
To prepare for a colonoscopy, it is necessary to cleanse your bowels using laxatives. This can be done with a variety of different laxative formulas, including oral laxative formulas, osmotic laxatives, and saline-based laxatives. It is important to follow the instructions provided by your doctor to ensure the colonoscopy can be performed successfully. In addition to taking laxatives, you may also need to make changes to your diet in the days leading up to the procedure, such as eating light and low-fiber foods. It is also recommended to avoid solid foods and stick to clear liquids the day before the colonoscopy.
What You'll Learn
Dietary restrictions before a colonoscopy
Preparing for a colonoscopy involves a process called colonoscopy preparation, which includes dietary restrictions and laxatives. This process usually begins a few days before the procedure and is essential for a successful colonoscopy.
Dietary Restrictions
- White bread, pasta, and rice
- Well-cooked vegetables without skin
- Fruit without skin or seeds
- Lean meat, chicken, or fish
You should also stop taking vitamins, supplements, and any over-the-counter anti-inflammatory or blood-thinning medications.
On the day before the procedure, you should only consume clear liquids. This includes sports drinks, clear juices (like apple and white grape), clear broth, soda, tea, and coffee without cream. It is important to stay hydrated, but avoid alcohol and drinks that are not clear, like milk or orange juice.
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Laxatives and their side effects
To prepare for a colonoscopy, it is essential to cleanse your bowels with a laxative formula. This is because the procedure requires your colon to be empty so that your doctor can see inside it clearly.
Laxatives are medicines that stimulate or facilitate bowel movements. They are available in different forms, such as liquids, tablets, capsules, suppositories, and enemas. They can be taken orally or rectally. Some common types of laxatives include:
- Osmotic laxatives: These work by drawing water into the colon, making it easier for stools to pass.
- Bulk-forming laxatives: These act like fiber supplements, increasing the bulk of stools by getting them to retain liquid.
- Stool softener laxatives: These make stools softer and easier to pass by reducing their surface tension so that they absorb more water.
- Stimulant laxatives: These stimulate the digestive tract walls, triggering rhythmic contractions of the intestinal muscles and speeding up bowel movements.
While laxatives are effective in relieving constipation, they can also have side effects. Some of the common side effects of laxatives include:
- Increased constipation if not taken with enough water
- Diarrhea, which can lead to dehydration and electrolyte imbalance
- Interaction with other medications, such as heart medications, antibiotics, and bone medications
- In rare cases, severe side effects such as severe cramps, weakness, skin rash, or swallowing difficulties
It is important to note that overuse of laxatives can lead to intestinal muscle and nerve response loss, resulting in dependency on them for bowel movements. Additionally, long-term use of non-fiber-based laxatives has been linked to an increased risk of colorectal cancer, although further research is needed to confirm this association. Therefore, it is crucial to use laxatives sparingly and only when necessary. Improving your diet and increasing your physical activity can also help reduce constipation and the need for laxatives.
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Bowel preparation kits
There are several different types of bowel prep kits available, and your healthcare provider can help you identify the right one for you. The two basic categories of colonoscopy prep are polymer-based formulas (PEG) and saline-based formulas (NaP).
Polymer-Based Formulas (PEG)
Polyethylene glycol (PEG) is the most commonly prescribed type of bowel prep formula. It is a polymer-based laxative that comes in powder form and is mixed with large volumes of water (up to 4 litres). PEG formulas are highly effective and gentle on the intestines, making them a good choice for people with irritable bowel syndrome (IBS). They also tend to be safer for people at risk of complications from fluid and electrolyte depletion, such as those with kidney or heart disease. However, the high volume of liquid required and the taste can make it difficult for some people to complete the prep.
Saline-Based Formulas (NaP)
Saline-based laxatives include sodium phosphate (NaP) as the primary osmotic agent, along with other mineral salts such as potassium and magnesium. These formulas come in tablet form, which may be easier for some people to swallow. However, the salts in these formulas can irritate the intestinal mucosa if you have an inflammatory gastrointestinal disease, and they may not be safe for those at risk of fluid-electrolyte shifts.
Other Options
If you are concerned about the volume of liquid or the taste of the standard PEG formulas, there are some lower-volume and flavoured options available, such as NuLYTELY or TriLyte. There are also combination formulas that mix PEG with another laxative, such as MiraLAX or Halflytely, which reduce the overall volume of the formula. Moviprep is another combination formula that mixes PEG with ascorbic acid.
Timing
You will typically begin your bowel prep several days before your colonoscopy, by changing your diet to low-fibre foods and clear liquids. You will then start taking your chosen laxative formula the afternoon or evening before your procedure. The exact timing will depend on the formula and the instructions from your doctor.
Side Effects
Bowel prep formulas can have side effects, including bloating, cramping, nausea, and diarrhoea. More serious side effects may include severe abdominal pain, vomiting, and electrolyte deficiencies. It is important to follow the instructions provided by your healthcare provider and to stay adequately hydrated before, during, and after the procedure.
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Recommended colonoscopy prep drinks
Colonoscopy prep drinks are used to clean out your bowels before a colonoscopy, so your doctor can see inside your colon clearly. Colonoscopy prep drinks are oral laxatives, and there are several different types of bowel prep kits available. Your healthcare provider can help you identify the right preparation for you.
Colonoscopy prep kits contain osmotic laxatives, which trigger your bowels to draw in more water from your body to force the substances through. The extra water softens your stools and increases the volume in your colon, triggering the muscle contractions that move everything out (peristalsis).
