A colonoscopy is a vital screening tool for detecting colorectal cancer and other abnormalities in the colon. The effectiveness of a colonoscopy hinges on a thorough bowel preparation, which involves dietary restrictions and the use of laxatives to ensure a clear view of the colon lining. Preparing for the colonoscopy is very similar to following a recipe. You usually want to check the recipe before the day you're going to cook the meal. If you wait until the day before your colonoscopy to prepare, it may be too late. This article provides a comprehensive guide to the low-residue diet, alcohol consumption, and other crucial considerations for optimal colonoscopy preparation.
The Importance of Colonoscopy Preparation
As a gastroenterologist, colorectal cancer screening is one of my most important tasks. Colonoscopies are the best colorectal cancer screening method. They can help your care team find and detect colorectal cancer at an earlier stage when it is easier to treat. During a colonoscopy, a gastroenterologist uses a scope to take a close look at the inside of your colon. For a doctor to get a good look at your colon, it needs to be clean. 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.
A colonoscopy allows your doctor to see anything abnormal in your colon, including polyps, or abnormal growth in the colon’s lining. Polyps may be benign or may grow into colon cancer if they aren’t removed. If you follow the prep instructions, getting a colonoscopy usually isn't as bad as what you may have heard. I think sometimes the hype is a little worse than the actual experience.
Understanding the Low-Residue Diet
For five days before your colonoscopy, you will want to stay on a low-residue diet. A week before your colonoscopy is a good time to start a low-fiber diet. While fiber is good for you, it can stick around your colon and gastrointestinal tract. Our providers have you start a low fiber (low residue) diet several days prior to your procedure to begin reducing residue in your colon and make it easier for you to clean out your bowels. This is a diet that you start the week of your procedure. Please see low fiber diet/low residue diet cheat sheet. Staying away from foods that are high in residue will make your prep more comfortable and successful.
When your doctor says you have an inflammatory bowel disease - like Crohn's disease or ulcerative colitis - they may suggest a low-residue diet. The basic idea is that you'll eat foods that are easy to digest and cut back on those that aren't. "Residue" is undigested food, including fiber, that makes up stool. The goal of the diet is to have fewer, smaller bowel movements each day. That will ease symptoms like diarrhea, bloating, gas, and stomach cramping. Your doctor may recommend this diet for a little while when you have a flare or after surgery to help with recovery.
Read also: Guide to Low-Residue Cooking
The general recommendation for preparing for a colonoscopy is to begin the low-residue diet 3 days before your procedure.
Foods to Include in a Low-Residue Diet
A shopping list for food, drinks, and other items you will need during your colonoscopy prep will help you have a successful prep. As long as you follow the general guidelines for the diet, you can mix and match as much as you'd like. There are many meal options to choose from on a low-residue diet. Softer foods like white bread, white rice, peeled fruits and veggies, and lean, tender meats are considered low in residue.
- Grains: Refined or enriched white breads and plain crackers, such as saltines or Melba toast (no seeds). Cooked cereals, like farina, cream of wheat, and grits. Cold cereals, like puffed rice and corn flakes. White rice, noodles, and refined pasta. Certain breads, cereals, and pastas, including white bread and grits (look for foods that are less than 0.5 grams of fiber)
- Fruits and Vegetables: The skin and seeds of many fruits and vegetables are full of fiber, so you need to peel them and avoid the seeds. These vegetables are OK: Well-cooked fresh vegetables or canned vegetables without seeds, like asparagus tips, beets, green beans, carrots, mushrooms, spinach, and squash (no seeds). Cooked potatoes without skin. Tomato sauce (no seeds). Fruits on the good list include: Ripe bananas. Soft cantaloupe. Honeydew. Canned or cooked fruits without seeds or skin, like applesauce or canned pears. Avocado. Pumpkin and other winter squashes (cooked or canned without seeds). Raw fruits like very ripe apricots, bananas and cantaloupe, honeydew melon, watermelon, peaches, and plums; other raw fruit is not a part of the diet
