Preparing for radiotherapy to the prostate: Use of micro-enemas

Supplement information to Radiotherapy information leaflet

1. Why we ask you to use a micro enema

If you have been given this leaflet, it is thought that your treatment could benefit from you using a very small enema, called micro-enema.

This instruction leaflet will show you how to use the micro-enema. If you are worried that you will have problems with the process, please discuss your concerns with your radiographer.

2. Getting your micro enemas

Your doctor will usually provide a prescription for your micro enemas or ask your GP to prescribe these.

If you have not received your micro enemas 3 days before your planning CT scan, please buy them yourself. Do not wait for a new prescription if this may delay starting them.

Ask for Micralax Micro Enema 5 ml or an equivalent sodium citrate micro enema.

Micro enemas are available without prescription from many pharmacies and online retailers. They may not be routinely available in supermarkets. Ask a pharmacist for help if you are unsure which product to buy.

You will usually need enough tubes for:

Your planning CT scan preparation
Your radiotherapy treatment preparation
2 tubes to bring with you for each appointment day

For a typical radiotherapy course of 5 treatments you will need about 15 Enemas.

3. When to use it

You will be asked to self-administer one micro-enema a day for the two days prior to your radiotherapy planning CT scan, when convenient, and then again for each of the two days prior to starting radiotherapy. You will also need to use the micro-enema on the day of your radiotherapy planning scan, prior to scanning, and on the days of your treatment.

If you require an MRI scan as part of the planning process, it is normally scheduled on the same day as your planning CT scan. If it is not scheduled on the same day as your planning CT scan, please ensure you follow the same micro-enema guidance for this. If you have two scans on one day you only need to use one enema prior to the first scan.

Please bring two tubes each day. If you forget to bring with you, just ask a radiographer and they will help you.

Please arrive 45 minutes before your appointment times. From the other information sheet given, you will see that you need to have a comfortably full bladder for treatment. Often when people empty their bowels, they will need to empty their bladder also. The order should therefore be:

1. Please arrive 45 minutes before your appointment time.
2. Use the micro-enema
3. Empty your bowels
4. After bowels empty, empty your bladder again
5. Follow drinking instructions

For any questions, or if you have any concerns, just ask your radiographer.

4. How to use a micro-enema

A micro-enema is a method of helping your rectum to empty, causing a small bowel movement or passing of wind. It should feel similar to your normal sensation of needing a bowel movement and be under your control. A micro-enema should be used even if you have already emptied your bowels that day.

The medication for the micro-enema comes in a small tube with a nozzle (see picture).

Do not use the micro enema, and contact your radiotherapy team or ask a pharmacist for advice, if you:

• Have inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis (if your disease is well controlled your doctor may advise it is safe to use enemas)
• Are allergic to sodium citrate, sodium alkylsulphoacetate, sodium lauryl sulphoacetate, sorbitol, or any ingredient in the product
• Have severe abdominal pain
• Are vomiting
• Have been told you may have a bowel blockage
• Develop a severe allergic reaction, such as swelling, breathing difficulty, collapse, or widespread rash

To use, you will be asked to go to the toilet and do this yourself: Remove cap

1. Squeeze the tube slightly so that a drop of liquid appears on the nozzle. Spread this over the nozzle to make it easier to insert.Gently insert the nozzle fully into your rectum (back-passage)

Squeeze the tube until it is empty.

1. Keep squeezing the tube as you remove the nozzle. This helps stop the liquid being drawn back into the tube.Dispose of tube in the waste bin with yellow or yellow/black stripped bag provided (not hand towel bin – clear bags)
2. Wash and dry hands

Return to the waiting room or walk around while waiting for the micro enema to work.

You will usually feel the need to open your bowels within 5 to 15 minutes. Most people only need to visit the toilet once. Some people only pass wind. If you feel the need to go before 10 minutes, try to wait for 10 minutes if you can, but do not worry if you cannot.

If you have not felt the need to open your bowels after 15 minutes, try to go to the toilet, but do not strain.

If your rectum is already empty, the micro enema may have little effect. This is not a problem.

Before your radiotherapy scan or treatment, please empty your bowel as often as you feel the need to do so.