Ensure a seamless screening with this expert advice
If you’re among the 19 million Americans scheduled for a colonoscopy this year, you probably have a lot of questions, some of which likely include concerns about preparing for the test.
If that’s the case, you’re not alone. Gastroenterologist Maurice A. Cerulli, M.D., an associate professor at Northwell Health in Long Island, N.Y., says that prep for the procedure—which consists of strong laxatives and fasting—scares away roughly 10 percent of patients between ages 50 and 75, the prime age for colonoscopies.
But he has a sentiment he likes to share with patients in advance: Yes, you can survive the pretest preparation.
“We can find a solution for everyone,” he promises.
How a Colonoscopy Works
The test involves threading a colonoscope, a long flexible tube with a camera, through the five-foot length of the large intestine. It can only successfully display the colon when it’s purged of all remnants of stool, which sometimes requires up to 16 hours of diarrhea that usually begins after taking laxative liquids. Several days before that, some foods are no longer allowed because they can be difficult to fully remove from the bowel.
Your doctor will provide instructions on this process, including information about the test-preparation kit prescribed. He or she will also find ways to help you get through the uncomfortable periods in the bathroom that are sometimes unavoidable.
Here are Dr. Cerulli’s top colonoscopy prep suggestions.
- Talk to Your Doctor in Advance
Several weeks before the screening, be sure to inform your doctor about your work schedule, insurance coverage, anesthesia concerns, and usual bowel habits.
“For instance, if you tend to be constipated or if you have kidney issues, we can change the preparation formula we use,” says Dr. Cerulli. “Or if a patient is terrified of sedation, I can use a pediatric colonoscope to make the procedure tolerable while fully awake.” - Create a Prep Calendar
When your doctor outlines when to start modifying your diet, fasting, and when to start taking your preparation drink, set reminders on your calendar or your phone. This will help you remember to avoid foods that can be tough to eliminate from your colon. If you envision roadblocks, mention them early. For example, laxative pills, alternate preparations, and enemas can be used if you can’t stomach the regular pre-colonoscopy drinks. - Remove Forbidden Foods
Keep “prohibited foods,” including seeds, nuts, popcorn, fatty foods, tough meat, whole grains, raw veggies, fruits with seeds (strawberries) and or edible skin (apples), and corn, broccoli, cabbage, beans, and peas out of easy reach, or replace them with foods or other edibles your doctor allows (see Tip #4) before the exam. - Head to the Store
Stock your colonoscopy supplies early. You’ll need bathroom products, day-before indulgences, various water flavorings, and clear fluids. (More on all of these below.)
One important item for your shopping list: something to make the liquid laxative more palatable. Some people swear by ice pops, Jell-O, clear sodas, or juices. Just don’t buy anything with a deep red, purple, or blue color that could leave a stain on the colon that a doctor might mistake for an abnormality.
“Anything transparent will do, from apple juice to white grape juice to ginger ale, and some people like bouillon to warm up,” says Dr. Cerulli. - Indulge Before “The Big Prep”
Although some doctors insist on switching to clear fluids well before the final pretest preparation period (to ensure no additional wastes can build up in the colon), Dr. Cerulli believes that allowing “light” treats immediately before the formal preparation schedule improves compliance.
“I’m a big fan of ice cream before the prep,” says Dr. Cerulli, who also recommends foods like soft cheeses, milk shakes, and white yogurt. These so-called “solid liquids” are particularly helpful for people who might become ravenously hungry at work before the test day.
Your doctor will tell you when your actual fast will begin. At that point, you’ll stop consuming all solid foods and switch to clear liquids only. - A Spoonful of Sweetener Helps the Medicine Go Down
You can also sweeten the preparation drink itself. “Anything that dissolves into a clear liquid is acceptable, but its best if you stick with artificially sweetened versions rather than sugar, which makes the intestinal lining absorb more water,” Dr. Cerulli suggests. “Be sure the liquid is chilled to cut the saltiness, though,” he adds.
Try sipping it through a straw on the back of your tongue to avoid having the liquid in your mouth for too long. Dr. Cerulli also recommends switching between sips of the preparation liquid and licks of a popsicle, small amounts of ginger ale, or flavored water or seltzer.
And of course, none of it can be heavily colored. - Equip Your Bathroom
About one to three hours after you’ve downed the first half of your laxative solution—roughly 16 hours before the colonoscopy is scheduled—the diarrhea begins. Stock your bathroom with magazines and books, plenty of aloe wipes, soft toilet paper, diaper cream, handwashing liquid, and towels within convenient reach.
Consider creating a relaxing playlist or queuing up your favorite podcasts to keep you company during extended bathroom visits. - Stay Hydrated
Throughout the prep process, and especially once you’ve been confined to the bathroom, it’s important to keep your digestive system moving with lots of clear liquids.
“Diarrhea removes fluids, so you’ll have to continually replace them with water in addition to the prep liquid to prevent dehydration,” says Dr. Cerulli.
But don’t consume a gallon all at once, he advises. Sip slowly, and alternate the prep drink with water flavored with lemon, clear juices, or sodas. Aim for eight ounces every 15 minutes. When the diarrhea is as clear as your liquids, possibly with a slightly yellowish hue, you’re done. Otherwise, amp up the water intake. - Keep Irritation at Bay
Nonstop bathroom trips create irritation, so keep aloe wipes handy.
“Your loose bowel movements contain lots of bile that can burn your skin, so regular toilet paper is inadequate,” says Dr. Cerulli.
But be careful not to apply any creams—including diaper rash ointment—until your skin is totally clean and dry. Otherwise, warns Dr. Cerulli, “creams can trap irritants that aren’t completely removed, and make things worse.”
Given the efficiency of the laxatives, you may want to wear an adult diaper to the exam or pack a change of clothes. - Prepare for Post-Procedure
Some people emerge from a colonoscopy feeling energized and refreshed, but many patients have some unsteadiness from the sedation. Be sure to arrange for a driver home from the test after you’ve finished; you won’t be allowed to drive yourself if you’ve been sedated.
Beyond that, expect some cramping and discomfort, which is mostly due to the carbon dioxide pumped into the colon during the test. You might also be a bit gassy but can otherwise return to your normal life fairly soon.
You’ll also be pretty hungry, Dr. Cerulli adds. His suggested post-procedure meal? An ice cream sundae with nuts, red berries, and a highly pigmented cherry on top.
