I think its fair to say that everyone’s stomach churns when their doctor says those dreaded two words: bowel prep. You might be asked to do bowel prep before some types of surgery, invasive procedures like colonoscopies or even some scans, the purpose being to “clear out” your digestive system and either provide a clear image or make operating easier. But what is the best bowel prep to take? Is one more effective than another? Is one easier to consume than another? Here I will review and compare two common forms of bowel prep which I have used several times: Picolax and Moviprep.
Picolax
How do you take Picolax?
Usually I take Picolax to prepare for colonoscopies, but I have recently also used it to prepare for abdominal surgery. Sometimes you may be told to avoid high fibre foods for a couple of days prior to taking bowel prep, but this has never been highlighted as greatly important in my case. The day before your procedure you are required to stop eating solid foods at around 8am and then you are only allowed clear fluids like water, tea, clear squash or strained broth for example. It’s important to carry on drinking plenty of clear fluids in order to replace those that are being lost, but only up until 2 hours before your appointment. After this time, you mustn’t consume anything, not even water.
As for the actual bowel prep, generally you are given two sachets of white powder containing numerous laxatives which each need to be mixed with 150ml of water and consumed the day before your procedure at certain times. Your doctor should tell you what time to drink each sachet, but for me personally the first sachet is generally consumed at 2pm and the second at 6pm when I have a morning appointment. You may also be asked to take some tablets like bisacodyl to help the wash out process along.
How does it work?
Picolax contains both stimulant laxatives and osmotic laxatives. The sodium picosulfate (the stimulant laxative) is activated by the natural bacteria found in the colon. It basically increases muscle contractions in the colon and rectum, moving their contents along so that the bowel can be emptied. The magnesium citrate (the osmotic laxative found in Picolax) causes water from surrounding tissue to be drawn into the lower bowel. This increases the water content and volume of stools, helping to “wash out” the bowel.
Everyone is different, but for me Picolax generally starts working an hour or so after drinking the first sachet. Now, this obviously isn’t pleasant at all no matter which bowel prep you take, but Picolax is known for its rather aggressive effect on the bowel. And by that I mean that you can expect nothing short of Niagara Falls on just about every trip to the bathroom (sorry about that rather graphic image…). It’s also very acidic and causes a burning sensation every time you go to the loo- nice. Testament to this is the sheer fact that when you mix the solution with water it reacts quite violently by bubbling up and turning red hot. Definitely don’t try and stomach it until it has cooled down!
What does it taste like?
I’m not going to lie, Picolax tastes like what I imagine a concoction of battery acid, stomach bile and rotten lemon would taste like i.e. absolutely vile. I have to hold my nose and only take 2-3 mouthfuls at a time to avoid being sick and drink squash in between in attempt to mask the flavour. Unfortunately, however, the taste lingers for hours after you’ve taken it and, given its effect on your insides, it makes you burp a lot which only brings back the flavour more- yuck.
How effective is it?
One thing I will say about Picolax is that, thanks to its aggressive nature, it definitely does work. Sometimes there may be a delay between drinking the first sachet and your first bathroom visit which makes people panic that it doesn’t work for them, but I would be shocked if it didn’t work for anyone on the planet eventually. For me, it usually takes several hours of constant and unpleasant toilet trips, but then I feel pretty confident that I’m empty. So, in my case, the effects of Picolax are quite contained timewise, which is quite important as I live a couple of hours away from my hospital and have to drive there the morning AFTER taking the bowel prep for my appointment. Despite this inconvenience, I can say that in over 8 years there have never been any Picolax related accidents and I only usually go to the loo once if at all on the day of the actual procedure. I will say though that it makes me incredibly bloated and uncomfortable, but I think that goes for any bowel prep to be honest! I have also never had any complaints of the images from colonoscopies or scans being distorted or unclear after taking Picolax, and I can usually tell this myself as my “fluids” do eventually run clear beforehand.
What about recovery after Picolax?
I usually go back to eating/ drinking a couple of hours after my procedure- unless it’s surgical. Drinking plenty of water does help to flush it out of your system, but if you have Crohn’s or Colitis, you may find that it will still take several days, or maybe even a week, before you feel fully recovered after taking Picolax. Unfortunately, it does have quite an impact on the bowel, and this can’t be reversed overnight. But soon it does wear off and you will feel better again, you just need to be patient.
Moviprep
How do you take Moviprep?