- Milk and Dairy: Milk and other dairy products are OK in moderation. Milk has no fiber, but it may trigger symptoms like diarrhea and cramping if you're lactose intolerant (meaning you have trouble processing dairy foods). If you are, you could take lactase supplements or buy lactose-free products. Dairy products like cheese, cottage cheese, milk, and yogurt (no more than 2 cups daily; avoid if you are lactose intolerant)
- Meats: Animal products don't have fiber. You can eat beef, lamb, chicken, fish (no bones), and pork, as long as they're lean, tender, and soft. Eggs are OK, too. Meats and other forms of protein including ground or tender beef, chicken and turkey, and seafood
- Fats, Sauces, and Condiments: These are all on the diet: Margarine, butter, and oils. Mayonnaise and ketchup. Sour cream. Smooth sauces and salad dressing. Soy sauce. Clear jelly, honey, and syrup Oils, butter, and sauces or condiments such as olive oil, mayonnaise, and ketchup
- Sweets and Snacks: You can satisfy your sweet tooth on a low-residue diet. These desserts and snacks are OK to eat in moderation: Plain cakes and cookies. Gelatin, plain puddings, custard, and sherbet. Ice cream and ice pops. Hard candy. Pretzels (not whole-grain varieties). Vanilla wafers Snacks like pretzels, saltines, or gelatin
- Drinks: Safe beverages include: Decaffeinated coffee, tea, and carbonated beverages (caffeine can upset your stomach). Milk. Juices made without seeds or pulp, like apple, no-pulp orange, and cranberry. Strained vegetable juices Drinks with caffeine including coffee or tea or carbonated beverages
Foods to Avoid on a Low-Residue Diet
On this plan, you'll stay away from:
- Coconut, seeds, and nuts, including those found in bread, cereal, desserts, and candy
- Whole-grain products, including breads, cereals, crackers, pasta, rice, and kasha
- Raw or dried fruits, like prunes, berries, raisins, figs, and pineapple
- Most raw vegetables
- Certain cooked vegetables, including peas, broccoli, Brussels sprouts, cabbage, corn (and cornbread), onions, cauliflower, greens such as kale, and potatoes with skin
- Beans, lentils, and tofu
- Tough meats with gristle and smoked or cured deli meats
- Cheese with seeds, nuts, or fruit
- Crunchy peanut butter, jam, marmalade, and preserves
- Pickles, olives, relish, sauerkraut, and horseradish
- Popcorn
- Fruit juices with pulp or seeds, prune juice, and pear nectar
- broccoli, cauliflower, Brussels sprouts, cabbage, kale, Swiss chard
- ch as cooked dried beans, beets, broccoli, Brussels sprouts, cabbage, cauliflower, corn, kale, lima beans, mushroom, okra, potato skins, spinach, peas, other legumes, and collard, mustard, and turnip greens)
- Raw fruit or dried versions and raisins
- Vegetables with seeds
- Tough meats, beans, peas, and peanut butter
- Raw nuts and seeds
- Pickles, dressing with fruits or seeds, preserves or jam
- Spicy foods or desserts and snacks with seeds like popcorn
Sample Low-Residue Diet Menu
As long as you follow the general guidelines for the diet, you can mix and match as much as you'd like. There are many meal options to choose from on a low-residue diet.
- Breakfast: Decaffeinated coffee with cream and sugar, Cup of juice, such as no-pulp orange juice, apple juice, or cranberry juice, Farina or cream of wheat, Scrambled eggs, Waffles, French toast, or pancakes, White-bread toast with margarine and grape jelly (no seeds)
- Lunch: Baked chicken, white rice, canned carrots, and green beans, Salad with baked chicken, American cheese, smooth salad dressing, and white dinner roll, Baked potato (no skin) with sour cream and butter or margarine, Hamburger with white seedless bun, ketchup, and mayonnaise - and lettuce if it doesn't make your symptoms worse
- Dinner: Tender roast beef, white rice, cooked carrots or spinach, and white dinner roll with margarine or butter, Pasta with butter or olive oil, French bread, and fruit cocktail, Baked chicken, white rice or baked potato without skin, and cooked green beans, Broiled fish, white rice, and canned green beans
Tips for Adapting to a Low-Residue Diet
If you enjoy whole grains, nuts, and raw fruits and vegetables, shifting to a low-residue diet may be hard. But if you prefer white bread and pasta, don't mind canned fruits and vegetables, and are happy to snack on saltines, it may come naturally. It's a great idea to keep a food diary for a few weeks. Track what you eat and how it makes you feel, so you know what works for you. Remember, this isn't a healthy way to eat for a long time because it skips many important nutrients. Ask your doctor if they know a nutritionist who can help make sure your diet is right for you and let you know if you need to take supplements.
