Bowel Prep: How to take Plenvu

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Why do I need to take PLENVU?

You have been prescribed PLENVU as a laxative to empty your bowel in preparation for your colonoscopy.

It does this by causing you to have diarrhoea, or frequent bowel movements. A clean bowel will allow the endoscopist to have a clear view of the inner lining of your bowel, which is important for accurate diagnosis and treatment.

Please ensure that you follow the instructions carefully as your procedure may have to be cancelled and/or repeated at another time if your bowel is not clean enough.

These instructions may differ slightly from the manufacturer’s information leaflet, however, please follow this schedule.

Do not take if you are allergic to any of the ingredients.

Expected side effects

You will experience diarrhoea as the purpose of PLENVU is to clear and cleanse the bowel.
You are also likely to experience some abdominal cramping.
Some patients may experience nausea and/or vomiting – if this is a problem, wait for ½ hour and then recommence taking PLENVU . Chilled PLENVU , drinking it through a straw and/or sucking a sweet may help resolve some side effects.
It is important that you continue to drink adequate amounts of fluid to avoid dehydration.

Very Common

Abdominal pain, a feeling of fullness in your stomach, bloating, tiredness, soreness/ pain of the anus (bottom), thirst and nausea.

Common

Hunger, headache, problems sleeping, dizziness, vomiting, indigestion, and chills.

Adverse reactions

Rarely, people can be allergic to PLENVU and may get an itchy rash (nettle rash or hives).

If any of the side effects become serious, or do not ease, or if you at all worried, or you notice any side- effects not listed above, you must seek advice from:

Endoscopy Department Tel: 01908 996 460 (Monday-Friday;8am- 6pm)
Your GP
NHS 111

What is PLENVU and how to take it?

PLENVU is a laxative designed to cleanse your bowel. It comes in a two-dose preparation:

Dose 1 is a single mango-flavoured sachet.
Dose 2 is two sachets (A and B) and fruit punch flavour.

All sachets must be taken with the right amount of water according to the timing of your appointment.

How to prepare for your procedure

7 days before your appointment: Stop taking any iron tablets as this can affect the quality of your test.
5 days before your appointment: Stop eating any food containing nuts/seeds/salads. If you take any opioids painkillers (such as morphine/codeine/codydramol) on daily basis, consider the possibility to stop them or reduce the usual amount to increase the effectiveness of the laxatives.
2 days before your appointment: Start with your low fibre diet (Please see the list of foods and drinks allowed on page 9) and stay on this diet until the procedure is done. A low fibre diet before taking your laxative plays a key-role in making sure that your colonoscopy is effective.

How to prepare PLENVU

Please make sure that you read the full instruction before you start preparing the laxative.

Dose 1

Fill a jug or bowl with ½ litre (500ml) of water.
Empty the contents of the dose 1 sachet into the water.
Stir until the powder is completely dissolved and the solution is clear.

Dose 2

Fill a jug or bowl with ½ litre (500ml) of water.
Empty the contents of sachet A and B into the water.
Stir until the powder is completely dissolved and the solution is clear.

You may add a cordial flavour such as lime but not blackcurrant, as this darkens the colon. Before taking the laxative, check the time of your appointment and select the appropriate instruction listed below.

It is important that you take both doses of the medication, the first dose is designed to soften the stools and therefore you may not go to the toilet as much as expected but the 2nd dose is designed to cause you to frequently open your bowel. You may want to ensure you have some soft toilet paper or wet wipes and you are allowed to apply a cream to the area if necessary.

Morning appointment

If you have been given a morning appointment, follow these instructions:

One day before your appointment

7-8 am Breakfast – See allowed food list.

No further solid foods until after the procedure – clear fluids only

You can make up the PLENVU solution now and refrigerate to make it easier to drink.

1 pm – Start drinking Dose 1 of the PLENVU preparation.

One glassful (250mls/ ½ pint) of about every 15-30 minutes until you have drunk it all. You may use a straw to help with the taste. It is important to drink at least an additional 500ml of water (2 glasses) or clear fluids.

6 pm – Start drinking Dose 2 of the PLENVU preparation.

It is important to drink at least an additional 500ml of water (2 glasses) or clear fluids.

The day of your appointment: No solid food.

If you take blood pressure tablets, please take these with a small amount of water on the morning of your procedure. If you are diabetic, do not take oral diabetic medications or short-acting insulin – if unsure please get in touch with your nurse/doctor about this. Stop drinking two hours before your appointment time or four hours if you are having a Gastroscopy & Colonoscopy.

