, strawberries, black pepper, corn or tomato skins. If by chance you have eaten these products, you should still proceed with your preparation.
  • Prescribed medications for heart disease, high blood pressure and asthma may be taken prior to your procedure, unless otherwise instructed. All other medications, including diabetic medications, should be brought along with you to be taken after your procedure.
  • DO NOT take aspirin or aspirin-type products such as Ibuprofen, Advil, Aleve, Nuprin, Motrin, Naprosyn, etc. for at least one week prior to procedure. Please do not take herbal remedies or supplements for at least one week prior to your exam. You may take Tylenol.
  • After your colonoscopy, if you had a biopsy or polyp removed: Please stop Plavix 7 days prior to your procedure, or Coumadin 4 days prior. Please consult the physician who prescribed the medication to make them aware.
  • Please advise the physician if you have a prosthetic heart valve, a serious heart murmur, or if you have had any cardiac procedures in the last year.
  • On the day of your colonoscopy you will receive intravenous sedation. These medications will impair your driving ability. You must arrange for someone to take you home after your procedure. The driver must remain in the facility throughout your procedure and recovery. You may not drive until the next day.
  • You will receive written diet instructions after your colonoscopy.
  • This packet contains the Movi-prep. If you are unable to complete the prep, please call the Doctor’s office and speak with a staff member. After hours, the Physician on call will contact you.

Movi Prep for Colonoscopy
Patient Instructions – Split – Dose Regimen

The MoviPrep carton contains 4 pouched and a disposable container for mixing. You must complete the entire prep to ensure the most effective cleansing.
The evening before your colonoscopy beginning at: 6pm

Step 1: Mix First Dose

  • Empty 1 Pouch A and 1 Pouch B into the disposable container
  • Add lukewarm drinking water to the top line of the container and mix until dissolved. If preferred, mix solution ahead of time and refrigerate prior to drinking. The solution should be used within 24 hours.

Step 2: Drink First Dose

  • The MoviPrep container is divided by 4 marks. Every 15 minutes, drink the solution down to the next mark (approximately 8 oz), until the full liter is consumed
  • Drink 16 oz of the clear liquid of your choice. This is a necessary step to ensure adequate hydration and an effective prep.

Step 3: Mix Second Dose

  • Empty 1 Pouch A and 1 Pouch B into the disposable container
  • Add lukewarm drinking water to the top line of the container and stir well If preferred, mix solution ahead of time and refrigerate prior to drinking. The reconstituted solution should be used within 24 hours.

Step 4: Drink the second dose the morning of your colonoscopy. You must COMPLETE drinking it four hours prior to leaving for your procedure.

  • The MoviPrep container is divided by 4 marks. Every 15 minutes, drink the solution down to the next mark (approximately 8 oz), until the full liter is consumed.
  • Do not drink or eat anything after completing the last does of your MoviPrep.

This colonoscopy prep causes the body to lose a significant amount of fluid and can result in dehydration. It’s important that you prepare your body by drinking extra clear liquids before the prep and remaining hydrated by drinking all required clear liquids during the prep. Also, replenish your system by drinking clear liquids after returning home from your colonoscopy.

If you have any questions, please call our office at 631-862-3600

CLEAR LIQUID DIET

This diet provides fluids that leave little residue and are easily absorbed with minimal digestive activity. This diet is inadequate in all essential nutrients and is recommended only if clear liquids are temporarily needed.

No red or purple liquids should be consumed!


Miralax Cleansing Procedure for Colonoscopy

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Miralax Bowel Prep for Colon Surgery

PAUL E. SAVOCA, MD, FACS, FASCRS

A bowel prep is done to clear the bowel of all solid matter. Its purpose is to cleanse the bowel for surgery or a procedure such as colonoscopy. Please follow these instructions exactly. Begin the bowel prep one day before your scheduled procedure. The cleansing is complete when the fluid passed is pale yellow without flecks of stool.

