When your doctor says it’s time to schedule a colonoscopy, do you start thinking up excuses to put it off? You may worry about unpleasantness and inconvenience as you prepare for the exam. But you should know that the prep process is much easier these days.
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Yes, one of the keys to a successful colonoscopy is the “clean-out” beforehand. But improvements — in the liquid you drink, the amount of liquid you drink and the timing — make the whole process easier to swallow.
Here’s what you need to know.
Regular colonoscopies can save your life
Most patients who develop colon cancer have no obvious risk factors. “If you have a colon, you are at risk for colon cancer. That’s why colonoscopies are vital for your health,” says Carol A. Burke, MD, Director of the Center for Colon Polyp and Cancer Prevention.
The American Cancer Society estimates that more than 50,000 people will die from colorectal cancer in 2017. Colorectal cancer is the second leading cause of cancer-related deaths among U.S. men and the third leading cause among U.S. women.
The good news? The death rate continues to drop, thanks to early screenings and better treatment. The key is to have regular exams as you age.
The prep helps your doctor spot signs of trouble
Drinking a laxative prep to cleanse the bowel is not everyone’s favorite thing to do. But it’s a key part of your colonoscopy. “If the colon lining is not clear of solid and liquid, then bowel residue polyps — which are a precursor for cancer — are sometimes missed,” says Dr. Burke.
Good preps make the exam more effective and efficient. If your prep is poor, the doctor may need to repeat your exam — and you’ll need to repeat the prep.
Three steps for a good prep
You’ll start preparing for your colonoscopy a couple of days before you drink the bowel-cleansing agent.
- Cut out fiber. Two days before your exam, you’ll switch to a low-fiber diet.
- Switch to clear liquids. One day before the exam, you’ll drink only clear liquids. “You need a lot of clear liquids to stay optimally hydrated and help flush the prep through the intestinal tract,” says Dr. Burke. “We have learned that having fewer hours between finishing the prep and starting the colonoscopy is the optimal cleansing strategy.”
- Start the prep. Many physicians today prescribe a split-dose regimen, where you take half the prep the night before and the other half the morning of the procedure. If you have an afternoon exam, you can drink the prep the morning of the procedure. If you have a morning exam (before noon), you can drink half the prep the night before and the other half about four hours before the colonoscopy. “Every day, it’s an early morning for the first few patients we examine, but they have the best clean-out,” says Dr. Burke.
In a recent study, she and other researchers compared the split-dose prep to conventional bowel-cleansing methods. They found that a split-dose bowel preparation decreased the intensity and duration of bowel movements, caused less patient inconvenience and improved bowel preparation.
A better-tasting solution
Dr. Burke says liquid bowel-cleansing agents have become more palatable. Several better-tasting and lower-volume solutions are now in use. Along with the half-gallon and split-dose approaches, this improves the experience for patients.
“The old gallon/4 liters of laxative solution has stiff competition these days with 3-liter, 2-liter and 10-ounce alternatives,” she says. “Of course, the lower-volume preps require additional clear liquids for action. Some of my patients have actually said the newest low-volume preps taste great, or that they love them.”
Look for an expert
Talk to your primary care doctor about when to start having regular colonoscopies. Your age, race and family history will affect the timing.
While primary care physicians and general surgeons can perform these procedures, “it’s best to have your doctor refer you to an endoscopist, who has special training and is highly experienced in colonoscopy,” says Dr. Burke. Your doctor can refer you.
When you’re not sure of a doctor’s credentials, ask about their complication rate, completion rate and adenoma (polyp) detection rate before having a colonoscopy, she says. The American Society of Gastrointestinal Endoscopy offers a list of questions that patients can ask.