Colonoscopy Preparation Made Easy
Sure, colonoscopy saves thousands of lives every year. And colonoscopy has become safer with new techniques, improved anesthesia, and certified office endoscopy centers such as Progressive Gastroenterology in Mineola. But that cleaning out. That prep sounds like the worst part. Can’t they make it any easier?
Well in fact we have made every part of the examination easier over the years and I want to talk to you about these changes and how they can make your experience comfortable and rewarding.
Anesthesia has truly advanced with propofol anesthesia being the anesthetic of choice at Progressive Gastroenterology and at most centers on Long Island. Although Versed and narcotics are widely used in other areas of the country, these occasionally cause nausea, vomiting, and prolonged sedation. The rapid elimination of propofol has made many want to take my anesthesiologist home. And unlike Michael Jackson, we have three professionals, myself, the anesthesiologist, and a Registered Nurse all attending to you to avoid complications.
The scopes have improved significantly. We have top of the line high definition colonoscopes as well as narrow band imaging and an irrigator pump to enhance visualization of all the nuances of the bowel wall so that even flat polyps are seen and removed with a high rate of sensitivity.
The third area of progress has been the development of well tolerated preparations for colonoscopy. The protocols at Progressive Gastroenterology minimize the volume of fluids to drink at one time, minimize the hunger, and maximize the quality of the bowel prep to get the highest possible detection of the colon cancer precursor benign tumors so they can be removed before causing trouble.
Why is it so important what kind of bowel preparation is given? Colonoscopy is a potential lifesaver for the prevention of cancer of the colon and rectum. Seeing is believing, and seeing the colon wall without feces and debris gives you the best chance of finding and removing the polyps.
Adequate hydration is the key to feeling well during the prep. Have some ice tea, broth, juice, coffee, Jell-O, soda, and ices. Drink, Drink, Drink, and when you think you drank enough, Drink a little more. Mix it up. Don’t have all cold fluids; Try some broth, as the salt and warmth will balance the cold and sweet juices and ices. Hydration is vital to not feeling weakened by the preparation. It also ensures a high quality preparation.
Splitting the preparation has been shown to be easier to take because you don’t have as much to consume all at once. It makes the preparation manageable, and more comfortable. More importantly, it has increased the quality of the preparation and is the new standard of the American College of Gastroenterology. We split all our preps, so that the first dose is started the afternoon or evening before colonoscopy, and the second dose begins at 5 to 6 before the colonoscopy. You are allowed to drink fluids and take your medications up to 4 hours before the procedure, minimizing the time you have nothing by mouth. Reducing the length of time you cannot drink, allowing you your coffee in the morning, has reduced the headache, thirst, discomfort of the fasting process. At the same time, it has improved the preparation quality.
Low blood sugar concerns many who do not do well without protein during their day. It leaves many people shaky and weak. A small amount of eggs or egg whites, or deli turkey slices, or a non-fiber protein drink like Ensure or Boost, can prevent those problems and does not reduce the quality of the preparation. These protein sources can be fit into the preparation up to 12 hours before the scope.
So your comfort during the colonoscopy preparation is enhanced by vigorously hydrating, splitting the dose to minimize how much you have to consume at one time, allowing you to drink, or have coffee up to four hours before the procedure, and offering you protein up to 12 hours before the procedure. Caffeine withdrawal headaches, hypoglycemia, weakness, and thirst are all avoided while ensuring a high quality preparation.
You will be going frequently to the bathroom, so prepare by having on hand Vaseline and moistened towelettes such as baby wipes, or Cottonelle flushable cleansing wipes to use instead of toilet paper.
Not everyone loves the same preparation. I will now review the most popular preps known as the Miralax prep, Moviprep, Suprep, and the Tablet prep. In October 2012 Prepopik will be available. Each has their advantages that I will outline.