On the day prior to your surgery:
Drink clear liquids only for breakfast, lunch and dinner. NOTHING TO EAT OR DRINK AFTER MIDNIGHT (YOUR SURGERY MIGHT BE CANCELLED SHOULD THIS OCCUR)

  1. 1:00 PM Take 4 Dulcolax tablets with a drink of clear liquids.
  2. 2:00 PM Mix the Miralax in a 64-ounce bottle of Gatorade or other clear liquid of your choice. Cap the bottle and shake the bottle to dissolve the powder. Most people prefer to drink the liquid chilled so you may want to place it in the refrigerator.
  3. 4:00 PM Start to drink the Miralax. Drink one glass every 10 to 15 minutes. Drink it quickly rather than sipping small amounts because it does not taste that good. Finish drinking the liquid in 2 hours. Be sure to drink all of the liquid.
  4. Midnight Do not eat or drink anything after 12 midnight. You may gargle but do not swallow any liquid. Do not smoke after 12 midnight.

The morning of the surgery

  • Do not eat or drink anything until your test is done. If you are to take
    your morning medicines, take with small sips of water only.
  • Bring all medicines you usually take (in the original containers) to the
    hospital with you.
  • If you are to take your morning medicines, take with small sips of
    water.
  • Talk to your doctor or nurse if you have any questions or
    concerns.

Discharge Instructions For Colon Surgery

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WHAT TO EXPECT AFTER YOUR COLON SURGERY

PAUL E. SAVOCA, MD, FACS, FASCRS

In-Hospital Care
After the operation the nursing staff will closely watch you until you have recovered from the anesthetic. You may even be cared for in the intensive care unit immediately following your surgery.

The recovery period after colon surgery varies. It usually involves a stay in the hospital from 3-7 days in uncomplicated cases. On return from your surgery you will have a catheter (plastic tube) in the bladder to measure and drain your urine.

After surgery you will be given intravenous fluids (a drip) through which antibiotics may be given. The drip will remain in place until you are able to drink enough fluids. It general requires 3-4 days before the colon has healed well enough to tolerate anything by mouth. You know the bowel has started to work again when you pass gas and/or have a bowel movement. You will then begin to take liquids by mouth and then solid food.

It is likely that on your return from surgery you will be wearing tight fitting stockings that are used to reduce the risk of blood clots forming in your legs. In addition, it is very important that you start moving as soon as possible. This helps to prevent blood clots forming in your legs and possibly going to your lungs. This can be fatal.

Also, you need to do your deep breathing exercises. Take ten deep breaths every hour to prevent secretions in the lungs from collecting. If this happens, you may develop pneumonia. At all costs, avoid smoking after surgery as this increases your risk of chest infection. Coughing is painful after abdominal surgery do not hesitate to use the pain medication provided.

Colostomy (“stoma” or “bag”)
Many patients undergoing colon surgery require a stoma. The colostomy or ileostomy drains bowel waste into an external bag attached to the abdomen. Most colostomy waste is softer and more liquid than normally passed bowel waste. The thickness of the bowel waste depends on where the stoma is. You will be taught how to clean around the colostomy and change the colostomy bag. The colostomy bag sticks to the skin around the stoma with special glue, and can be thrown away when dirty. This bag does not show under clothing, and most people learn to take care of these bags themselves. Stomas may be temporary or permanent, if reversible a second operation is always required.

Wound
Your wound will usually have no visible stitches or staples and is usually covered with a dressing. In certain cases staples or stitches are used to close the incision and will need to be removed at a later date.

Drains
You may also have a small tube that drains into a bag or a bottle from near your wound. This drain removes fluid from the surgical site and is usually removed within a few days after surgery at the bedside.

