Nervous About Colonoscopy Prep? A Doctor Explains What You Can Really Expect
Plus find out the scheduling trick that makes this crucial cancer screening easier
You already know how important it is to get screened for colorectal cancer starting at age 45, and the recent tragic passing of beloved actors Catherine O’Hara, 71, and James Van Der Beek, 48, from the disease has brought that reality into stark relief. But before you can get the procedure, you need to prep. Keep reading for everything there is to know about what this entails, including simple ways to make colonoscopy prep easier and a common misconception dispelled, so you can sail through with confidence.
Why colonoscopy prep is so important
It might be a bit of a pain to prep for the procedure but it’s a necessary step to get the most accurate results, says Anish A. Sheth, MD, chief of gastroenterology at Penn Medicine, Princeton Medical Center and author of What’s Your Poo Telling You? He confirms that screening starts at age 45 for everyone, and earlier for those with a family history or other high-risk conditions like inflammatory bowel disease (IBD).
“While stool and blood tests are available, colonoscopy remains by far the most effective test for preventing cancer and detecting precancerous polyps. But the exam is only as good as the prep—if the view isn’t clear, small polyps, especially concerning flat ones, can blend into the background of the colon and might be missed.”
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The crucial timing you need to know
One key bowel prep step is easy to miss, notes Dr. Sheth. “I think the first thing people don’t always realize is that it actually starts three days before your colonoscopy,” he reveals. “Your diet needs to change—we recommend avoiding roughage, fiber, nuts and seeds during this time.” A welcome addendum: You can eat just about anything else including meat, pizza or pasta.
What to expect during colonoscopy prep
Though prep instructions vary slightly from location to location, in general you’ll be on a clear liquid diet the day before the procedure. “Later that afternoon or evening, you’ll begin the prep solution,” says Dr. Sheth. “Research clearly shows that splitting the prep into two doses—half the evening before and half the morning of the procedure—results in a more effective cleanout than taking it all the day before.”
That’s why most healthcare providers now recommend this split-dose approach. “It’s a little bit annoying for patients who have early morning procedures, because they have to get up at an ungodly hour to drink the second half, say, at 3 a.m. for an 8 a.m. procedure,” he acknowledges.
But studies consistently show that taking the second half closer to the procedure leads to better results.” A simple way around this “rude awakening” is to schedule your colonoscopy later in the morning so that you can take the second dose of prep at a more reasonable hour such as 6 a.m. for an 11 a.m. procedure.
Why you should skip the add-ins
If you’re wondering whether you can add Gatorade or Crystal Light to your prep to make it easier to drink, it’s best not to. “There are about half a dozen prep options on the market, and in most cases you shouldn’t mix the solution with anything else,” cautions Dr. Sheth.
“Some older regimens, like certain MiraLAX-based preps, are different, but most solutions today come pre-mixed. Typically, you’ll drink a small amount of the prep solution—about five to 10 ounces—followed by plenty of water, then repeat the process for the second dose.”
While you generally shouldn’t mix anything into the prep itself, you can have approved clear liquids throughout the day, such as black coffee, black tea, broth, Gatorade or gelatin, he adds. “These options help provide a little energy and, just as importantly, help you stay hydrated.”
Will colonoscopy prep disrupt your day?
“We usually recommend taking the day of the procedure off, but most people can go to work the day before and after,” says Dr. Sheth. “It’s important to understand that while many people assume the day before will be completely disrupted by prep, the main change is just your diet—you won’t start drinking the solution that causes diarrhea until the afternoon or evening.
So, while there’s a common misconception that you’ll be pooping your brains out at work, in reality, you’ll just be sipping broth or clear liquids while your colleagues are having sandwiches. We try to minimize disruption and make it clear that you usually only need to take one day off for the procedure itself.”
Can you take a tablet instead of liquid prep?
You probably know that the liquid prep for a colonoscopy is a bit… well, the medical term is “yucky.” That begs the question: Is there an alternative? Yes, but it’s not typically recommended, declares Dr. Sheth. “People often ask about tablets used to clean out the colon for a colonoscopy, but they generally don’t work as well. They also may not be ideal for people with certain kidney concerns because of potential phosphate-related risks, so we tend to shy away from pill-based preps.”
That said, some people are prescribed tablet forms of the prep. “We typically reserve them for very specific patients, usually those who’ve had significant difficulty tolerating liquid preparations in the past and are unlikely to do well with them again,” explains Dr. Sheth.
“They’re not a first-line option, but for people who’ve struggled with vomiting or simply can’t tolerate large amounts of the sweet, salty solution, they may be an alternative. You still have to drink plenty of water, of course, but most people are able to manage the standard liquid prep.”
The bottom line on colonoscopy prep
With rates of colon cancer on the rise, especially among younger people, it’s never been more important to get a colonoscopy. And while prep isn’t anyone’s idea of a good time, it sets the stage for a successful procedure and the early detection that can make all the difference—for your health and peace of mind.
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