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A colonoscopy might seem like a faraway thing … until it’s time to schedule your first one. If you’re approaching 45 — the recommended age to start colorectal cancer screening — you’re not alone if you’re feeling some dread. Sure, there’s the prospect of a tube going up your rectum and colon, but at least you won’t feel that under sedation. You will feel the 24 hours beforehand, downing bowel prep solution and sitting on the toilet.
But fear not, there are ways to make the colonoscopy prep process go more smoothly. Here are the best tips from gastroenterologists at UW Medicine and Fred Hutch Cancer Center.
Tip #1: Remember your “why”
There’s no getting around the fact that colonoscopy prep is not going to be the most fun 24 hours of your life. It’s disruptive and uncomfortable, and it’s natural to want to avoid it. But it’s important to remember why you’re doing it — you’re substantially decreasing your risk for colorectal cancer, which kills about 50,000 people each year.
“Even though going through a colonoscopy can be intimidating, the benefits are preventing colorectal cancer or diagnosing it at an earlier stage,” says Cynthia Ko, MD, MS, a gastroenterologist at the Digestive Health Center at UW Medical Center and a professor of Gastroenterology and Medicine at the UW School of Medicine. “Preventing colon cancer means not having to go through colon cancer treatment such as surgery or chemotherapy.”
And finding colorectal cancer early dramatically increases the chances that it will be treatable. The survival rates go from about 90% when detected early to about 15% when it’s caught late and has spread to other parts of the body.
Keep this in mind when you’re tempted to cut corners, like skimping on that second dose of bowel prep solution.
“A properly prepped colon enables the best view of the colon, allowing for a more accurate diagnosis and a safer procedure,” says Ko. “If someone doesn’t do a good job on their bowel prep, they might have to do it all over again or come back sooner for another colonoscopy with a good prep.”
And no cheating on the low-fiber diet that you need to start five days before your colonoscopy.
“Be very careful with fibrous foods, nuts and seeds in the days leading up to the colonoscopy,” says Isabel Hujoel, MD, a gastroenterologist at UW Medicine. “High-fiber foods or foods with nuts or seeds in them are harder to clear from the colon, and if they are in the colon at the time of the colonoscopy, they can clog up the scope and make the procedure challenging to complete.”
Plus, if you do a good job with your prep and no polyps or cancers are detected, you most likely won’t have to do it again for another 10 years.
Tip #2: Think about when to schedule your colonoscopy
Most bowel preps are now split into two doses. You take the first one the evening before your colonoscopy and the second six hours before. That means it pays to think about whether you’d rather have your colonoscopy in the morning or the afternoon.
“Morning procedures used to be in high demand, but with split dosing that is now used, patients need to wake up in the middle of the night to drink the second half of the prep for a morning appointment, so afternoon procedures have been increasingly popular to allow the patient to sleep through the night,” says Stephen Rulyak, MD, MPH, a gastroenterologist at Fred Hutch Cancer Center and an associate professor in the Division of Gastroenterology at the UW School of Medicine. “It really amounts to patient preference.”
Scheduling an afternoon appointment might allow you to get a bit more sleep, but it also means you’ll have to wait longer (on a very empty stomach) to get your procedure over with. Weigh the pros and cons, and schedule a time that works best for you.
Tip #3: Ask your doctor about low-volume bowel prep options
When most people think about bowel prep, they picture traditional laxative formulas like GoLYTELY, which require drinking 4 liters of salty, bad-tasting solution.
Traditional larger-volume bowel prep formulas are still often prescribed, and for good reason. They’re extremely effective at cleaning out your colon and are generally covered by insurance.
That said, there are now low-volume options that work for many people. These include formulas that only require 2 liters of liquid or over-the-counter osmotic laxatives that can be mixed with a sports drink. There are also saline-based laxatives, like Suprep and Clenpiq, which come in much smaller 6-ounce bottles, and Sutab, which is a pill.
If your GI doctor only offers traditional prep, feel free to bring up low-prep options.
“The small-volume preps can’t be used in some patients with conditions like renal insufficiency and significant congestive heart failure,” says Rulyak. “But if patients want a small-volume prep, they should by all means ask.”
One last thing to keep in mind? Even if your doctor is able to prescribe a low-volume prep or pill, there’s no escaping the fact that you’re going to need to down a lot of fluids.
“With the low volume preps or the pill-based preps, there is less of the prep solution, but patients still have to drink a lot of water,” says Ko.
Tip #4: Flavor and chill your bowel prep solution
Whatever kind of bowel prep you’re using, one of the most commonly shared tips is to stick the liquid in the refrigerator before drinking it.
“Drink the laxative cold, as this will lessen the salty and somewhat ‘chemical’ taste of the prep,” says William Grady, MD, a gastroenterologist at the Digestive Health Center at UW Medical Center, the medical director of the Fred Hutch GI Cancer Prevention Program Clinic and the Rodger C. Haggitt Professor of Medicine at the UW School of Medicine.
Another hack? Add lemonade or sports drink powder to your bowel prep liquid if it’s not already flavored. Or have a sports drink on hand as a chaser. Just make sure it’s clear or yellow (absolutely no red, blue or purple beverages).
Tip #5: Know what you can eat the day before
The morning of the day before your colonoscopy, you should still be able to eat solid foods before going on an all-clear-liquid diet for the rest of the day.
“There are good data that show that a light, low-fiber breakfast early in the morning on the day prior to the procedure does not decrease prep quality, although patients should confirm their physician is OK with this,” says Rulyak.
What kinds of things can you eat that morning? Here are some ideas:
- Eggs
- Plain or vanilla yogurt
- Plain rice
- Cereal
- Crackers
- Plain pasta
Once you start your clear liquid diet, you can still eat and drink some things besides water and bowel prep, and it can help to have something chewy or salty while you’re drinking your solution.
“Clear liquids definitely include gummy bears (basically firm Jell-O),” says Rulyak. “Chicken broth is fine too, as are Jello, clear juices, tea and black coffee.”
But once again, no red, blue or purple gummies, Jello or juice.
Tip #6: Don’t try to drink your bowel prep too quickly
While it might be tempting to get it over with and down all your solution at once, that’s not a great idea.
“If you gulp it down too quickly, it can cause nausea or bloating,” says Ko.
If you do have nausea, slow down — some people find that using a straw helps. If you’re really struggling with nausea, ask your doctor about getting prescribed an anti-nausea medication.
Tip #7: Prepare for your time on the toilet
Once you start taking your bowel prep, you’re going to want to be close to a toilet — so maybe don’t plan any outings or have guests over the day before your colonoscopy.
Grady has some tips for your time on the porcelain throne:
“For the toilet, use wet wipes or Preparation H wipes to ease irritation, and comfort grade 2-ply toilet paper,” he says. “Also, pick some interesting or fun reading material or videos for your time on the toilet.”
It could also be helpful to have a barrier or hydrocortisone cream on hand for irritation.
You got this
These tips won’t necessarily make colonoscopy prep pleasant, but being prepared and knowing what to expect will go a long way. And it might not be as bad as you think.
Neelendu Dey, MD, a gastroenterologist at Fred Hutch Cancer Center and an associate professor in the Division of Gastroenterology at the UW School of Medicine, had heard so many bad things about bowel prep from his patients that he was expecting the worst when it was time for his colonoscopy.
“This played to my advantage, however, as I breezed through it,” says Dey. “My advice to others would be to tell yourself that it’s going to be tough but that you can do it, and to be patient with yourself. And look forward to the first meal after the procedure, which will taste incredible!”