Read also: Vegetables for a Low-Residue Diet
The Clear Liquid Diet Before Colonoscopy
On the day of your prep, your diet should be clear liquids ONLY. It's essential that you stay on a clear liquid diet the day before your colonoscopy. Follow a clear liquid diet the day before your procedure. A clear liquid diet starts a day or two prior to procedure. You are only allowed jell-o, popsicles, strained broth, and liquids that you can see through when you pour them out.
While the term ‘clear liquid diet’ might sound like it only includes water and broth, it includes anything that you could put into a glass dish and still read a newspaper underneath. Your doctor will provide guidance on when to begin a clear liquid diet before your colonoscopy. Generally, you begin having all clear liquids and no solid foods the day before your procedure, which includes options like popsicles, Jell-O, and ginger ale.
Foods and Drinks to Avoid
Steer clear of eating or drinking anything with red, orange or purple food coloring the day before your procedure. Many doctors ask patients to avoid drinks that contain red, purple, or blue coloring can stain the walls of your colon. During your colonoscopy, these stains can interfere with the test and look like blood or other abnormalities. Foods and drinks with green or blue coloring are totally fine before a colonoscopy. If I see green in your colon, for example, I won’t confuse it with blood. Milk products are permitted up until the day before a colonoscopy, when you need to drink only clear liquids. Similar to how certain dyes can affect your colonoscopy, traces of milk can hide a possible polyp in the walls of the colon.
Alcohol and Colonoscopy Preparation
Do not drink alcohol during the prep process. You cannot drink alcohol the day prior or the day of your procedure. Although many spirits are technically clear, alcohol is dehydrating, and you will already be losing a lot of fluids due to the colonoscopy prep. Alcohol may interact with the sedatives used during the procedure.
Colonoscopy Prep Solutions
There are different varieties and flavors of colonoscopy prep, but they all work in a similar way. A common misconception about the prep solution is that you are supposed to drink it all at once. Instead, we recommend a more effective way to clean your colon called split-dose prep. Save the other half of the prep for the morning of your procedure. One easy way to make your prep taste better? Drink it cold. Using a straw can block some of the prep’s flavor and make drinking your prep quicker. Some prep solutions come with a flavoring packet. You don’t need to use the flavoring packet that comes with your prep. One perk of using electrolyte packets is that they can help you stay hydrated. Prepping for a colonoscopy means drinking lots of fluid - and flushing lots of fluid out of your body. One lesser-known tip for getting through your prep? Place a menthol candy under your tongue to block the prep’s taste.
Read also: Understanding the Low-Residue Diet
Most patients can use our Standard Miralax Bowel Preparation. Prescription preparations can be sent to your pharmacy of choice upon request and at the discretion of your provider. Our Standard Miralax Bowel Preparation is all available over the counter. We have prep kits available for purchase in our Londonderry office. Plenvu, Suprep, Golytely, and Clenpiq can be sent to your pharmacy at the discretion of your provider.
The Colonoscopy Procedure
A colonoscopy is relatively quick. In total, the procedure only takes about a half hour to 40 minutes. Most of that time, you’ll be asleep under anesthesia. A colonoscopy is also painless since you don't have any nerves in your colon. So, even getting polyps removed doesn’t hurt. The good news? Usually, you don't have to do it all that frequently. If you are at average risk for colorectal cancer, you should get a colonoscopy every 10 years starting at age 45. But if we don’t find anything or the findings are benign, you only need a colonoscopy every 10 years. We strive to give you a high-quality exam every time so that we don’t have to repeat your colonoscopy more often than necessary. Blood thinners (see below) need to be held prior to procedure (time varies).
All facilities set their own schedule for each procedure day. GSGI will schedule you for a specific date, facility, and provider. No, please follow our prep instructions that we have supplied you with. To avoid any late fees, please be sure to call our office 7 business days prior to your procedure.
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