Colonoscopy preparation is extremely important because if your bowel is not prepared properly for the test then the doctor will not be able to see if anything is wrong.
A colonoscopy test involves your doctor visually inspecting the inside of your bowel using a special flexible telescope/camera. Sometimes the doctor will look directly at the inside of your intestines but usually the pictures will be transmitted to a screen.
Imagine if your bowel is still full of poop; the doctor will not get to see much!
This article will take you through the different ways that your bowel can be cleaned out ready for the test.
You will be given instructions by your doctor which you should follow but the information here will let you know what to expect and tips on how to cope.
The two main ways to clean out your bowel are either through following a special diet or by taking very strong laxatives. In practice many doctors recommend a combination of the two.
If you have a colonoscopy examination coming up then my advice is to start preparing at least 5 days ahead.
If you start reducing what goes in then there will be less to come out! So work back from the day of the exam and gradually reduce the amount of fiber in your diet.
I was advised that I didn't need to do this as the strong laxative I was given would take care of everything but I wish with hindsight that I had ignored this piece of advice. I would not have been sitting on the toilet for quite so long and would not have suffered such a volume of diarrhea!
It has also been found that patients who rely on the laxative alone and do not adjust their diet do not always have a clean enough bowel. This can result in a waste of time for you and the doctor if they cannot see properly.
The instructions on some laxative products will say that no colonoscopy preparation diet is necessary but this does not always work out for the best.
If you normally suffer from constipation tell your doctor as they may want to prescribe a regular laxative for you to take 2 or 3 days before the test.
Clear your schedule completely the day before the examination because unfortunately you will need to be in the bathroom!
Arrange to have any children or elderly parents looked after. You won't be able to do it.
The basic principle of the colonoscopy preparation diet is to do the opposite of what all the health professionals are always telling us to do.
So you know how you are always being told to eat more fruit and vegetables and to go for wholefoods like brown rice and wholemeal bread; well in the lead up to a colonoscopy everything must be white and bland!
The idea is to start cutting out fiber almost a week before and then gradually reduce the fiber to nothing and reduce the amount of solid food you are eating so that just before the test you are only having clear fluids.
By doing this your bowel will be nice and empty and the doctor will get a clear view of the intestinal lining.
This will make it much easier to for them to notice any abnormalities.
The colonoscopy preparation diet should start at least 5 days before the test.
At the beginning you can eat everything on the 'Eat List' below but as the test gets nearer cut out all fruits and vegetables.
The day before the test and on the day of the test most doctors recommend only clear fluids.
clear fluid is something you can see through and which has no bits. So
cloudy does not qualify and neither does chicken noodle soup! Well,
unless you strain out the chicken and the noodles. (You can eat the chicken and noodles up to day 2 before the test as long as there are no vegetables in your soup) You can have tea or
coffee but it must be without milk. Clear bouillon, consomme, Oxo,
Bovril, energy drinks, clear fruit juices and cordials qualify. Do not drink anything red or purple.
Sometimes you only have to start the clear fluid diet after lunch if your appointment is in the afternoon the next day.
Most doctors ask you to be nil by mouth for two hours before the test.
The thought of not having anything but clear fluids for hours is very worrying for many people in our modern times when it is rare to be very far from food.
Be assured that not eating for 24 hours will not do you any harm as long as you drink enough to prevent dehydration. (If you are diabetic this is an exception and you should be under medical supervision.)
If you really miss having something in your mouth then you can overcome this by sucking sweets such as:
You can also suck popsicles/ice pops and eat Jell-O/Jelly as long as they are not red or purple. So stick to lemon, lime or orange flavors. These things will not jeopardize your colonoscopy preparation.
The colonoscopy preparation diet involves cutting out certain groups of foods.
It is not always obvious but we do get a lot of our fluids from certain foods especially fruits and vegetables.
When we are not eating these foods we need to drink more fluids to compensate or we risk becoming dehydrated.
It is important when following this diet to drink between 8 and 10 glasses of clear fluids every day.
After you have taken the laxative preparation you will have lots of diarrhea so it becomes even more important to drink plenty to replace the fluids you are losing. The laxative instructions will tell you how much you need to drink.
Many people have said that the day before the colonoscopy is the worst day of the whole process and I found this myself. Colonoscopy preparation is not easy! Getting your bowel clean involves having a lot of diarrhea, usually some abdominal pain, very occasionally nausea or in some rare cases vomiting.
As we have said earlier make sure that you have a day where you do not have to go out or do anything.
Stay very close to the bathroom because the need to open your bowels can come on very suddenly. Some people actually set up camp in the bathroom with a chair or cushions and blankets to make it more comfortable.
Wear loose clothing that is easily removed as you may need to get undressed in a hurry!
Make sure you have some magazines, a good book or something nice to watch on screen to relieve the boredom and provide a distraction.