Miralax or generic PEG-3350 also sold a Dulcolax Balance (not to be confused with Dulcolax Laxative, or Dulcolax Stool Softener) is not FDA approved for colonoscopy preparation, but has been widely used. Because it does not have electrolytes, there is some risk of electrolyte imbalance, but this has not been a major concern in well people, but may be of concern in patients with poor kidneys, or on diuretics. Overall it has been the best tolerated preparation and has the least taste aversion. The powder is mixed in 2 quarts of beverage such as ice tea, apple juice, Gatorade, Crystal Light. Unlike its sister GoLytely or Nulytely, Colyte, and Half Lytely, there is no unpleasant taste, saltiness, or sulfur because of the elimination of the electrolytes. The volume is small. Only one quart is drank at one time (over an hour). The powder does not change the taste of the apple juice or whatever you mix it in. Apple juice is a favorite, and I have personally mixed it into a quart of Snapple, and a quart of Gatorade Ice, the colorless version of Gatorade. You can tell a mild thickening of the fluid, but the taste is normal. Two hours after the first quart take 2 tablets of Dulcolax or bisacodyl 5mg laxative. This may cause cramping, and has been reported to cause ischemic colitis in some patients, perhaps one in a thousand. Cramping is common after Dulcolax. Again the advantages are taste, small volume of only one quart at a time, and lowest cost. Disadvantages are cramping with bisacodyl laxative, and lack of FDA approval.
Moviprep is a very widely used preparation due to relatively low volume (only two pints at a time), excellent efficacy, the avoidance of the cramping associated with bisacodyl. It is not a great tasting prep, but this can be offset by using Crystal Light Green Tea, which effectively offsets the taste. Crystal Light Green Tea comes in a variety of fruit flavors such as raspberry and peach. I recommend using a straw. The advantages also include good hydration which leads to a very low incidence in complications associated with volume depletion.
Suprep is the lowest volume liquid prep on the market since the FDA took Fleet’s phosphosoda preps off the market due to kidney injury, and excess salt load. You only have to take one pint at a time. This is very small for some one who wants an excellent FDA approved preparation that is easy to take with only one pint at a time. You do want to flush it down with a couple of 16 ounce beverages to chase it over the next hour. There is much less cramping because there is no bisacodyl laxative. The taste is not as pleasant as Miralax prep, but the small volume makes that not troublesome. Keys here are adding extra fluid due to the low volume of the prep.
Many people come in asking for a tablet rather than having to drink something that may not taste great. The Tablet Prep or Osmoprep, is an excellent FDA approved preparation with high quality cleansing like the others reviewed here. It is not for people on salt restricted diets, people with heart failure, kidney disease or people on diuretics. If you have high blood pressure that is not well controlled or using medications such as ACE inhibitors, Angiotensin Receptor Blockers (ARB) or water pills (diuretics), this is too salty a preparation for you. These people have increased risk of kidney damage and electrolyte imbalance due to high phosphorus and sodium, similar to Fleet’s Phosphosoda or Fleet’s Enema. For well patients this is an excellent preparation as long as you take it with adequate fluids. You still have to drink, but you can drink what you like, and it doesn’t taste bad. There are 32 pills to take, again like the other preps split over two doses. For example begin the afternoon or evening before the colonoscopy with 4 tablets and a glass of juice. 15 minutes later have 4 tablets and a cup of broth. 15 minutes later try 4 tablets with a glass of ice tea. 15 minutes later take 4 tablets with a cup of coffee. Finally 15 minutes later try a glass of ginger ale with the last 4 pills. Its that easy, and avoids any taste aversion. The second dosing 5 to 6 hours before the colonoscopy only has 12 pills and 3 glasses, so is even easier.
We will expand this section after December 2012 when Prepopik is available and we have some experience to share with you.
So there you have 5 well tolerated preps allowing you to choose between taste, volume, and a tablet prep, depending on your individual needs and preferences. Good drinking leads to a great preparation. Great preparation leads to cancer prevention. I have outlined ways to make the preparation comfortable and not as unpleasant as you may have heard. Now you can tell your friends that you had the easiest most comfortable colonoscopy experience and it saved your life!
Photo By: Patrik Jones CC BY 2.0