A colonoscopy is a vital screening procedure used to detect and prevent colon cancer. While the procedure itself is generally quick and painless due to sedation, many individuals are apprehensive about the preparation process. This article provides a comprehensive guide to the colonoscopy preparation diet and other essential steps to ensure a successful and comfortable experience.
Why Colonoscopy Prep is Crucial
Colonoscopy prep is necessary to clear the rectum and colon before the procedure. An incomplete bowel prep could mean missed polyps, while a successful prep allows for better visibility during the colonoscopy. The goal of colonoscopy prep is to ensure that the colon is empty and clean before the screening. It is necessary for the whole colon to be visible to the video camera on the end of the colonoscope; otherwise, it is impossible to carry out this screening process effectively.
Advance Planning and Preparation
When you schedule your colonoscopy, you’ll receive detailed instructions from your doctor. It’s important to read them over well before your appointment, and call your doctor if you have any questions. Clear your schedule for the evening before and the day of your colonoscopy, and make plans for someone to go with you the day of the colonoscopy. Get a head start on your preparations and head to the store at least a week before your colonoscopy.
Key Supplies to Have on Hand
- A prescription or over-the-counter laxative specified by your doctor
- Low-fiber foods
- Sports drinks, juices, and broths
- Moist wipes
- Diaper cream
Dietary Guidelines for Colonoscopy Prep
People are recommended to follow particular instructions in preparation for a colonoscopy, including following a specialized colonoscopy prep diet and activity plan. During colonoscopy prep, one should aim to eat a diet which is nutritious, but which does not cause large amounts of feces to form in the intestine.
Three to Four Days Before the Colonoscopy
For three days before a colonoscopy, it is recommended that you follow a low-fiber diet and avoid anything containing nuts and seeds, including seeds inside treats, smoothies, fresh fruits and veggies. Nuts and seeds contain insoluble fiber, which provides bulk in your stool. Avoiding them will help you more easily clear out your bowel. Avoid fruits and vegetables with seeds or indigestible fiber since they are difficult to digest and may interfere with your doctor’s ability to examine your colon.
Read also: Can I Drink Diet Coke Before a Colonoscopy?
Eating low-fiber food for three or four days before the procedure will help to empty the colon, because low-fiber foods are easy to digest and leave one’s system quickly.
Foods You Can Eat:
- White bread, pasta, and rice
- Well-cooked vegetables without skin
- Fruit without skin or seeds
- Lean meat, chicken, or fish
- Eggs
- Potatoes without skin
- Smooth peanut butter or almond butter
- Breads and cakes made with refined white flour such as bagels, muffins or rolls
Foods to Avoid:
- Seeds, nuts, or popcorn
- Fatty foods
- Tough meat
- Whole grains
- Raw vegetables
- Fruit with seeds or peel such as apples, berries or figs
- High-fibre cereals such as bran flakes or granola
- High-fibre vegetables such as corn, broccoli, cabbage, beans or peas
- Legumes such as dried peas, lentils or split peas
Switching to a soft-food diet at least 48 hours before the colonoscopy may make your preparation easier. Soft foods include scrambled eggs, smoothies, vegetable purees and soups, and soft fruits, like bananas.
The Day Before the Colonoscopy: Clear Liquid Diet
The day before before the colonoscopy, it is recommended to avoid solid food completely. Consuming liquids only for this time period helps prevent new fecal matter from forming, entering the colon and being present during the screening, and will ensure that the colon remains empty and clean.
It is important to avoid red and purple food dyes as they can discolor the lining of the colon and make it harder to see the area being examined during the colonoscopy.
Drinks and liquid foods which are suitable to eat the day before the screening include:
- Clear broth, including chicken, beef, or vegetable
- Clear, light-colored juices such as apple, white grape, lemonade without pulp, and white cranberry
- Flavored water
- Jell-O or other gelatin without fruit (taking care to avoid red and purple food coloring)
- Popsicles without fruit or cream
- Water
- Soda
- Sports drinks such as Gatorade and Propel (light colors only)
- Tea and black coffee without any cream, milk or sweetener
Staying hydrated is important -- drink lots of clear liquids, such as sports drinks, clear juice like apple and white grape, and clear broth. Soda is OK, and so are coffee and tea, but without cream. You can have gelatin and ice pops, but stay away from anything colored red, blue, or purple. The dyes can discolor the lining of the colon and make it harder for the doctor to see. Also, avoid alcohol and drinks you can’t see through, like milk or orange juice.
Read also: Colonoscopy and Weight Management
Medications and Supplements
Three days in advance, it is important to stop taking fiber supplement products, as these help the body to produce fecal matter and would work against the colonoscopy preparations. At this point, you should stop taking vitamins or other supplements, as well as any medicines that contain iron.
