Colonoscopy Prep Questions and Answers
It's completely understandable to feel nervous about a colonoscopy. However, the risks of colon cancer far outweigh the discomfort of a screening. Colorectal cancer is the second leading cause of cancer deaths in the United States, leading to more than 50,000 deaths every year. It's a simple procedure that could make all the difference. Routine testing is recommended for people age 50 and older with a normal risk of colon or rectal cancer. Your doctor may recommend getting screened earlier, or more frequent testing, if you have a higher risk.
Fortunately, colon cancer is one of the most preventable types of cancers. The number of colon cancer diagnoses has decreased over the past decade thanks to awareness, prevention and routine colonoscopies.
Why Do I Need a Colonoscopy?
A colonoscopy is a crucial step to catching colon cancer early. In many cases, colon cancer doesn't cause noticeable symptoms until the disease has advanced. Recent statistics show regular colonoscopies could prevent nearly 60% of deaths from colon cancer. A colonoscopy can detect a polyp, a growth of cells on the lining of the colon, before it becomes cancerous. Your doctor can remove the polyp, stopping cancer before it even starts.
Colonoscopies can check for a variety of symptoms and their causes:
- Abdominal pain
- Anemia
- Blood in stool or rectal bleeding
- Dark or black stools
- Diarrhea
- Unexplained weight loss
What to Expect
Because of colonoscopies, colon cancer is one of the most preventable types of cancer. Prepare for the procedure and confidently go into your appointment. Talk with your doctor about any questions you have.
- Anal creams: You can apply Desitin, A & D ointment, Vaseline or any other cream to the anus during the prep.
- Brushing teeth: You can brush your teeth the morning of the prep.
- Bowel preparation: You may have heard about the colonoscopy prep drink. Today's bowel preparation drink is much easier to drink than in the past. Ask your doctor if you can add flavored crystals like Crystal Light or lemon juice to the solution. You may also find it easier to drink if you chill it in the refrigerator first.
- Clear liquid diet: One or two days before your colonoscopy, you'll need to be on a clear liquid diet.
- Low fiber diet: Four days before your colonoscopy, you must follow a low fiber diet.
- Medications: Make sure your doctor knows about your current medications and ask if it's safe to keep taking them leading up to the procedure. Let your doctor know if you're allergic to any medications.
- Menstrual period: You can have a colonoscopy during a menstrual period. Let your doctor know if you are or might be pregnant.
- Smoking: You can continue smoking during the prep.
- Length of procedure: The entire procedure usually takes 30 minutes or less. You should plan to be at the facility for approximately 2 - 3 hours. The amount of time may vary from patient to patient, depending on how much sedation is needed and how you feel afterwards.
- Pain: You will be given sedation during the procedure to help you stay comfortable. You may experience some cramps and discomfort briefly during the exam.
- Sedation: The goal of the sedation given during the procedure is to make you drowsy and keep you comfortable but still be slightly awake so you can breath on your own and roll over if needed.
- Bowel Movements: Because your intestines were completely cleaned out for your procedure, it may take a couple of days of eating solid foods before you have a bowel movement.
- Driving and transportation: The sedation medication given during your procedure impairs your judgment and reflexes. You may feel sleepy, groggy or confused and are considered legally impaired. It can take several hours for the side effects of the sedatives to wear off, so you aren’t permitted to drive for 24 hours following your colonoscopy. A trusted person must drive you home or accompany you on public transit. They also need to stay with you until the next day.
- Eating: Generally, you can eat immediately after your procedure. Occasionally, there is mild nausea from the sedative medications. You may not have a full appetite until the following day.
- Recovery: Colonoscopies are common, simple procedures, and you’ll be able to go back to your usual routine the next day. After the colonoscopy, you will be taken to an observatory area for 30 to 60 minutes until the side effects of the medication wear off. If your doctor removed a polyp during the colonoscopy, you might need to be on a temporary special diet. If no abnormalities were found, you should be able to eat once you get home. After you get home, you should spend the rest of the day relaxing.
