After it’s over, everyone will tell you, “The prep’s the hardest part.”
For the best results, the colon needs to be absolutely clear of stool (bowel movements, feces). Small or flat polyps or nonpolypoid colorectal neoplasms (which are both flat and depressed) can hide under stool. Poor preparation may require that the colonoscopy be repeated on another day or that important polyps will be missed. All preps will produce large volumes of watery diarrhea.
So, even if it’s tough, it’s important. If you have trouble finishing your prep, call your doctor right away so something else can be suggested.
Most colonoscopy preps begin with clear liquids the day before the procedure. No milk or dairy products, but water, clear juices, ginger ale, tea, jello, clear broth, or sports drinks are fine. It’s important not to drink anything red since the dye may conceal a problem in the colon.
Before your colonoscopy let your doctor know about any kidney or cardiac problems you have since some sodium phosphate preps (Visicol®, or OsmoPrep®) may have serious side effects on the kidneys. The elderly may have more difficulty with dehydration or electrolyte unbalance.
Talk over what the best prep might be for you with your doctor. Remember the best prep is one you can finish.
- Will it be difficult for you to drink large volumes of liquid that may not taste very good?
- Are pills hard for you to swallow?
- Do you have cardiovascular or kidney problems?
- Do you have insurance coverage for a prescription or would an over-the-counter prep be better?
Colonoscopy prep choices include:
- High volume polyethylene glycol (PEG) solutions of up to 4 liters of fluid. An 8 ounce glass is drunk rapidly every ten minutes. PEG preps also include sodium and potassium salts to replace electrolytes lost during extensive watery stools. PEG preps include GoLytely®, NuLytely®, and Colyte®.
- Miralax® is a PEG powder that may be mixed with 2 quarts of clear Gatorade.
- MoviPrep® is a lower volume liquid prep that combines PEG, sodium and potassium salts, and ascorbic acid (vitamin C). It is lemon-flavored, provided in two pouches that are mixed in 1 liter of water. It can be refrigerated for up to 24 hours which may make it easier to take.
- LoSo Prep™ is based on magnesium citrate and avoids high amounts of sodium.
- Prescription pill formulations of sodium phosphate including Visicol™ and OsmoPrep®. Both require that 32 to 40 tablets be taken with clear liquids over a period of time. Your doctor will provide the schedule for taking the pills.
- Over-the-counter Fleet’s Phospho-soda is no longer on the market.
The latest information from gastroenterology research shows that the best prep may be one that is split between two days — the day before your colonoscopy and the day of the procedure.
Tips from Friends
Here are some ideas from fellow patients to make things easier.
- Prepare by having 3 to 4 quarts of clear liquids on hand and include some jello and broth to feel like real food.
- If your prep is liquid, keep it very cold and use a straw.
- Avoid a sore bottom with extra soft toilet tissue and baby wipes (no alcohol). Pat dry gently.
- Consider staying in the bathroom with something to read rather than racing back when the urge to go is strong.
- Plan your prep time so you get a good night’s sleep.
- Drink, drink, drink — but not only water. Sports drinks can replace lost electrolytes and sugar so you won’t feel so wobbly the next day.