If you have abdominal pain then use a covered hot water bottle, heat pad or warm wheat bag on the area.
When you think that the diarrhea has stopped snuggle up with your favorite cushion in bed or on the couch and don't think about doing anything energetic!
Whichever brand you are given they all taste pretty disgusting so a bit of help is needed. They normally come in the form of a powder which is mixed with water. This makes a very salty tasting drink which can be hard to stomach for some people. Some people are lucky and get given tablets.
Make sure it is very cold when you drink it as the taste will be less noticeable. So, mix it up a little ahead and chill before drinking. Some people even put the prep in the freezer for a short while.
Mix with a flavored drink to disguise the taste. Some people like powdered lemonade, some add Gatorade or Lucozade. Most flavored drinks will do as long as they are clear and do not contain any bits. Avoid red colored fluids as they can affect the quality of the pictures.
Drink through a straw as you will not taste the fluid as much.
Clean your teeth after you have drunk the laxative to get rid of the taste from your mouth.
Some doctors will now prescribe a new generation of laxatives which come in tablet form and so do not taste as bad. These are not suitable for everybody as they can put more strain on the kidneys and so cannot be used if you have kidney problems or are elderly.
Some people find that the laxative drink makes them feel sick. If you are prone to sickness or if you want to be on the safe side ask your doctor to give you some anti-sickness medication to help with this problem.
It is inevitable that even if you have followed the colonoscopy preparation diet to the letter you will have some diarrhea as a result of the laxatives you have been prescribed.
This can cause soreness around the anus (butthole). To help prevent this happening use wet wipes. Make sure that they are flushable and some people find that using wipes that incorporate aloe vera are soothing.
Use some barrier cream around the area. This is the same kind of cream that is used for babies with diaper/nappy rash. A well known brand is Sudocrem or you can use zinc and castor oil cream or Vaseline.
Seven days before the test you must stop taking any medications or vitamin supplements that contain iron because the black coloration it causes will interfere with visibility.
Pain killers which contain codeine should be stopped four days before the test because they have a constipating effect. Also stop taking Loperamide (Lomotil).
Bulk forming laxatives which contain husks to bulk out the stools like psyllium (Metamucil), methylcellulose (Citrucel, Celevac) and polycarbophil (FiberCon), isphaghula (Fybogel), sterculia (Normacol) should be stopped at least two days before the test and preferably earlier. Check with your doctor.
Stop eating bran and cereals containing bran at least 5 days before the test.
Your doctor should be made aware of any blood thinning medications that you are taking like Coumadin/Warfarin. One of the possible side effects during colonoscopy is a risk of bleeding, especially if a biopsy needs to be done or polyps removed. You may be asked by your doctor to stop your medication about 5 days before the test.
If you are taking contraceptive medication then the diarrhea caused by the colonoscopy preparation laxative will make it ineffective. You should continue taking your pills but either refrain from having sex or use other methods of contraception for at least 7 days after the diarrhea or vomiting stops.
Make sure that your doctor knows about any pre-existing health conditions and any medications that you are taking.
This is especially important if you have kidney problems, a heart condition, diabetes or glaucoma.
If you have read this article you may be thinking that you do not want to go through all that! It does not sound fun but many many people have had this test and some are very grateful that their problem was caught early and dealt with.
It is definitely worth putting up with a bit of discomfort in order to know that your bowel is good condition or if you do find out that there is a problem so that it can be sorted out quickly and not cause you heartache in the future.
Follow the instructions given to you by your doctor and use the information in this article to help you to get through a difficult time.
Good colonoscopy preparation is vital because the last thing you want to happen is to be mid-test with the flexible camera in-situ and have the doctor say "sorry I can't carry on, visibility is poor". So make sure that you are clean and ready!
There is a lot of information about how to get your colonoscopy preparation right but not so much about what to do afterwards.
Most people will bounce right back and have no problems although you should look out for any signs of bleeding and/or severe abdominal pain and report them to your doctor immediately. You can find more information about risks and after effects here.
Your gut has had a massive clear out which many people may think is a good thing but unfortunately a lot of friendly bacteria can be cleared out at the same time. It is a very good idea to take a course of high quality probiotics following the test. Look for one with a high number of bacteria and a wide variety of strains.
Colonoscopy preparation is important but getting your bowel back on track afterwards is also important. Think of it like this, athletes warm up but they also cool down.
Diarrheanurse hopes that your colonoscopy preparation goes well and that you get good results from your test. If not then you will know what you are dealing with and have given yourself a chance to get the best treatment.
Well done for getting the test done. It is not the greatest fun in the world but it is an important way of checking on the condition of your bowel!
Milk: Day Donaldson https://www.flickr.com/photos/thespeakernews/15479047167
Lentils: Justinc https://commons.wikimedia.org/wiki/File:3_types_of_lentil.jpg
Duck consomme: T.Tseng https://www.flickr.com/photos/68147320@N02/8369986736