- Side Effects: The most frequent side effects are slight abdominal pain and cramping caused by the air used to inflate the colon during the procedure. This discomfort usually passes quickly and only lasts a few hours. Immediately following the colonoscopy, you may experience side effects from the medications and sedatives, and those will wear off throughout the day. It’s common to feel sleepy, groggy or confused.
- Working: Due to the sedation given during the procedure, you should plan to rest at home for the remainder of the day. You may resume your usual activities 24 hours after your procedure.
Colonoscopy Prep: Food & Drink
4 Days Before: Low Fiber Diet
Four days before your colonoscopy, you must follow a low fiber diet. The hulls from popcorn and some nuts and seeds can stay in the colon for days. During your procedure, the hulls can appear as growths in the colon. Popcorn hulls, small seeds/nuts can also clog the suction channel of the scope, which make the scope inoperable and cause the procedure to be stopped.
Low Fiber Diet Guidelines
| Eat | Don't Eat |
|---|---|
| White bread, rolls, biscuits, croissants and melba toast | Breads or rolls with nuts, seeds or fruit |
| Waffles, French toast and pancakes | Whole wheat, pumpernickel, rye breads and cornbread |
| White rice, noodles, pasta, macaroni and peeled cooked potatoes | Potatoes with skin, brown and wild rice and kasha (buckwheat) |
| Cooked cereals: farina, cream of rice | Granola and granola bars |
| Cold cereals: puffed rice, Rice Crispies, Corn Flakes and Special K |
| Eat | Don't Eat |
|---|---|
| Margarine, butter, oils, mayonnaise, sour cream and salad dressing | Nuts, seeds and coconut |
| Plain gravies | Jam, marmalade and preserves |
| Sugar, clear jelly, honey and syrup | Pickles, olives, relish and horseradish |
| Spices, cooked herbs, bouillon, broth and soups made with allowed vegetables |
All desserts containing nuts, seeds, dried fruit, coconut or made from whole grains or bran |
| Coffee, tea and carbonated drinks | Candy made with nuts or seeds |
| Plain cakes and cookies without nuts and seeds | Popcorn |
| Gelatin, plain puddings, custard, ice cream, sherbet and popsicles |
Granola, fiber and health bars |
| Hard candy | |
| Pretzels | |
| Ketchup and mustard |
| Eat | Don't Eat |
|---|---|
| Strained fruit juices | Prunes and prune juice |
| Canned fruit, except pineapple | Pineapple |
| Ripe bananas | Raw or dried fruit |
| Melons | All berries, figs, dates and raisins |
| Eat | Don't Eat |
|---|---|
| Ground, well-cooked tender beef, lamb, ham, veal, pork, fish, poultry and organ meats | Tough, fibrous meats with gristle |
| Eggs | Dry beans, peas and lentils |
| Peanut butter without nuts | Peanut butter with nuts |
| Tofu |
| Eat | Don't Eat |
|---|---|
| Milk, plain or flavored | Yogurt with nuts or fruit and/or granola |
| Yogurt, custard and ice cream | |
| Cheese and cottage cheese |
| Eat | Don't Eat |
|---|---|
| Tender cooked and canned vegetables without seeds | Raw or steamed vegetables |
| Carrots, asparagus tips, green and wax beans, pumpkin, spinach and lima beans | Vegetables with seeds |
| Winter squash, peas, broccoli, brussels sprouts, cabbage, onions, cauliflower, baked beans, peas, lettuce, sauerkraut and corn |
1-2 Days Before: Clear Liquid Diet
A clear liquid diet leaves no residue in the intestines or the stomach, giving the doctor a better look at the lining of the colon. It ensures you stay hydrated, which helps you recover faster after the procedure.
One or two days before your colonoscopy, stop eating solid foods and drink only clear liquids. However, you’re not just stuck with water on those days. You can even continue drinking your morning coffee. Some drinks and foods that qualify as clear liquids and others that don't include:
| Drink or Eat | Don't Drink or Eat |
|---|---|
| Water (plain, carbonated or flavored) | Solid food of any kind |
| Coffee (you may use sugar or sweeteners, but no cream) | Dairy products including milk, cream and powdered creamer |
| Jell-O (avoid red or purple) | Anything colored red or purple, like grape soda or cherry Jell-O |
| Flavored broths | Soup with noodles, meat or vegetable |
| Fruit-flavored beverages like lemonade | Alcoholic beverages |
| Carbonated drinks, including dark beverages like root beer or cola | |
| Sports drinks | |
| Flavored ice pops (avoid red or purple) | |
| Tea | |
| Hard candy such as lemon drops or mints | |
| Chewing gum |
Can I drink anything other than water while I'm prepping for the colonoscopy?