Pathology Report/Need for further treatment
Depending on the pathologist’s report, which is available 5- 7 days after the operation, further treatment may be required. These include:
Surgery- in rare circumstance an additional operation is required
Radiation Treatment- this been used for some people as the main treatment for rectal tumors but is not normally used in colon tumors. Radiation therapy is not as effective as surgery for patients who could normally be treated by bowel removal.
Chemotherapy (use of drugs to treat tumor) is usually used together with surgical removal and may not be offered as the only treatment”.

Postoperative Instructions (after Discharge)

  1. Soft diet for first week. Try eating six (6) small frequent meals rather than 3 big meals. Excessive sweets tend to make the stools more liquid. Add one new food at a time in small mounts. Drink plenty of fluids.
  2. Fiber: Avoid raw vegetables and raw fruits for 1-2 weeks. Gradually increase the fiber in your diet, as this will thicken the stool. Lessen the doses of Metamucil, Konsyl or Citrucel if abdominal cramps or bloating occur.
  3. Activity: Avoid activity which causes pain. Walking and climbing stairs OK. No lifting more than 20 lbs and no vigorous sports for 4-6 weeks or as directed.
  4. Resume home medications except: Aspirin or NSAIDS unless otherwise directed by the Doctor.
  5. No driving until seen in the office, riding in the car as a passenger is permitted.
  6. Common problems
    • Wound problems: It is okay to shower and get the incision and staples wet. Some drainage from the incision is common; a light gauze pad over the incision can be helpful. If drainage is cloudy or associated with fever > 101 degrees, call the office.
    • Medication reactions: Reactions to medicines can occur. The most common symptoms are nausea, vomiting, or itching related to taking the medication. If this occurs stop the medication and contact the office.
      *Note: All Narcotics cause constipation*
    • Urinary difficulties: Urinary tract infections occasionally occur following abdominal surgery. Pains with urination and/or blood in the urine are symptoms of infection. Bring these symptoms to the doctor’s attention at your post-op visit.
    • Bowel obstructions: abdominal cramps, bloating, nausea, vomiting, and constipation. When these develop, call your physician for advice. If the symptoms are mild, you may restrict intake to liquids only and avoid solid food. If the symptoms are severe or if persist beyond 24 hrs, call your physician.
    • Irritation around anus from severe diarrhea: Use Destin ointment or Skin protective paste. Avoid vigorous wiping after a bowel movement. Instead use a shower nozzle attachment to clean the area. A warm tub bath or sitz bath is also helpful. Pat gently dry afterwards. Baby wipes can be used instead of toilet paper.
    • Steroid withdrawal: If you had been on prednisone for a long time and have now stopped the medication, you are at risk for steroid withdrawal if the weaning is too rapid or if you are in a stressful situation. The manifestations may be vague with sever fatigue, nausea, fever/chills and joint aches being the most common. If there is no improvement within 24 hours, call your physician.
    • Infection: If you experience fever above 101 degrees, shaking, chills, lower abdominal discomforts, difficulty in passing urine and sometimes drainage of pus from wound, call your physician.
  7. Call the office on the day of your discharge to make follow up appointment in 1 to weeks (as directed at time of discharge).

On-call physician: To reach the doctor on call, dial the office number anytime day or night 631-862-3600.

The following is a brief list of the most common issues for which you should contact the physician:

