Colonoscopy Prep

PREPARATION FOR COLONOSCOPY
  
Cleansing the bowel to prepare for a colonoscopy is essential.  Various colon "preps" are available, each with their own advantages and disadvantages.  Listed below are the most common colon preps used today.  Tips to optimize the effectiveness of each prep are also highlighted.

 
Colyte / Nulytely / Golytely Prep
  
This prep is often considered the most reliable, thorough, and safest to use.  Some patients find it challenging as it requires drinking a large amount of fluid (four liters) over a few hours.  Others appreciate its rapidity and simplicity.

1. The entire day prior to colonoscopy, we recommend eating clear liquids only. Clear liquids include coffee, tea, soda, jello without solid fruit, juices without pulp (grape, apple, cranberry), and clear soups (chicken broth, bouillon).  Tip: Avoid red and purple jello as these can discolor the inside of the colon making the exam more challenging.

2. At 4 PM the day prior to the colonoscopy, start drinking the CoLyte/NuLytely.  Tip: Chilling the CoLyte/NuLytely or adding a flavor pack will often make it more palatable.  Try to drink an 8 oz. glass every 15 - 20 minutes, and try to complete the prep within 5 hours, if possible.  Tip: Many people become bloated and nauseous during the prep; if this occurs, stop drinking until these feelings pass.  You have all night to finish the prep, so don't feel pressured to force it down.  Tip: Recent studies have found that splitting the prep over two days may be more effective than taking the whole prep at once.  To perform a "split prep", drink half of the prep the night before the test and the second half early the morning of the test.  You must finish the whole prep and stop drinking two hour before the test is scheduled.  This approach is best for patients having their colonoscopy in the afternoon or for those who are having trouble drinking the whole prep at once. 

If you are simply unable to take the entire prep, but have drunk at least 1/2 of it and have had several good movements, the test may still be possible.  Tip: Take two Dulcolax (bisacodyl) tablets 2 hours after you have stopped the CoLyte/ NuLytely, and then the next morning use tap water or Fleet enemas until the return is clear.

3. On the day of your procedure, you may have clear liquids and take your usual medications until 2 hours prior to your procedure.  You should take nothing by mouth for 2 hours prior to your procedure.  Diabetics should be scheduled early in the morning, and take 1/2 of their usual insulin dose.
 
 
Two Day Prep
 
This prep is often employed for those who cannot drink large volumes of fluid or those who, in the past, have had suboptimal results with a standard prep. 

1. Two days prior to the colonoscopy, start a clear liquid diet as described above, and remain on it until after the procedure.   

2. Two days prior to the colonoscopy, at about 2 PM, drink an 8 oz bottle of Magnesium citrate.

3. One day prior to the colonoscopy, your physician will typically recommend another liquid laxative (low volume Colyte, Fleet Phospho-soda, Miralax, ect.) along with two 10 mg Ducolax (bisacodyl) tablets.
 
4. On the day of your procedure, you may have clear liquids and take your usual medications until 2 hours prior to your procedure. You should take nothing by mouth for 2 hours prior to your procedure. Diabetics should be scheduled early in the morning, and take 1/2 of their usual Insulin dose.
 
 
Fleet Phospho-soda Prep
 
Fleets Phospho-soda's active ingredient is sodium phosphate.  This prep is simple and reliable, but may be inappropriate or even dangerous for some people with certain medical conditions such as congestive heart failure, kidney disease, suspected bowel obstruction, advanced liver disease, etc.  As some patients may not be aware they have any of these conditions, we tend to avoid using this prep.

Due to concerns of kidney injury with sodium phosphate preps, the FDA has recommended these products not be available over the counter (OTC) for bowel cleansing.  In the appropriate patient, a sodium phosphate prep my be available by prescription.
 
1. The entire day prior to colonoscopy, we recommend eating clear liquids only.  Clear liquids include coffee, tea, soda, jello without solid fruit, juices without pulp (grape, apple, cranberry), and clear soups (chicken broth, bouillon).  Tip: Avoid red and purple jello as these can discolor the inside of the colon making the exam more challenging.

2. At 4 PM the day prior to colonoscopy, mix 45ml (1.5 fluid oz. or 3 tablespoons) of Fleet Phospho-soda with 12 oz. of either water, ginger ale, apple juice, or lemon-lime soft drink.   Important:  Drink 3 large glasses of water within the next 2 hours.

3. At 10 PM the day prior to colonoscopy, take a second dose of Fleet's Phosphosoda.  Again, mix 45ml (1.5 fluid oz. or 3 tablespoons) with 12 oz. of either water, ginger ale, apple juice, or lemon-lime soft drink.  Important:  After each dose, drink 3 large glasses of water within the next 2 hours.

4. At 4 PM the day prior to colonoscopy, take two 10 mg Dulcolax (bisacodyl) tablets.

5. On the day of your procedure, you may have clear liquids and take your usual medications until 2 hours prior to your procedure. You should take nothing by mouth for 2 hours prior to your procedure. Diabetics should be scheduled early in the morning, and take 1/2 of their usual insulin dose.
 
 
Visicol and OsmoPrep
 
These preps are variants of the Fleet Phospho-soda prep.  The active ingredient, sodium phosphate, is the same, but in a pill form.  Therefore, the same cautions apply to this prep, which may be inappropriate or even dangerous for some people with certain medical conditions such as congestive heart failure, kidney disease, suspected bowel obstruction, advanced liver disease, etc.

Due to concerns of kidney injury with sodium phosphate preps, the FDA has added a black box warning to Visicol and OsmoPrep addressing the risk of acute phosphate nephropathy.  Given this new warning these preps are currently prescribed only in very selective cases.

1. The entire day prior to colonoscopy, we recommend eating clear liquids only.  Clear liquids include coffee, tea, soda, jello without solid fruit, juices without pulp (grape, apple, cranberry), and clear soups (chicken broth, bouillon).  Tip: Avoid red and purple jello as these can discolor the inside of the colon making the exam more challenging.

2. At 4 - 6 PM the evening prior to the exam, take 3 VISICOL tablets with at least 8 oz. of water every 15 minutes. The last dose will be 2 tablets, for a total of 20 tablets. Do not exceed 20 tablets.   Important: Drinking all the recommended water with this prep is essential for its efficacy and safety. 

3. The morning of the colonoscopy, ideally 4 hours before the test, an additional 8 tablets must be taken.  Use the same dosing schedule of 2 or 3 tablets with at least 8 oz. of water every 15 minutes.  You may have clear liquids and take your usual medications until 2 hours prior to your procedure.  You should take nothing by mouth for 2 hours prior to your procedure.  Diabetics should be scheduled early in the morning, and take 1/2 of their usual insulin dose.
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