Yes, it's important to drink a variety of allowed clear liquids to avoid becoming nauseated and dehydrated. Clear liquids include: apple and white grape juice or other non-citrus juices without pulp, Gatorade, ginger ale, diet or regular 7-Up, Sprite or colas, Kool Aid, water, clear broth, popsicles and hard candies without filling. Black coffee or tea without cream or powdered creamer and Jell-O without added fruit (no red/purple coloring) are also OK. You may drink clear liquids up until two hours before your procedure.
Why can’t I drink or consume anything red or purple during my clear liquid diet?
Avoid anything colored red or purple, like grape soda or cherry Jell-O. The food dye can cause misinformation during the colonoscopy. The exact diet instructions will vary, so consult with your doctor. When you consume something red or purple such as red jell-O, it can stain the colon or appear to be blood. To help ensure an accurate exam, these liquids should be avoided.
Colonoscopy Prep: Medications
Can I take other medications before the procedure?
Yes, except the ones you were told to hold/stop by the doctor or nurse. Generally, you should take prescribed medication, as directed, both on the preparation day and on the day of the procedure. However, don’t take anticoagulants (blood thinners) for at least 2-7 days prior to the procedure. These include Coumadin, Plavix, Xarelto, vitamin E, ibuprofen and other NSAIDs. If you’re on any of these medicines, please let us know well in advance of the procedure. Aspirin can usually be continued.
- Anti-anxiety medication: You may take your anti-anxiety medications with a small sip of water.
- Diabetes medication
- Before the day of your procedure, follow the instructions from your gastroenterology office about changes to the amount and timing of your diabetes medication.
- The morning of your procedure, don’t take any diabetes medicine. You can resume your medication after the procedure when you’re ready to start eating again. If you have questions, call the physician that manages your diabetes and tell them about your prep. They can determine how to adjust your medication.
- Diuretics (water pills): If you take diuretic medicine such as Lasix, Spironolactone, Hydrochlorothiazide (HCTZ) or any others, don’t take your diuretic medicine the day of your colonoscopy.
- Weight-loss medication: Injectable weight-loss medications can delay food passing through your stomach. Most injectable weight-loss medications need to be stopped for at least one week prior to your procedure. Please let your gastroenterology office know if you’re on any weight-loss medications, so they can direct you on how long you need to pause them.
Do I need antibiotics before the procedure?
No. In general, most patients don’t need antibiotics prior to a colonoscopy. This includes patients with artificial knees/hips, mitral valve prolapse, pacemakers and artificial heart valves.
I accidentally took ibuprofen/NSAIDs or aspirin, will my procedure need to be rescheduled?
It’s unlikely, but call the doctor to be sure. These medicines thin blood and make it a little riskier for bleeding during your coloscopy.
Colonoscopy Prep: Bowel Prep and Laxatives
What is a Bowel Preparation Drink?
Today’s bowel preparation drink is much easier to drink than it used to be. Patients can now choose half-gallon options, instead of a full gallon, to split up the dose. Many doctors allow patients to drink half the night before the colonoscopy and half the morning of, making it a little easier.
This drink acts as a laxative to help clear out the bowels. Ask your doctor if you can add flavored drink crystals, like Crystal Light or lemon juice, to the solution. You may also find it easier to drink the solution if you chill it in the refrigerator first.
Bowel Prep FAQs
Don't let fear of the unknown prevent you from taking control of your health. Schedule your routine colonoscopy today. Early detection is key to preventing colon cancer and ensuring successful treatment. Remember, your health is worth it. If you have any questions, don't hesitate to call the team at your colonoscopy location or ask your doctor through the MyUnityPoint patient portal.