What is bowel prep?
Cleansing the colon before a colonoscopy is called bowel preparation, or “bowel prep.” It involves taking medication that causes diarrhea, emptying the colon. The medication is taken by mouth, and comes in liquid or tablet form. You will also need to change what you eat during the day or two before the colonoscopy.
Why is bowel prep important?
Before a colonoscopy procedure, it is very important that a bowel prep is done. This will help clean out the colon so that your doctor can thoroughly examine the colon. If the colon is not clean, and there is stool residue in the colon, there is a good chance that polyps or other lesions can be missed which defeats the purpose of the colonoscopy. In these situations, sometimes you have to do the bowel prep over a two day period and repeat the procedure either soon or at a shorter interval than normally advised.
Your doctor will prescribe the type of bowel prep that is best for you. You will receive specific instructions. In general, here is what you can expect:
- Your doctor will tell you to change your diet at least one day before your colonoscopy. Usually you will need to limit your diet to clear broth, tea, gelatin desserts, ginger ale, sherbet, and clear fruit juices (the ones you can see through), such as apple juice.
- It is advisable to eat a low fiber diet (avoid roughage, green leafy vegetables, corn etc.) for 3 days before the colonoscopy.
- You need to avoid gelatin desserts and liquids that are red or purple.
- It is important to avoid dehydration during bowel prep. Drink more fluids than you usually do.
- Your doctor will tell you exactly when to stop eating and drinking before your
- Follow carefully all the steps your doctor prescribes.
Can I continue to take my current medications?
Tell your doctor what medications you’re taking, especially aspirin products, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Most medications can be continued. Some can interfere with either the prep or the colonoscopy.
What medicines are used for bowel prep?
Several types of bowel prep medications are available as follows. It is usually better to split dose the prep- that means to take half of the bowel prep in the evening before the test and other half of the prep in the early morning of the test. The prep usually should be finished at least 2-4 hours before the procedure.
Your physician may recommend one of these or other preps which are available. You will need to carefully follow your doctor’s instructions about the exact dose and timing of your prep. Some types of prep may be covered by your medical insurance. You’ll want to find out if you have any out-of-pocket costs.
1. Golytely- This prep has polyethylene glycol (a laxative) along with electrolytes. A total of one gallon of liquid is to be taken. Usually 2 liters of liquid is taken in the evening before the colonoscopy and 2 liters of liquid is taken on the early morning of the colonoscopy.
2. Half-lytely and dulcolax prep- This prep also has polyethylene glycol along with electrolytes. This has 2 liters of liquid along with two tablets of dulcolax that is taken usually the evening before the colonoscopy. It is better to drink 1 liter in the evening before the colonoscopy and 1 liter of liquid on the early morning of the colonoscopy.
3. Moviprep- This prep has polyethylene glycol ,electrolytes and vitamin C. This is a 2 liter prep, taken 1 liter in the evening before the colonoscopy and 1 liter of liquid on the early morning of the colonoscopy.
4. Suprep- This prep has sodium sulfate, potassium sulfate and magnesium sulfate. It is available as two 6 oz. bottles that are taken as per directions on the kit. Each 6 oz. bottle contents must be diluted with water to a final volume of 16 oz. that needs to be taken the evening before the colonoscopy. Also drink additional 32 oz. of water within one to two hours. The second 6 oz. bottle diluted with water to a final volume of 16 oz. needs to be taken early morning of the colonoscopy. Also drink additional 32 oz. of water within one to two hours.
5. Magnesium Citrate- This is a prep that is very economical and includes two 10 oz. bottles of magnesium citrate that is a saline laxative. This is availabe over the counter. Usually one bottle is taken in the evening before the test and one bottle is taken in the early morning of the colonoscopy. Plenty of fluids should be consumed during the prep.
6. Osmoprep- This prep includes 32 tablets. Usually 4 tablets are taken every 15minutes for 5 doses in the evening before the colonoscopy and 4 tablets are taken every 15minutes for 3 doses in the early morning of the colonoscopy with plenty of fluids.
What determines the type of prep I get ?
Your medical condition is the most important factor in deciding which type of bowel prep is best for you.
Tell your doctor if you are pregnant or breast feeding, or if you have a history of bowel obstruction. Let the doctor know if you have high blood pressure. Also, mention if you have any heart, kidney or liver disease, or if you have had any of these diseases in the past. You need to mention any allergies you have to medications to the doctor. If you have had difficulty with a bowel prep in the past, be sure to mention this as well. Other factors in choosing the type of prep are the time of the colonoscopy appointment, individual preferences (taste and amount of medication), and out-of pocket costs.
What if I forget to take the medication when I should, or remember too late to finish the prep?
Call your doctor immediately and ask what to do if you are not able to complete the bowel prep as advised.
What are the common side effects of bowel prep?
The type and severity of side effects differ among patients. They also vary with the product used. Some patients have nausea, vomiting, bloating (swelling in the abdomen) or abdominal pain. A prep can cause kidney failure, heart failure or seizures, but this is rare. Your doctor will explain the possible side effects of the prep selected for you.
Some of the bowel preps cost much more than others. If the bowel prep that your doctor has prescribed is too expensive, call your doctor to see if a more economical alternative will be suitable for you. Many companies usually also provide a discount coupon to offset the cost of the medication. Ask your doctor’s office for details.