Preparing For a Colonoscopy

The Essential Steps in Preparing for Your Colonoscopy

Woman doctor talking to patient in hospital
What do you need to know if order to prepare for your colonsocopy?. David Sacks/Stone/Getty Images

If you have a colonoscopy scheduled, your doctors office has probably told you the steps to take to be prepared. Let's take a look at how you can best prepare, the reasons for planning ahead, and review what you should know before having this important test.

The Importance of Your Colonoscopy

The first and most important step in getting ready for your colonoscopy is to understand why this test is done and its importance relative to other preventive health measures you may take.

Understanding what a colonoscopy may be prevent—and imagining what may happen if you were to skip this test altogether—can be helpful if you feel inconvenienced or uncomfortable about your upcoming test.

Screening colonoscopies are one of the significant reasons that deaths from cancer are declining. While there has been some controversy over the importance of mammograms in screening for breast cancer and PSA tests in screening for prostate cancer, there is little controversy over the benefit of colonoscopies in reducing colon cancer deaths. The evidence that they make a difference—that they lower the risk that someone will die from colon cancer—is strong.

It's thought that if everyone who meets the criteria for a colonoscopy had this procedure done, we could reduce the death rate from colon cancer in the United States by 60 percent. Colon cancer is currently the 3rd leading cause of cancer-related deaths in both men and women.

Colonoscopy and Colon Cancer Prevention - Early Detection and Prevention

Another very important difference between screening colonoscopies, and, say, mammograms or PSA tests is that colonoscopies may actually prevent cancer.

Like mammograms and PSA tests, colonoscopies play a role in early detection. A colonoscopy may find cancers in the earliest most treatable stages of the disease, and in doing so, improve colon cancer survival rates.

Yet colonoscopies are different in an important way. They may also work to prevent the development of cancer in the first place. If precancerous polyps, or polyps that may become precancerous are found, they can be removed during a colonoscopy. (Note: not all polyps lead to colon cancer.)

So colonoscopies play a double role in reducing colon cancer deaths; they can aid in early detection but can also work as a method of primary prevention.

When Should You Have a Colonoscopy (and When do You Need More?)

Therefore the most important step is to decide you should follow guidelines and have a colonoscopy performed.

It's important to note that guidelines for colon cancer screening are designed for the public based on average risk. If you have a family history of colon cancer or any other risk factors for colon cancer, you may need to have a colonoscopy at a younger age, or have these tests done more frequently.

It's also important to note that colonoscopies for colon cancer screening are designed for people who do not have any symptoms; who are "asymptomatic." If you have any symptoms of colon cancer, such as abdominal pain, blood in your stool, or have developed an unexplained anemia, or unintentional weight loss, you may need tests in addition to a colonoscopy.

A colonoscopy—with an adequate prep—is fairly good at detecting colon lesions. Yet a colonoscopy may miss some lesions and does not give any information about your small intestine, stomach, pancreas, liver, or other organs in your abdomen.

Colonoscopy Fact and Fiction

Now we are getting to the most difficult step—scheduling the procedure. Unfortunately, many people get stuck at this step. Take a moment to learn about some of the myths and the facts and fiction regarding colonoscopies so you can get past some of these fears.

Scheduling Your Colonsocopy

The second most important step—after understanding why you are having a colonoscopy—is to schedule the appointment.

If you are trying to figure out when to fit a colonoscopy into your schedule, the phrase "just do it" is appropriate. Many people end up foregoing a colonoscopy (and sometimes regret the decision) because they spend too much time trying to figure out the right time to do it. If this sounds like you, just go ahead and schedule it, and worry about details later on.

If, in contrast, if you are convinced you want to have a colonoscopy soon and won't risk putting it off, it may help to schedule the procedure at a good time. Many people like to schedule their test on a Friday, giving themselves a weekend to recuperate if needed. Most people feel ready to return to work the next day and have no after effects, but some people have bowel changes that last a few days. If you schedule the test at a good time (not the day before going on a vacation to paradise) you will be less worried that your colonoscopy will interfere with your life. In our busy society, every chance to reduce stress is worth it!

Understanding the Risks and Complications

Once you have your colonoscopy scheduled—since this is perhaps the most difficult step—take some time to learn more about the procedure and remind yourself of the benefits. As with any procedure, there are things that can sometimes go wrong. Take some time to thoroughly understand the risks and possible complications of a colonoscopy.

In the Weeks Prior to Your Colonoscopy

If you are taking any medications which can thin your blood, your doctor may ask you to discontinue these prior to your colonoscopy. This is not always the case (for example, if you have heart disease your oncologist may still want you to take your aspirin.) Talk to your doctor and find out what you should do ahead of time. Some medications need to be discontinued for as long as two weeks prior to your procedure. Keep in mind that this includes over-the-counter and herbal preparations as well. Aspirin and non-steroidal anti-inflammatory medications such as Advil (ibuprofen) can increase bleeding and should be avoided unless your physician believes the benefits of these medications outweighs any risk of bleeding. There are many herbal preparations and dietary supplements which can increase bleeding as well.

In the Days Prior to Your Colonoscopy

Your physician will likely recommend a certain diet prior to your procedure. This may begin several days ahead of time. Make sure to follow these recommendations closely, and talk to your doctor if you will have any difficulty, for example, if you have diabetes.