Afternoon appointment

If you have been given an afternoon appointment, follow these instructions:

One day before your appointment

7-8am Breakfast – See allowed food list.

1pm Lunch – Have a light meal from the allowed foods list.

No more solid food after lunch until after your procedure

You can make up the PLENVU solution now and refrigerate to make it easier to drink.

6pm – Start drinking Dose 1 of the PLENVU preparation.

The day of your appointment: No solid food.

If you take blood pressure tablets, please take these with water on the morning of your procedure at least 1 hour before taking the bowel preparation.

If you are diabetic, do not take oral diabetic medications or short-acting insulin – if unsure please get in touch with your nurse/doctor about this (see full instructions on page 6 & 7).

7 am – Start drinking the second dose of the PLENVU preparation.

It is important to drink at least an additional 500ml of water (two glasses) or clear fluids. You should finish your PLENVU and additional water at least 2 hours before your colonoscopy.

Stop drinking two hours before your appointment time or four hours if you are having a Gastroscopy & Colonoscopy.

Information for patients with diabetes

Hypoglycaemia

If you have a reading below 4mmol/l this is called a ‘hypo’ and you may experience the following symptoms: Sweating, shakiness, dizziness, blurred vision, headache, fatigue, confusion, weakness.

Some people do not get symptoms, or get them at readings much higher than 4mmol/l. This is called ‘Impaired hypo awareness’. Please let staff know if you do not feel your hypos. If your glucose level is below 4mmol/l (This must be confirmed on a glucose meter) you need to take fast acting glucose (15-20g carbohydrate, even if you feel well). If you are fasting, it is recommended that you use a clear glucose juice (Lift juice) or 150 – 200ml of clear apple fruit juice. Check your blood glucose again in 10-15 minutes and if still below 4mmol/L repeat your treatment if needed. Check again until your blood glucose is above 4mmol/L.

Please let the staff know that you have done this when you arrive at the hospital.

Please remember to bring with you to hospital:

Diabetes medication (e.g., tablets, insulin) that you usually take for your diabetes.
A supply of insulin needles (if you take insulin or other injectable treatment)

Insulin treated diabetes

On the day of your procedure, from 6am onwards, you should monitor your blood glucose every 2 hours prior to your arrival at hospital and bring your record with you. If you are driving, you should also check your blood glucose just prior to starting your car and drive only if your blood glucose is more than 5 mmol/L.

Insulin Pumps: Please inform staff if you are on an insulin pump as some procedures can interfere with the function of the pump. Contact the diabetes team for MKUH on 01908 995 967 or [email protected] for a care plan to follow during your admission.

Tablet treated diabetes

Insulin may need to be given via a vein in some circumstances. Your blood glucose will be checked hourly during this time. This will stop and normal medications resumed as soon as you feel well enough to eat and drink again. Please see our web page for further information about diabetes management www.mkuh.nhs.uk/diabetes-care

After your procedure

After your procedure, you will be offered food and drink when you feel able to eat. Once you are eating and drinking normally, you should resume taking your normal diabetes medication from that meal onwards. The healthcare team will be able to give you further advice on this.

If you become unwell, especially if you are vomiting and unable to eat or take medication. Contact your usual diabetes team/GP surgery or 111. Please ensure you let them know you just had a procedure.

What Low Fibre Diet shall I follow?

Here is the list of food and drink allowed, you may want to cut it to put it on your fridge or take a photo on your phone to help with your food shopping before your procedure.

Low residue foods you can eat	High Fibre foods to avoid
ü White cereals such as cornflakes or rice-based cereals. ü White rice and pasta. ü Plain white biscuits such as rich tea, custard creams, nice or malted milk. ü White bread, crumpets, and scones (without dried fruit). ü Well cooked meat, fish, cheese, or egg ü Potatoes without the skin. ü Jelly (NOT red ones)	× Bread – wholemeal, high bran, granary, high fibre or half wholegrain. × Wholemeal pittas, chapattis and muffins. × Cereal bars, digestive biscuits, fruit cake, fig rolls. × Wholemeal lasagne/pasta. × Brown rice. × High fibre or bran crisp breads and crackers. × Wholemeal, wholegrain bran or high fibre cereals, porridge, and muesli. × Nuts and seeds. × Fruit – fresh, frozen, cooked and dried. × Beans, lentils, and chickpeas. × Potatoes with skin on.
Drinks allowed	Drinks to avoid
ü Water ü Tea and/or coffee without milk ü Soft drinks ü Fruit juices without pulp ü Clear soup	× Alcohol × Milk × Any red or purple drink × Drinks containing pulp