  • Large amounts of bloody leakage from the wound.
  • Blood in the stool.
  • Fever and chills.
  • Pain that is not relieved by prescribed pain killers.
  • Tender, swollen abdomen.
  • Swelling, tenderness, redness at or around the incision
References for further study
The Surgical Clinics of North America Murray, John, J. (Ed), W. B. Saunders Company, Philadelphia, Volume 73, Number 1, February 1993,
Medical Oncology A Comprehensive Review, Pazdur, R. (Ed),
Huntington, New York, 1993.
Comparison of manually constructed and stapled anastomoses in colorectal surgery Docherty, J., McGregor, J., Arkyol, A., Murray, G. and Galloway, D
Annals of Surgery, 221: 76-184, 1995.
In-Hospital mortality and associated complications after bowel surgery
Ansari, M., Collopy, B., Hart, W., Carson, N., and Chandraraj, E
Australian and New Zealand Journal of Surgery, Vol. 70 pps 6-10, 2000. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials, Song, F., and Glenny, A.
British Journal of Surgery, Vol. 85, pps 1232 -1241, 1998.
Risk Factors for Morbiditand Mortalit After Colectomy for Colon Cancer,
Longo, W et.al. Dis Colon Rectum, Vol 43, No. 1., pps 83-91, January 2000
Post Colectomy Syndrome, World Journal of Surgery, Schoetz, D Vol. 15, pps 605 -608, 1991.
Bladder and Sexual Dsfunction after Surgery for Rectal Cancer, Kinn, A. and Ohman, U, Dis Colon Rectum., January 1996.
Effect of anterior resection on anal sphincter function, Horgan, P., O’Connell, P., Shankwii, C. and Kirwan, W., British Journal of Surgery, Vol. 76, pps 783-786, 1989.

Discharge Instructions For Stoma Reversal Surgery

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POST SURGICAL INSTRUCTIONS FOR STOMA CLOSURES

  1. Dressing: Apply soft gauze over the old stoma site and change as needed. Showers or baths OK, remove dressing before. Pat gently dry afterwards. The wound usually closes completely in 8 weeks.
  2. Bowel function tends to be erratic up to 6 months after surgery; frequent bowel movements and seepage at night are common in the first few months. The body adapts and this improves gradually over the first year. When stabilized, the stool consistency is usually pasty to formed.
  3. Anti diarrheal medications:
    • Benefiber/Metamucil/Konsyl/Citrucel
    • Imodium (2mg) or Lomotil (2.5mg) by mouth, 30 minutes before meals and at bedtime as needed. (Maximum 8 a day of each)
    • As diarrhea improves, use Imodium or Lomotil less frequently.
    • Metamucil/Konsyl/Citrucel is free of major side effects and, though not essential, we advise its use.
  4. Possible problems:
    • Pouchitis: Abdominal cramps, low grade fever, urgency, blood in stool, aches and pain in muscles or joints, and sometimes nausea. The best treatment is Flagyl 250 mg by mouth, every 8 hours for 2 weeks. Call your physician if this is the first attack or if there is no improvement after 3 days of Flagyl in subsequent attacks.
    • Wound problems: It is okay to shower and get the incision staples wet. Some drainage from the incision is common; a light gauze pad over the incision can be helpful. If drainage is cloudy or associated with fever > 101 degrees, call the Doctor.
    • Urinary difficulties: Urinary tract infections occasionally occur following abdominal surgery. Pains with urination or blood in the urine are symptoms of infection. Bring these symptoms to the Doctors attention at your post. op visit.
    • Bowel obstructions: abdominal cramps, bloating, nausea, vomiting, and constipation. When these develop, call your physician for advice. If the symptoms are mild, you may restrict intake to liquids only and avoid solid food. If the symptoms are severe or if persist beyond 24 hrs, you must call your physician.
    • Irritation around anus from severe diarrhea: Use Desitin ointment or skin protective paste. Avoid vigorous wiping after a bowel movement. Instead use a shower nozzle attachment to clean the area. A warm tub bath or sitz bath is also helpful. Pat gently dry afterwards. Baby wipes can be used instead of toilet paper.
    • Steroid withdrawal: If you had been on Prednisone for a long time previously for ulcerative colitis and have now stopped the medication, you are at risk for steroid withdrawal if the weaning is too quick, or if you are undergoing a stressful situation. The manifestations may be vague with feelings of being rundown, giddy, nausea or severe joint aches. If there is no improvement within 24 hours, call your physician.
    • Infection: Fever, shaking, chills, lower abdominal discomfort,difficulty passing urine and sometimes drainage of pus from wound, call your physician.
  5. Call the office on the day of discharge to schedule a follow-up appointment for approximately 2 weeks.