Comparing to see if picosalax in combination with low residue diet is as good for bowel cleanliness and better tolerated than current bowel preparations used for morning colonoscopies.

INTERVENTION: Picosalax bowel preparation in combination to low residue diet Picosalax Two sachets, each to be mixed in 250ml of water *One to be taken 9pm the day prior to the colonoscopy *One to be taken 4am on the day of the colonoscopy The low residue diet is to start 2 days prior to the colonoscopy and cease when bowel preparation starts * Examples include : *Milk (regular, low fat, skim), water, lemonade, soda or mineral water, clear (not coloured) Gatorade or other sports drinks *Regular white bread/toast, rice bubbles, white rice, regular pasta, potatoes (peeled), rice noodles, plain rice crackers, white flour, sugar *Eggs, Chicken breast (no skin), white fish fillet (no skin) *Plain cream cheese, cheddar cheese, ricotta, fetta, cottage, parmesan or mozzarella cheese, white sauce *White coloured yoghurt (no added fruit or inulin), mayonnaise, cream, sour cream, butter and margarine, oil for cooking *White chocolate, vanilla ice cream, lemonade icypole, clear jelly, custard, “milk bottles”(confectionery Adherence will be assessed through a food diary that the patient fills up during the two days prior to the colonoscopy CONDITION: effectiveness of bowel preparation tolerability of bowel preparation PRIMARY OUTCOME: Quality of bowel cleanliness‐ this is assessed via the Ottawa bowel cleanliness scale which has 2 components: ; 1. Three sections of the colon ‐ the degree of washing and suctioning required to obtained a clear mucosa with a score allocated ; 2. The total amount of fluid present in the entire bowel ; ; The 2 components are then added to determine the final score ; A score of 5 or less is deemed successful. ; A score of 6 or more is deemed unsuccessful. SECONDARY OUTCOME: A history of constipation, laxative use or opoid analgesia usage affects the quality of bowel preparation‐ this is determined through a patient questionnaire completed and handed over on the day of the colonoscopy Caecal and terminal ileal intubation rates Patient tolerance, acceptance and compliance with the study bowel preparation in comparison to current bowel preparations used‐ assessed via a questionnaire Polyp to adenoma detection rate ratios. ; The total polyp numbers for each patient is determined by the end of the procedure. ; The removed polyps are then examined and proportion of adenomatous polyps are then determined by the pathologist. ; A ratio is then calculated from both these values. ; time taken to complete the procedure INCLUSION CRITERIA: Consenting adult patients (aged 18 years and greater) undergoing outpatient colonoscopy for clinically accepted indications. Clinically accepted indications generally include but are not restricted to iron deficiency anaemia, surveillance of bowel polyps, colorectal cancer screening, assessment of symptoms such as abdominal pain, diarrhoea and constipation, assessment or investigation of inflammatory bowel disease.