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Down the garden path

Once upon a time an elderly woman living in the rural wilds of West Oxfordshire received through the post her appointment for a bowel X Ray. With the appointment came the laxative. It was winter, and very cold. The only lavatory was beyond the vegetable patch, down the garden path.

The instructions didn't tell her what would happen when she dutifully took the laxative in the evening, and the fact that she lived through the hypothermia to tell Bandolier the tale was due entirely to guardian angels.

Bandolier was therefore delighted to read a report of two laxative regimes given before colonoscopy [1]. A questionnaire was given to 165 patients, given either sodium picosulphate or polyethylene glycol. Nine adverse effects were listed on the questionnaire, and patients were asked to score each of them on a scale of 0 to 2 depending on severity. All the patients (mean age 60, range 22-86) replied. Twenty-two patients (13%) had faecal incontinence, and forty-two reported sleep disturbance. Interestingly younger patients complained significantly more often than older patients about taste disturbance, nausea, fullness and cramp.

I can see clearly now ...

The colonoscopist could not see clearly in 5 of the 165 patients, despite the bowel preparation. On a ten point rating scale (0 = least favourably, 10 = most favourably), patients rated sodium picosulphate significantly higher than polyethylene glycol.

The authors conclude that, although two previous publications said that polyethylene glycol gave better results, in their view both preparations were satisfactory for colonoscopy and patients preferred sodium picosulphate.


  1. TD Heymann, K Chopra, E Nunn et al. Bowel preparation at home: prospective study of adverse effects in elderly people. British Medical Journal 1996 313: 727-8.

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