Compared to Picolax, you have to drink a very significant quantity of Moviprep which is my main dislike of this type of bowel prep. The day before the procedure you have to stop eating in the morning, usually at around 8am again. Then, you are only allowed clear fluids until a couple of hours before the procedure. There are two doses of Moviprep, but this time each dose needs a “sachet A” and a “sachet B” to be mixed with 1 litre of water. Yes, that’s right, you have to drink an entire litre of the stuff each time. For me, the first dose was at 1pm and the second was at around 6pm.
How does it work?
Unlike Picolax, Moviprep only contains osmotic laxatives; the kind which draw water from the rest of the body into your bowel to soften stool and make it easier to pass. The lack of stimulant laxatives in Moviprep may mean that you experience less cramping and that the effect is less violent and sudden than that of Picolax. For me, this manifested in the fact that my stools gradually got looser over a period of a few hours rather than almost immediately turning to complete liquid. As for frequency of needing the bathroom however, I found little difference between the two.
What does it taste like?
Okay, so the taste is still pretty vile. Let’s just say that whoever invented bowel prep didn’t factor what it tasted like into the equation. Moviprep certainly isn’t as volcanic as Picolax, in that it doesn’t boil and bubble in some kind of toxic chemical reaction when you mix it with water. Initially I thought that this would make it easier to drink, however what I actually discovered was that the quantity was very unmanageable and the more I drank, the worse it seemed to taste. It was still like rotten lemon, but almost salty, like if someone filled up a bucket with dirty sea water and left some dead lemons in it for a couple of years to fester- yum! But unlike the Picolax which you can consume relatively quickly as each dose is only ½ cup, I found Moviprep never-ending and I was literally drinking it for about 7 hours straight without much of a break in between the doses. And even then, I was sick from the taste and quantity combined and I couldn’t finish the whole amount.
How effective is it?
Luckily, my procedure still went ahead and was successful anyway, but I didn’t feel anywhere near as reassured as I do after taking Picolax. Sure, I was still going to the loo a lot with Moviprep, but it wasn’t “contained” like it is with Picolax i.e. it wasn’t over within a few hours, I was going throughout the night and even the day of the procedure- which I really didn’t appreciate. The images still came out clear enough, but I don’t think Moviprep was as effective as Picolax at totally emptying my bowel or making my stool go completely clear.
What about recovery after Moviprep?
Leading on from the fact that the effects of Moviprep were not overly contained, it took me longer to get over the side effects of Moviprep than it usually does for Picolax. It just seemed to be more gradual as opposed to the complete clear out and the blank (or should I say empty) slate that I then build upon when I start eating again after having Picolax. I felt like there may still be some Moviprep in my system even after the procedure which prolonged my recovery somewhat.
Overall review
Convenience: Picolax wins given its quick doses.
Taste: Moviprep wins (just) given its less volcanic nature.
Manageability: Picolax wins given its far lesser quantity.
Effectiveness: Picolax wins given its complete “clear out”.
Recovery: Picolax wins given the blank slate it provides.
So, it looks like we have a clear winner! It may get some stick, and after the first time I ever had bowel prep, I never thought I would praise Picolax, but nowadays I always ask for it instead of Moviprep and I tolerate it far better. I haven’t even been sick on the last two occasions that I had to take it- whoop!
But, no bowel is pleasant as you’ve probably gathered. So, below are some general tips to make it a little more bearable.
General advice for bowel prep
- Stay near at a toilet at ALL times whilst doing bowel prep and for the rest of that day/ night.
- Keep a sick bowl handy just in case.
- Having said that, do all you can not to be sick, even if it means holding your nose like I do- the more you’re sick, the less effective the bowel prep is and the more dehydrated you become.
- Drink squash in between mouthfuls of bowel prep to mask the taste.
- Drink plenty of water and clear fluids until 2 hours before the procedure to combat dehydration.
- Use soft wet wipes instead of toilet paper and a barrier cream each time you go to the toilet to combat soreness.
- Bring some spare underwear with you on the day of your procedure or maybe even some sanitary pads if you’re concerned or you have to make a long journey
- Don’t forget to do your bowel prep- you don’t want your procedure to be cancelled
- And most importantly, don’t take short cuts. If you only do one sachet instead of the stated dose for example, you may well still have the procedure and think that you’ve gotten away with it, but if the images are unclear, you may have to do the bowel prep and the procedure all over again! Do things right the first time and don’t take the risk.
Me and My Crohn's 