Ask your doctor whether and when you should stop taking any prescription medicines you use regularly and any over-the-counter anti-inflammatory or blood-thinning meds. Physicians or hospital staff will advise on whether and when to stop taking any prescription medicines that are normally used regularly, and on the use of over-the-counter anti-inflammatory medications, such as ibuprofen.
On the day of the procedure, if it is scheduled for the morning, avoid taking any medication unless specified by medical personnel, with the exception of blood pressure, heart and seizure medication. If a colonoscopy is scheduled for the afternoon, a person may take their routine medication, other than medications that they were instructed to avoid.
Pain medication that is part of the NSAID group, like ibuprofen or aspirin, has historically not been recommended for use for several days or even more than a week before screenings where an additional procedure that causes bleeding is scheduled, such as a biopsy or polypectomy. This is due to the perceived increased risk of postoperative bleeding. However, some recent research suggests that there may not be a need to avoid all NSAIDs. Always follow a doctor’s recommendations closely before taking any medications, including NSAIDs, before a colonoscopy.
Bowel Cleansing: Laxatives and Enemas
The aim of colonoscopy prep is to pass all the fecal matter from the area to be examined during the screening, so that there is nothing left to obstruct the view of the colonoscope. To aid the process of emptying the bowel, one will be prescribed a laxative product to take as part of the colonoscopy prep. In some cases, enemas may also be prescribed.
Read also: Colonoscopy Diet Instructions
Laxatives
You'll drink the laxative the evening before your colonoscopy and will stop eating solid food after breakfast the day before. You'll take strong laxatives the night before your colonoscopy to clear your digestive tract. The method recommended for most people is split dosing. You’ll drink a half-gallon of liquid laxative in the evening, and then you’ll get up about 6 hours before your appointment to drink another half-gallon.
Laxative medications help the stool to pass smoothly through the colon. Before a colonoscopy, osmotic laxatives are most commonly prescribed. These work to empty the bowel by drawing the water from the large intestine into the stool in order to soften it, making it easier to pass. These are usually drunk dissolved in large amounts of water. Specific instructions for preparing the solution vary from brand to brand, and will found be on the packet of the product that has been prescribed. Seek medical advice if there is any confusion about how to prepare the solution and when to take it. Because these medications work by keeping water in the bowel, it is important to drink enough liquid to stay hydrated. Drink water, or one of the recommended liquids, regularly throughout the colonoscopy prep plan.
Most colonoscopy prep products start working two to three hours after they are taken, although the exact time-frame varies between medications. In some cases, if bowel movements do not begin to occur when expected, an extra dose may be needed. However, it is always advisable to follow the specific instructions that come with the product in relation to taking an extra dose and to consult with one’s medical provider in case of any doubts.
Types of Colonoscopy Prep Kits:
- Polyethylene glycol (PEG) kits: Bowel prep for colonoscopy often uses a laxative called polyethylene glycol (PEG). It comes as a powder, and you mix it with lots of water. It may include electrolytes, or you can take it with a sports drink. PEG bowel preps work well for colonoscopy prep, and they're gentle on your intestines, which is especially good for people with IBS symptoms. But they do require a lot of drinking (up to 4 liters), and the taste can be hard to handle.
- Oral sodium phosphate (OSP) kits: These colonoscopy prep medications in tablet form have sodium phosphate and other ingredients. You'll drink less water with them, around 3 liters instead of the typical 4. While they may work well, OSP medicines can cause stomach-related side effects.
- Saline-based kits: Saline-based laxatives use sodium phosphate (NaP) as the active ingredient, as well as minerals like potassium and magnesium. These are often in tablet form and can substitute liquid bowel prep. This type of bowel prep can be easier to swallow for people who struggle with PEG preps. But a saline-based laxative may irritate your intestines if you have an inflammatory GI disease. It's also unsafe for people with a higher chance of fluid-electrolyte imbalances due to certain health conditions or medications.
- Hybrid kits: If you're worried about bloating, cramping, gas, or other side effects, talk to your doctor about a hybrid bowel prep. These use an osmotic laxative (the active ingredient that makes you poop) along with one that may cause fewer side effects.
If you have kidney disease, a PEG prep is your best bet to avoid health problems related to losing fluid and electrolytes.
Tips for Tolerating the Laxative Solution:
You probably won’t enjoy the taste of the solution, but there are tricks to help get it down:
- Mix it with something flavored, like a sports drink or powdered drink mix.
- Keep it well chilled.
- Drink it through a straw placed far back on your tongue.
- Follow it with a sip of something good-tasting.