The Colonoscopy "Prep" - Cleaning out Your Colon

Your doctors office will probably send you written information describing the preparation for a colonoscopy in depth. It's important to read this information thoroughly, as research tells us that many people are not properly prepared. In order to be able to adequately visualize your colon in its entirety, all stool has to be eliminated.

A colonoscopy prep is usually done through a combination of:

  • Purgatives - Purgatives work by stimulating the evacuation of the bowel. Several options are available, such as goLYTELY solution, TriLyte solution, and many more. The choice between these multiple treatments varies between different physicians and there are advantages and disadvantages to each. For those who are elderly or have other medical conditions, it's thought that preparations with ethylene glycol may be the safest. In contrast, sodium phosphate solutions should be avoided in the elderly or people with significant medical conditions, due to the effect of these solutions on the kidneys.
  • Enemas - An enema involves the introduction of a liquid through your anus and into your large intestine. The liquid is held for awhile and then passed. Enemas can be very effective in reducing the amount of fecal matter in the colon. Possible side effects of enemas include hyponatremia (a low sodium level in the blood) other and other electrolyte disturbances.
  • Fasting (not eating) - Again, make sure to follow your doctors recommendations on diet prior to your procedure.
  • Comfort treatments - Medications may be recommended which ease the discomfort of bowel evacuation as well. These may include Reglan to reduce nausea and heartburn, and Mylicon or Mylanta (to reduce gas so that things flow more comfortably through your bowels.)

Physicians who perform colonoscopies differ with regard to the colon "prep" they recommend, but the goal is the same. Your colon needs to be cleaned out enough to see any areas which could pose a problem in your future . Since colonoscopies are more accurate with a good prep, and people often claim that the prep is the worst part of the colonoscopy, it pays to make sure your prep is adequate the first time. Far too often these procedures need to be rescheduled after a better prep, putting you through the anxiety of scheduling and preparing a second time.

As another pointer, learn about what not to do during your colonoscopy prep.

The Night Before Your Colonoscopy

Most of the time you will be asked to refrain from food or drink after midnight on the eve of your procedure. If you are taking any medications, make sure to talk to your doctor. Most often, people are told to take their regular medications the night before and on the day of the procedure with small sips of water.

You Will Need a Driver and a "Babysitter"

The anesthesia usually used for a colonoscopy is referred to as monitored care anesthesia, conscious sedation, or "twilight sleep." You may sleep through the procedure or may be awake but unconcerned about what is happening. Since the anesthesia can stay in your system for some time, you will be required to have a driver to take you home. If you live alone, you will also have to plan for someone to stay with you for 24 hours after the procedure.

The Colonoscopy Procedure

Take a few moments ahead of time to learn about what happens during the colonoscopy procedure.

After Your Colonoscopy

As noted above, after your colonoscopy you will need someone to drive you home and stay with you for 24 hours. Most often you can return to eating a normal diet. Due to the effect of anesthesia, many physicians recommend avoiding alcohol for the first 24 hours as well. If you did not have a polyp removal, you can usually resume normal activities at that time.

If you had a polyp removed, your doctor will likely recommend that you restrict your activities over the next week. During this time you should avoid strenuous exercise, lifting heavy objects, and travel.

Complications are uncommon, but you should call your doctor if you develop a fever, moderate to severe abdominal bloating and pain (some discomfort and bloating is normal), or if you experience bleeding (more than one tablespoon.)

Bottom Line on Preparing for Your Colonoscopy

If you've scheduled your colonoscopy, you should congratulate yourself. Taking the time to do this procedure is one of the easiest ways (according to solid studies) to reduce your risk of dying from cancer. Since colon cancer often has a lead time (it progresses from slightly abnormal changes to precancerous polyps and then cancer) it is one of the few cancers that can be caught early or prevented entirely though a screening procedure.

That said, colonoscopies are not entirely fool proof. If you have or continue to have any symptoms of colon cancer, make sure that you talk to your doctor even if you had a "normal" colonoscopy. Symptoms are the way our body tells us that something is wrong. Ask questions until you get an answer.

The preparation for your colonoscopy may seem like a pain, but we are learning more and more that the inconvenience of the procedure is well worth the transient discomfort of the prep and procedure in the long run. Take a moment to look over these tips and tricks for colonoscopy preparation from those who have been there.

Sources:

Ho, S., Hovesepians, R., and S. Gupta. Optimal Bowel Cleansing for Colonoscopy in the Elderly Patient. Drugs and Aging. 2017. 34(3):163-172.

Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.

Kurlander, J., Sondhi, A., Walijee, A., Menees, S., Connell, C., Schoenfeld, P., and S. Saini. How Efficacious are Patient Education Interventions to Improve Bowel Preparation for Colonoscopy? A Systematic Review. PLoS One. 2016. 11(10):e0164442.

Liu, Z., Zhang, M., Li, Y., Li, L., and Y. Li. Enhanced Education for Bowel Preparation Before Colonoscopy: A State-of-the-Art Review. Journal of Digestive Diseases. 2017 Jan 9. (Epub ahead of print).

Continue Reading