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Preparing for a Colonoscopy
Is this your first time having a colonoscopy?
If so, you’re probably a bit nervous about the colonoscopy procedure, maybe even feeling a little embarrassed.
If this is your second time, odds are the procedure is the least of your concerns, and you’re wishing you could avoid the colonoscopy prep. The good news is that most of our patients are able to use a “split-dose” pill prep (Osmoprep), which offers a less-harsh cleanse alternative.
The reality for most patients is that while the idea of a colonoscopy seems invasive of one’s privacy and edges on “taboo,” it’s the prep itself that winds up being the most difficult part.
Routine colonoscopies take less than an hour to complete from start to finish. However, the preparation takes much longer because the body must evacuate all of the solid waste matter in the large intestine and the “new stuff” entering the colon from the small intestine.
Colon Preparation Yields Accurate Colonoscopy Results
Cleansing the colon as thoroughly as possible is a very important step in a successful colonoscopy as any remnants of solid bits or food dyes can skew the doctor’s image, resulting in a potential false alarm.
The point of this guide is to answer any questions you may have about the colonoscopy preparation steps.
Additionally, we’ll emphasize the importance of adhering to your colorectal specialists’ specific instructions so your bowels are completely empty and ready for the procedure.
Colonoscopy Preparation FAQ’s
Why is colonoscopy prep so important?
Your prep begins before you “clean out” the bowels in the form of a clear diet day. In addition to eliminating solid foods from the intestinal tract, this clear diet keeps food dyes from interfering with the doctor’s view and diagnosis.
Without adhering to this part of the prep, and without a completely clean colon, dye, solid debris and/or residue can mimic blood. Residue can also mask irregularities, discolorations or polyps that should be noted and/or potentially removed.
Accurate colonoscopy results are essential to your good health.
I’m a healthy, 50-year old woman. Why do I need a colonoscopy?
For many years, men had the highest rates of colon cancer.
Unfortunately, as the result of significant shifts in lifestyle over the past few decades, this is no longer the case. Although it is true that colon cancer is more likely to develop in younger men, than younger women, cancer rates between men and women, 50-years and older, are about equal.
Currently, colon cancer is the third leading cause of death for women over the age of 50 after breast and lung cancers.
If you are a younger woman with a family history of colon cancer, your doctor may recommend a colonoscopy, or perhaps a fecal immunochemical (FIT) test, or a sigmoidoscopy to be on the safe side.
We’ve posted this video testimonial from a female patient that explains her experience of a colonoscopy prep.
Why can’t I just do a regular enema or two?
While an enema can be used as a “rescue” procedure for patients whose bowel prep was incomplete, saving them from having to reschedule, enemas are not thorough enough to cleanse the colon completely.
It takes the human body about 30-40 hours to move foods from the mouth, through the g.i. tract and then evacuate solid waste from the bowels. The enema only cleans out a portion of that process. In the meantime, more solid and liquid waste moves through the intestines and into the colon.
Colonoscopy prep involves a clear-diet day before the procedure, as well as a gentle but thorough laxative step. Together, they ensure there is no solid waste available to interrupt the view of the colonoscopy camera.
Should I take the day off during my colon prep and/or procedure?
If you work during the day, you’ll adhere to a clear diet the day before your prep but should be able to start the cleansing portion of the prep when you get home that evening.
If you work nights, you may want to reschedule the shift before your prep because you’ll want to be close to your home for the eight or so hours required to clean the bowels out.
Because you are sedated for the colonoscopy itself, you must take the day of the actual procedure off work, and make sure you have someone available to drive you home afterward as you will still be under the influence of sedatives.
What is a clear liquid diet?
The good news is that a clear liquid diet is not as bleak as it sounds.
You won’t be uncomfortably hungry, while simultaneously promoting the accuracy of your colonoscopy results. Plus, the less solid foods you consume the day before, the less harsh the cleansing process will be for you.
Food and drink approved for a clear diet include:
- Tea/Coffee (no milk)
- Clear/light-colored drinks like apple juice, white grape juice and lemonade without pulp. Avoid grapefruit juice, cranberry or dark berry juices, etc.
- Clear broth (chicken, beef or veggie)
- Clear sodas
- Light-colored sports drinks (like Gatorade)
- Jello or gelatin products without food dyes (no reds/purples)
Dairy products are out, as are any soups that aren’t broth-only, and you must also avoid drinking alcohol.