Colonoscopy prep kits also contain electrolytes, as the purging process can be very dehydrating. Electrolytes are built into your bowel prep recipe to prevent significant deficiencies, which can have severe consequences.
Types of Colonoscopy Prep Kits
Colonoscopy prep kits fall into two basic categories, depending on the type of laxative they use:
Polymer-Based Formulas (PEG)
The most commonly prescribed bowel prep formulas use a polymer-based laxative known as polyethylene glycol 3350 (PEG). PEG is a large molecule that can't be absorbed through your colon, causing a hyperosmotic effect. PEG formulas are typically in powder form and are mixed with large volumes of water. They may include electrolytes or be taken with a sports drink.
Pros of PEG Bowel Prep Kits
PEG bowel prep kits are highly effective for colonoscopy prep. The PEG molecule doesn't disturb the intestinal mucosa, making it a gentler choice for people with irritable bowel syndrome (IBS). PEG formulas are also considered safer for people at risk of complications from fluid and electrolyte depletion, such as those with kidney, liver, or heart disease.
Cons of PEG Bowel Prep Kits
PEG bowel preps often require drinking large volumes of formula (up to 4 litres), and the taste can be difficult for some people. Incomplete bowel prep can lead to an ineffective colonoscopy and may require rescheduling. To address these issues, flavour options are now available, and you can also add your own flavour with a powdered drink mix (avoiding red-coloured powders).
Saline-Based Formulas (NaP)
Saline-based laxatives include sodium phosphate (NaP) as the primary osmotic agent, often combined with other mineral salts such as potassium and magnesium. These formulas offer an alternative to drinking your colonoscopy prep, as they come in tablet form. The salts contain natural electrolytes, but electrolyte imbalances can still occur, and some people may be at risk of mineral overdoses.
Pros of Saline-Based Laxatives
Sodium phosphate bowel preps may be easier for some people to swallow, and they are equally effective when taken as directed. For those who find it challenging to complete a PEG bowel prep, a NaP formula can improve compliance and ensure a successful colonoscopy.
Cons of Saline-Based Laxatives
The salts in NaP formulas can irritate the intestinal mucosa if you have an inflammatory gastrointestinal disease. NaP formulas are not recommended for those at risk of complications from fluid-electrolyte shifts, including people with certain pre-existing conditions or those taking certain medications.
Hybrid Formulas
Bowel preps that combine an osmotic laxative with another type of laxative, such as MiraLAX, Halflytely, and Prepopik, may be better tolerated and have fewer side effects.
Tips for Colonoscopy Prep Drinks
- Ask your doctor about new, low-volume prep options, which require drinking a smaller quantity of the prep mixture.
- Mix the traditional GoLYTELY prep drink with lemon-lime Gatorade or a clear flavour of Crystal Light to improve the taste.
- Drink a few sips of white grape juice or apple juice after each glass of the prep solution to improve the taste.
- Refrigerate the prep before drinking it, and shake the mixture before consuming it.
- Use a straw to help contain the taste and make the prep easier to drink.
- Split the doses, drinking half of the solution in the early evening and the second half later at night, to improve tolerability and stool clearance.
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Colonoscopy prep timeline
Colonoscopy prep is a crucial step in ensuring a successful procedure. Here is a detailed timeline to guide you through the process:
Three to Four Days Before the Colonoscopy:
- Eat a low-fiber diet. Avoid raw fruits or vegetables, whole corn kernels, nuts, seeds, and popcorn.
- Stop taking fiber supplements and anti-diarrheal medication.
- Consult your doctor about adjusting prescription medications, especially blood thinners, diabetes medications, or cardiac medications.
Two Days Before the Colonoscopy:
Continue with the low-fiber diet, avoiding red, blue, or purple dyes that may interfere with the test.
One Day Before the Colonoscopy:
- Consume only clear liquids, such as sports drinks, clear juices (apple or white grape), clear broth, tea or coffee without cream, soda, and gelatin. Avoid solid foods and coloured liquids.
- Drink at least 8 glasses of liquid to stay hydrated and prevent dehydration.
- In the late afternoon or evening, start drinking the prescribed laxative solution to clean out your colon. Drink it as directed by your doctor, usually within a specific timeframe.
The Morning of the Colonoscopy:
- Finish drinking the remaining laxative solution, typically 4-6 hours before your appointment.
- Do not drink anything at least 2 hours before the procedure.
- Get everything ready for your appointment, including a list of medications, important medical information, and personal items like glasses or a phone.
At the Office:
Check-in, make any necessary payments, and go through the intake process, including heart monitoring and blood pressure measurements.
After the Colonoscopy:
- You will be monitored after the procedure, and it is normal to experience cramps or slight discomfort.
- You can start eating again slowly, with easy-to-digest foods. Avoid alcohol for 24 hours.
- Go back to your normal schedule 24 hours after the procedure, but avoid alcohol, driving, and signing legal documents until the day after.
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Frequently asked questions
It is not advisable to take diet laxative tea before a colonoscopy. It is recommended that you follow a low-fiber diet and drink clear liquids one day before the procedure. You should also take a bowel prep kit, which is an oral laxative formula, to ensure your colon is clear for the colonoscopy.
Before a colonoscopy, it is recommended to eat plain foods such as plain chicken, white rice, pasta, or bread. You should also avoid solid foods and drinks with red or purple colouring, milk or milk products, and alcohol. Drink clear liquids such as apple juice, tea, coffee (without milk), and sports drinks.
A bowel prep kit is an oral laxative formula that helps to clear your bowels before a colonoscopy. It is important to use a bowel prep kit to ensure your colon is clear so that your healthcare provider can see inside your colon during the procedure.