My grand plan with LivingSick.com was to merge my inner thoughts about living with Crohn’s disease and how it’s impacted my life with real-life, concrete tips. If you are a regular reader of mine, you’ll know that I prefer to have my head in the clouds, and that I’ve neglected the tips portion of my blog for too long now. That stops today. Well, at least for an hour or two.
Many people are facing their first colonoscopy and have heard how awful the purging process can be. Having had four colonoscopies, at least six capsule endoscopies, and three small bowel resections, I’ve been forced to purge at least 13 times in the last seven years. I consider myself an expert–a grand connoisseur of impossibly salty liquids and nauseating horse pills if you will. I’ve thankfully developed a system to see me through these hard days and nights that I hope will help you, too.
1. Forget about scopes up your rear and concentrate on the prep. When you are sedated, you won’t care about your dignity so check that fear immediately and get down to the real business, which is preparing for the prep. Do NOT wait until the last minute to look at the kit your doctor prescribed, or to read what you need to do the days leading up to the prep. Some doctors want you to start a low-residue diet a few days leading up to the prep while others will just have you fast the day before. You will need to pay close attention to your doctor’s instructions because some medicines can’t be taken up to a week before your procedure. The person in charge of scheduling your appointment will give you an instruction sheet and will go over it with you. Keep this sheet in a safe place.
2. My advice is to ask to use the Miralax/Gatorade prep recipe and stay away from the prescription preps, including GoLYTELY, because you will not “go lightly”. Not only is it expensive, but it’s vile tasting. I’m gagging right now just typing this. A lot of gastroenterologists have moved to the Miralax/Gatorade prep recipe because it’s tolerable and effective. (But never underestimate the power of a pharmaceutical sales rep. It could be the doctor will prescribe what he’s been sold into believing is the best, so you will have to ask if you can use this over-the-counter mixture that doesn’t cost $4,000.) It involves dissolving a bottle of Miralax powder in 64 ounces of Gatorade. Your gastroenterologist will give you a sheet of paper listing how many ounces of Miralax should be dissolved in the Gatorade, and tell you how much you should drink and when. This schedule is based upon the time of your colonoscopy appointment.
3. Buy two 32 oz bottles of Gatorade and refrigerate them before separating the Miralax powder between the two (per your doctor’s instructions). Buy two different flavors–I prefer the Frost Glacier Freeze flavor which is light blue. I also use orange. Having two different flavors of Gatorade will make sure you don’t get too sick of one because you’ll be drinking a lot of liquid over a short period of time. Your gastorenterologist will warn you against red and purple flavors that may stain the inside of your bowel and look concerning during the test. (Heed that warning because you do not–I repeat–do not want to have to repeat your colonoscopy.) Pour the already chilled liquid over ice–it helps make it more tolerable.
4. Do NOT buy a flavor of Gatorade that is one of your favorite flavors in the world. For example, if you love orange-flavored Tang (no judgement here, but yuck), don’t choose orange-flavored Gatorade. Drink only tolerable flavors for prep days because you don’t want to ruin your favorite drinks. Again, if you love drinking lemonade on a hot summer day, do not choose lemonade-flavored Gatorade because you will not want to drink another glass of lemonade for a very long time after your procedure. It becomes a food aversion, like being unable to eat seafood for a few years after taking a cruise to a tropical island only to spend the entire time chained to the toilet with Norovirus.
5. Please note that a lot of people experience nausea that is either induced by the prep liquid or the act of actually purging so be prepared for this. Ask your doctor for a prescription for Zofran (ondansetron) or Phenergan (promethazine), which are anti-nausea meds. Take the prescribed dose 30 minutes before you start drinking. I’ve found that it helps to take the medication before you start, because everything is running through you once you’re well into “The Purge” (not to be associated with the movie, although no less terrifying). You can ask for a prescription for Zofran that can be dissolved on your tongue so you can take it in the middle of the night or early the next morning if you are super-nauseated (but check with your gastroenterologist to see which medications are safe to take the morning of your procedure).
If you get sleepy from Phenergan, stick with the Zofran. You don’t want to fall asleep and then have to purge every five seconds and be in some quasi-antihistamine-diarrhea-induced nightmare. (Basically, if you’re a Mad Men fan, you’ll pull a Don Draper and hallucinate about the whore house you grew up in, or about what you’ll look like when you’re dead. I may be exaggerating, but seriously, I’ve gotten a contact high just watching this season’s episodes.)
6. If you have Crohn’s disease and deal with your regular friend, Intestinal Cramps–who likes to overstay his welcome–take your anti-spasmodic 30 minutes before you start drinking to lessen the cramps. I’ve always found that the nausea and intestinal cramping are the worst at the beginning of the prep, and taking the meds before you start can help ease the spasms before they become too painful.
7. If you have symptoms that indicate narrowing of your bowel, whether from scar tissue or inflammation, and are not following the Miralax prep, make sure you are not using a prep kit that calls for a pill laxative. These kits will ask you to take two pills to begin “The Purge”, and then you’ll follow with the nasty salt-liquid later. I’ve found these pills cause very painful cramping–their laxative effect is much less gentle than the liquid (which is as gentle as a rusty nail-covered two-by-four). One time, I almost went directly to the ER because the pills were violently trying to force everything I’d eaten since junior high school through a narrowed hole in my small bowel a little too quickly. Let me just say, OUCH.
8. Your laptop is your best friend. Hug it, love it, tell it it’s special. With its magical interweb powers, you can watch entire television series while on the toilet, and you’ll be on the toilet a lot. I usually choose a series that has gotten good reviews and watch it on prep days/nights. You can prepare your entertainment before you start purging, and buy a DVD, start a Hulu account, or even find the entire series online for free. I also play a lot of Solitaire. An embarrassing amount of Solitaire.
9. Start prepping 1-2 hours earlier than your instruction sheet advises. This has allowed me to get some sleep and not spend the entire night running back-and-forth to the bathroom. If the instructions say to start at 6 p.m., I start at 4 p.m.; and then I start my morning prep at the same time my doctor’s office tells me to on the instruction sheet. If you give yourself plenty of time to prep, you will be completely cleaned out and not worried about whether or not you’ve purged enough. Also, this will decrease the need to pull over at every McDonald’s on the way to the endoscopy center/hospital because you will basically have nothing left to donate to the toilet by this point. But then again, don’t be surprised when your body still insists on trying!
10. Use septic/sewer-safe baby wipes and not toilet paper. Blot and don’t wipe. TUCK’s Medicated Cooling Pads are a godsend. Be nice to your poor, abused butt because it will feel like a 45 year-old man who is trying to reclaim his glory days by staying out all night doing Jägermeister shots with 21 year-old strippers.
I hope these tips help. If you have any advice to add, please feel free to share your tricks in the comments below–I’d love to collect as many colonoscopy words of wisdom as I can to make this procedure easier for my readers. In the meantime, happy purging!
- Prepping for a Colonoscopy: Why It’s a Necessary Evil (nlm.nih.gov)
- Preparing for a colonoscopy? There’s an app for that (clickondetroit.com)