Your doctor will provide a comprehensive of foods you can, and can’t, have during the clear-liquid diet portion of the cleanse.
Can I take regular meds during the liquid diet and preparation period?
Your doctor will meet with you during a pre-procedure consultation, to discuss any prescription meds you are on and to provide instructions on what you can and can’t take.
Most prescription medications are fine, the exception being blood thinners. Ideally you should not take any blood thinners for 7-10 days before the procedure so it is important to talk to your primary care physician and your CRS physician if you are taking medications including:
- Vitamin E
If you are diabetic, speak with the physician managing your diabetes and s/he will let you know how to adjust your insulin dosage accordingly.
It’s very important that you bring a complete, updated list of the medications you’re taking so your doctor can select the right prep, and correct instructions, for your colonoscopy procedure.
What pain relievers can I take before the colonoscopy?
The large majority of CRS patients do not experience any significant pain or discomfort as a result of their colonoscopy.
However, if you have pre-existing pain or a headache in the week leading up to the procedure, it’s recommended that you take Tylenol or acetaminophen.
Avoid pain relievers that include blood thinners, such as:
- Naproxen sodium
What pain relievers can I take after the procedure?
If you didn’t have any polyps or other tissue removed from the colon, you can take your pain reliever of choice.
If you did have tissue of any kind removed, you should stick to acetaminophen products, and avoid those with blood thinners for 7-10 days afterward.
A small amount of residual bleeding can occur if tissue was removed for biopsy, so you want to minimize the bleeding and allow the site to heal completely.
Will I need stool softeners afterward?
It’s a grand irony that after all that bowel prep, some patients wind up slightly constipated as a result of dehydration.
Drinking plenty of water afterward, as well as healthy, high-fiber foods (fruits, veggies, beans, whole grains) will help.
If you do become constipated, use a stool softener that does not contain a laxative.
Can you get a headache during prep and/or after a colonoscopy?
Some patients find they get a slight headache during the prep or after their colonoscopy.
This is nothing to worry about and may be rooted in a range of factors from dehydration and lack of sleep the night before, to the adrenaline let-down for those who feel stress or worry leading up to the procedure.
The let-down from the sedative may also cause a slight headache for some.
Either way, re-hydrating, rest and Tylenol or acetaminophen should do the trick.
It’s been a couple hours and my bowel prep isn’t working. Now what?
It can take 3-4 hours for the colon prep to “kick-in,” and even longer if you have certain medical conditions.
Women often experience a slight delay because their colons are longer than men’s.
If it’s been more than 4-hours and you haven’t felt the urge to go, contact the colorectal specialist’s office and check-in.
If you’ve followed all the instructions provided, stuck to the clear-liquid diet and taken the cleanse pills or solutions, odds are your prep will move forward in a timely manner within a matter of 2-4 hours.
Read, Is My Bowel Prep Working, for more information on the topic.
How do I know if my bowel prep was successful?
The best sign of colonoscopy prep success is when, on the morning of the procedure, the only thing you are passing is a very clear or light colored (often yellow) liquid, with minimal to no residue.
If the liquid you’re passing is still brown in color or contains solid residue or other particulate matter, contact your doctor’s office ASAP so they can tell you how to proceed.
Often, a simple enema (they have probably provided you with a one-time enema pack or instructed you as to what you should have on hand) is all that’s needed to finish the cleanse.
What should I do if I’m really nervous, afraid or anxious about the colonoscopy procedure?
It’s completely normal to be nervous, and even afraid, of your first colonoscopy.
- Be honest with your doctor about your anxiety. While the procedure is always done gently and respectfully, your doctor will take extra time to explain things and ensure you’re comfortable if s/he knows you fear or nervousness is heightened.
- Take the time to read all of the educational and informational literature provided for you by the doctor’s office. Knowing exactly what will happen can really help you feel more “in control” of the process.
- Individuals who have experienced sexual abuse can be particularly sensitive, even averse to colonoscopy procedures. Consider letting your doctor know you were sexually abused (you can even do this via email if that’s more comfortable for you). Your doctor will know to proceed with greater care and with respect to your consent.
- Deep breathing and relaxation exercises are very helpful for alleviating nerves. Consider downloading a mindfulness meditation app to listen to beforehand.
Have more questions about colon cancer or a routine colonoscopy? Get in touch with Colon and Rectal Specialists, the Richmond area’s oldest continually operating groups of colon and rectal surgeons in the country and the largest state-of-the-art practice on the East Coast with three locations.