- Suck on a lemon slice or piece of hard candy after drinking.
- Add flavorings such as ginger and lime.
It is possible for drinking the solution to make one feel nauseous. Tips which may help a person to avoid nausea include:
- Sipping the solution slowly
- Taking breaks between sips
- Using a straw
- Cooling the liquid instead of drinking it at room temperature
If nausea is known to be a problem for the affected person in general, or has been experienced in a previous screening, anti-nausea medications may be recommended. To avoid vomiting, it can also be helpful to leave longer intervals between drinks. If someone does vomit after consuming a dose of the solution during their colonoscopy prep, it is important to repeat the dose.
Enemas
In some cases, following the specialized food intake plan and using laxatives are sufficient to empty the bowel. However, other people, particularly those who are suffering from constipation, may need additional assistance to empty the bowel before their colonoscopy. If the bowel is not fully empty following colonoscopy prep, an enema will be prescribed.
The type of enema which is incorporated into colonoscopy prep is called a cleansing enema. It involves injecting liquid into the bowel via the rectum. This helps the body to push out any remaining waste. The liquid which will be used is usually a water-based solution with a small concentration of stool softener. The volume of water stimulates the movement of the large intestine, which in turn stimulates the bowels to expel both the solution and any remaining fecal matter.
If the bowel is not completely cleansed following an enema, the process can be repeated one or two more times. It is possible to undergo an enema in hospital, or to purchase an enema kit to carry out this process at home. The doctor will identify the most suitable option for the individual undergoing the colonoscopy.
What to Expect During Bowel Cleansing
Once the laxative starts working, you’ll have frequent, forceful diarrhea. You may have cramps and bloating. If you have hemorrhoids, they may become irritated. You may also feel nauseated and even vomit. If so, your doctor may recommend you take a short break.
Try these tips to make yourself as comfortable as possible:
- Stay in the bathroom -- bring something to entertain yourself, like a book, television, or laptop.
- Apply diaper cream before the diarrhea starts.
- Use moist or medicated wipes to clean yourself.
The purge process may still be happening as you head to your appointment. If you’re worried about having an accident, consider wearing adult diapers and pack extra clothes.
What does colonoscopy prep poop look like? If you have completed the process appropriately and it has worked effectively, your stool should look like urine or clear water. Prep is complete when bowel movements become watery and clear. This means that the colon is empty of fecal matter and is ready to be viewed by the colonoscopy camera without obstructions. The length of time that it takes to reach this point will vary between people and will depend on factors, such as their overall gastrointestinal health, and how well the prep diet plan was followed. When bowel movements become clear enough to see the bottom of the toilet bowl, colonoscopy prep can be considered complete.
Seek medical attention if significant amounts of blood, or blood clots, are passed during colonoscopy prep. Colonoscopy prep may cause any hemorrhoids that are present to bleed slightly, as they might normally during a bowel movement. In all cases where bleeding appears to come from a source other than existing hemorrhoids, or is excessive, a medical opinion should be sought as soon as possible, and the bleeding should be mentioned before the procedure.
If a person usually suffers from constipation or chronic constipation, they may need an extended prep period before their colonoscopy. It is helpful to discuss constipation issues with the doctor when planning a colonoscopy, so that the preparation time can be adjusted if needed. An extended preparation period typically involves the use of enemas and doubling the colonoscopy prep time-frame. Prep will then involve a period of over three or four days of eating low-fiber food, followed by two days of consuming nutritious liquids and colonoscopy prep solution.
The Day of the Colonoscopy
Don’t eat or drink anything - even water - 3 hours before your procedure. This step is important to help prevent you from getting sick after your procedure. People who drink right before the procedure risk getting sick and breathing stomach contents into their lungs while sedated.
Some hospitals request a longer window without liquids, so follow their instructions. You’ll need to avoid taking anything by mouth. This includes smoking or chewing gum.
In all cases where sedatives are used, it is advisable to arrange for a friend or family member to accompany the person having the colonoscopy to and from the hospital. This is because, in general, avoiding activities such as driving is recommended for a time after the use of sedatives. The timeframe of this period depends on the specific sedative used.
You'll likely be asleep or sedated during your colonoscopy, so you won't feel anything. Colonoscopies happen while patients are asleep or heavily sedated. Experts suggest that most people start colon cancer screening at age 45.
After the Colonoscopy
After your colonoscopy, you might feel bloated or gassy for a few hours. It's also normal to see a bit of blood in your first bowel movement after the exam. But if you keep seeing blood or have ongoing stomach pain or a fever, contact your doctor.
Yes, but it's water weight, and you'll probably gain it back after the procedure.
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