Stereotactic Ablative Body Radiotherapy (SABR) Additional information: Bowel and Bladder preparation

If you have been instructed to follow more specific bowel and/or bladder preparation, please follow this advice before your planning scan and every day before treatment. Please arrive 45 minutes before your scheduled appointment to do this preparation within the department.

Micro-enema

Introduction

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

These micro-enemas are safe to use unless you have an inflammatory bowel disease, such as Crohn’s Disease or are allergic to any of the ingredients. These are:

• sodium citrate
• sodium lauryl sulphate
• sorbitol

If you think you this may apply to you, please discuss with the radiographer at your radiotherapy planning scan appointment.

When to use it?

The doctor will provide you with a prescription to pick up the micro-enemas at least two days before your planning CT scan. You will need to use the micro-enema before your radiotherapy planning scan and before each treatment.

You need to self-administer, at home, one micro-enema a day, starting two days prior to your radiotherapy planning scan and then again one a day starting two days prior to starting radiotherapy.

On appointment days you will need to administer the micro-enemas in the department. Please bring two tubes each day. If you forget to bring them with you, just ask a radiographer and they will help you.

1. Please arrive 45 minutes before your appointment times.
2. Await instruction to use the micro-enema
3. When you have the urge to go, empty your bowels and bladder
4. Follow the required drinking instructions (if required)

How to use the micro-enema?

You will be asked to go to the toilet and do this yourself:

1. Remove cap.
2. Squeeze the tube a little to get a drop of liquid and spread it over the nozzle – this makes it easier to insert.
3. Gently insert the nozzle fully into your rectum (back-passage).
4. Squeeze the tube to put all the contents into your rectum.
5. Keep squeezing as you remove the nozzle – this stops the contents being pulled back into the tube.
6. Dispose of tube in the waste bin with yellow or yellow/black striped bag provided (not hand towel bin – clear bags).
7. Wash and dry hands.
8. Return to the waiting room or walk around while waiting for the micro-enema to take effect.

You will feel the need to have a bowel movement within 10-15 minutes. Most patients only need to visit the toilet once. You may only pass wind. If you feel the need to try to empty your rectum before 10 minutes, try to hold it if possible for the full 10 minutes. Do not worry if you can’t. If you have not felt the need to empty your bowels after 15 minutes, try to do so, but please don’t strain.

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

If your rectum is already empty, the micro-enema will have little effect. If this is the case, please do not be concerned.

Empty bladder

You may be asked to have an empty bladder for you radiotherapy CT planning scan and for each radiotherapy session, please follow this advice.

• Please avoid drinking any fluid in the 45 minutes prior to your appointment.
• Before going into the planning or treatment room, a radiographer will ask you to empty your bladder, even if you have already been shortly before.
• If you have performed a micro-enema and have emptied your bladder when you emptied your bowels, please refrain from drinking any fluid and inform your radiographer that you have managed to empty your bladder plus your bowels.

Full bladder

You may be asked to have a full bladder for you radiotherapy CT planning scan and for each radiotherapy session, please follow this advice.

• Please await instruction from a radiographer to start drinking your water. Empty your bladder within the designated patient toilets and then drink the required amount of water over around 5-10 minutes.
• It will take 30 minutes for your bladder to fill up after finishing drinking.
• If you have performed an enema and emptied your bladder, start the drinking procedure straight away.
• If you are very uncomfortable and need to empty your bladder, please do so but inform the radiographers.
• Please tell your radiographers if you have a urinary catheter. The catheter can be clamped in order to allow your bladder to fill as above.

Contacts

If you have any worries or questions about any aspect of your treatment, please do not hesitate to contact one of the team.