Getting ready for surgery: Bowel preparation with a laxative and antibiotics : University College London Hospitals NHS Foundation Trust

This information is for patients having gynaecology surgery who may also need bowel (colorectal) surgery as part of their cancer treatment.

Your surgeon has prescribed two oral antibiotics and a laxative to help empty your bowel before surgery. Research shows that taking antibiotics along with a laxative can help to prevent complications after bowel surgery, such as infections.

The laxative you will take is called Moviprep®. It is a lemon-flavoured drink that works by emptying your bowel until your poo is clear and watery. This is very important for surgery, so follow the instructions carefully when you take Moviprep®. If you have any questions or concerns, please contact your healthcare team.

The table below gives instructions on when to eat, drink and take your antibiotics and laxative before surgery. It’s important that you follow these guidelines closely.

You will also find a list of foods and drinks you can have in the section ‘Low-fibre diet and clear fluid options’.

One day before surgery
8am	1st dose of oral antibiotics Low-fibre breakfast
12pm – 2pm	Low-fibre lunch
2pm	2nd dose of antibiotics
3pm	1st dose of Moviprep® No more food after this time
6pm	2nd dose of Moviprep®
6pm – 10pm	400 - 500mls of clear fluids or 4 bottles of Nutricia PreOp® (clear fluids only if you have diabetes)
10pm	3rd dose of antibiotics
Aim for 1 cup of clear fluid every hour through the day. Continue with clear fluids up until 6am on the morning of surgery.

Morning of surgery
5am – 6am	2 bottles of Nutricia PreOp® or 2 glasses of water if you have diabetes.

Nutricia PreOp® drinks are carbohydrate-rich drinks which help you to stay hydrated and reduce feelings of hunger. These drinks are not recommended if you have diabetes.

You will have four sachets of Moviprep®: two labelled ‘A’ and two labelled ‘B’.

1. Mix the solution:

You can make the solution ahead of time and store it in the fridge to cool. You must use it within 24 hours of preparing it.

Take one sachet A and one sachet B.
Pour both sachets into a container that holds 1 litre.
Add 1 litre of lukewarm drinking water and stir until the powder dissolves and the solution is clear or slightly hazy. This may take about five minutes.

2. Drink the solution:

Drink the entire litre over one to two hours.
Aim to drink one glass every 10 to 15 minutes.

3. Stay hydrated:

Be sure to drink at least 500mls of clear fluids in addition to the Moviprep® to keep hydrated.

After your first dose of Moviprep®, expect to have diarrhoea (loose poo) within a few hours. You may also feel some cramps or pain in your tummy. Moviprep® is meant to clean out your bowel, so it’s best to stay close to a toilet.

Your bottom may become sore from frequent trips to the toilet. To help with this, you can apply petroleum jelly (such as Vaseline®) or a barrier cream (such as Sudocrem® or Drapolene®) after each time you go to the toilet.

Moviprep® is generally safe but it can cause some side effects:

Feeling sick or being sick
Bloating or stomach pain
Soreness around the bottom
Dehydration - Dehydration risk is higher for elderly people, those with kidney, heart or liver problems, or anyone taking diuretics (water tablets). Moviprep® is designed to be safe for these groups, so the risk is very low. If you have concerns, please talk to your doctor.
Low blood pressure
Kidney problems
Allergic reaction - Rarely, an allergic reaction may occur. Stop taking Moviprep® and go to the nearest Emergency Department (A&E) if you experience any of these symptoms:
- rash, itchy or red skin
- swollen hands, feet or ankles
- headache
- fast heartbeat (palpitations)
- shortness of breath.

Side effects can vary from person to person. Your doctor will talk to you about these risks and answer any questions.

Important: Do not take the Moviprep® if you are, or think you might be, pregnant. Contact your healthcare team for advice instead.

Do not take any tablets or oral medicines within one hour of taking Moviprep®. Moviprep® may flush these medicines through your system before your body can absorb them, so they may not work properly.

We will advise you on taking your regular medicines during your preoperative assessment appointment, which happens before your surgery.

Note: If you take the oral contraceptive pill, use extra contraception for seven days after taking Moviprep®.

Low-fibre foods

Breads / Flours / Cereals / Potatoes

Foods to choose	Do not eat
White flour products (such as breads, scones, crackers) Ground oatmeal porridge Corn flakes Rice cereals Chapatti, naan or cornbread Mashed potato or well-cooked potatoes without skins Well-cooked white pasta, rice, cous cous or noodles	Breads (granary, seeded, wholemeal and wholegrain) Crispbread or rye breads Malted fruit bread Wholewheat breakfast cereals, such as Weetabix™ or shredded wheat Cereal bars Tortilla chips or Twiglets™ Wholegrain pasta or rice

Pulses

Foods to choose	Do not eat
Smooth hummus Refried beans and other pureed beans Smooth dhal	Whole beans (including baked beans) Lentils or peas

Meat / Fish / Eggs / Meat alternatives

Foods to choose	Do not eat
Eggs Plain tofu Fish with no bones Soft, tender, minced or pureed lean meat or poultry with skin removed	Red meat Tough, gristly meat or skin including pork scratchings Fish with bones like sardines or with edible bones like whitebait

Vegetables

Foods to choose	Do not eat
Peeled and cooked until soft, mashed or pureed vegetables (carrots, swede, parsnip) Tinned or jarred tomatoes without skins or pips (tomato juice, passata, puree) Smooth vegetable juices	Raw vegetables or salads Corn (sweetcorn, popcorn) Skins of vegetables (for example skins of baked potato, tomato, cucumber or bell peppers) Tough stalks (such as celery or broccoli) Onions

Fruit

Foods to choose	Do not eat
Peeled and soft fruit without pips or pith Cooked or tinned fruit that has been peeled (for example apples, pears, peaches, nectarines or apricots) Avocado (smooth guacamole) Smooth fruit juice and smoothies without pips or seeds Fruit jellies and jams without pips	Fruits with seeds, pips, pith, skins or fibres (for example berries, kiwifruit, citrus fruits, grapes, rhubarb or plantain) Raw or dried fruit (such as figs, prunes, dates or apricots) Jams or fruit spreads containing seeds or fruit bits

Dairy

Foods to choose	Do not eat
Milk, cheese, smooth yoghurts, yoghurt drink	Yoghurts or cheeses with seeds, nuts or fruit pieces

Cakes and biscuits

Foods to choose	Do not eat
Plain-flour sponges Biscuits (chocolate, gingernut, sandwich, wafers or shortbread) Cakes (Madeira, banana bread, Swiss roll, teacakes) Danish pastries (without dried fruit)	Fruit cakes or biscuits containing dried fruit, fruit peel, nuts or seeds

Clear fluids

Drinks to choose	Do not choose
Water Tea or coffee (no milk) Herbal tea (no milk) Squash or cordial diluted in water Clear fruit juice (for example apple juice) Clear soup (such as Bovril™) Ice lollies (not milk based) Energy drinks (such as Lucozade®, Gatorade® or Powerade®) Nutricia PreOp ® drinks, if provided by your surgical team	Milk-based drinks, including plant-based milk Fresh fruit juice Fruit smoothies