Colonoscopy Tips

I recently got a colonoscopy because I have a family history of colon cancer and I’m having some recurrent upper left abdominal pain, chronic constipation, and minor rectal bleeding. It went pretty well (Excellent prep and no polyps! Just internal hemorrhoids. >.>;;).

I’d like to talk about my experience and share some tips, both for myself in the future and for anyone else who might be getting a colonoscopy. I had a lot of anxiety about the prep and procedure beforehand. I was worried the scope would be too big since I’m a smaller person, but learning that they do colonoscopies on children helped with that. I was also worried that it would hurt or feel weird, but I saw someone on a forum say that they don’t remember anything after getting the anesthetic and that helped me be more calm about it. Besides that, there were a couple of things the instructions I received weren’t that clear about, so I thought I would write a guide to clear up some of the less obvious stuff.

This is from a patient’s perspective; I have no medical training. Read all the prep instructions very carefully and if you’re not sure of anything, ask your doctor.

Planning:

1. Ask your doctor what other options you have besides colonoscopy. FIT test is when they take a whole-bm stool sample and look for a certain type of blood can that be indicative of cancer. FIT test may be sufficient to check for colon cancer if you are over 50 and have no symptoms. Sigmoidoscopy is when the scope only goes through the bottom-left part of the colon. It also allows the scope to view up the left side of the colon. For sigmoidoscopy, you don’t have to drink a lot of liquid, but you do have to fast the day before, take a laxative the night before, and do 2 enemas in the morning. Sigmoidoscopy often doesn’t require pain meds or sedation and carries less risk of perforation, but you may have to prep again and do a full colonoscopy if the test detects something abnormal. CT or MRI scans may also aid in diagnosis. CT scans use a fair bit of radiation but they only take about fifteen minutes and are cheaper than MRI. MRI can take up to an hour and is a bit more expensive, but it doesn’t expose you to radiation.
2. If you have periods, try to set the date of the procedure the week after your period. Period poops make for great pre-prep!
3. I did it in December, but if I were to do it again I would do it in a warmer season because fasting, being up all night, and wearing a hospital gown are all more uncomfortable in cold weather.
4. If you’re prone to constipation like I am, take Miralax in an electrolyte drink every day in the weeks leading up to the procedure. I’ve never had Miralax on its own work for me, but I got curious when I saw the prep involved Miralax + electrolytes, so I tried it in an electrolyte drink, and it actually worked! When the physician’s assistant (PA) told me to take it every day, I was worried it would give me too much diarrhea, but it really wasn’t bad… Miralax doesn’t give you the urgency of stimulant laxatives like senna or Dulcolax, so I found I could mostly go out and do my normal activities on it.
5. Drink a lot of fluids. If you’re not in the habit of counting 64 ounces a day, now would be a good time to start. The cups I use hold about ten ounces of water, so 64 ounces is about 6 glasses for me (a standard measuring cup is 8 ounces). I like to use a tally counter in my pantry to keep track at home, and ranger beads if I’m on the go.
6. Avoid red meat and heavy foods for a couple weeks before the procedure (I think this was in the instructions, so pretty basic).
7. Ask your doctor what kind of anesthetic they’ll use during the procedure. I was worried about getting fentanyl because my dad had a horrible reaction to it, but I didn’t know that was what they were going to use until the day of, so we didn’t really have time to discuss alternatives. Luckily I didn’t have a reaction to it (they gave me Benadryl and that may have helped), but I wish I had discussed with my doctor what drugs they were going to use in advance.

Seven Days Before:

They say to stop taking vitamins (particularly B vitamins and iron) seven days before the procedure, so I wasn’t sure if I could keep taking Liquid IV or Skratch Labs’ electrolyte drinks. However, they say Corn Flakes are okay and they have added vitamins, so I don’t know specifically which vitamins in what amounts are okay. I decided to stick with yellow Gatorade because it has no added vitamins.

Three Days Before:

Dyes:

They say not to have foods with red or purple dyes because it could mess with the results, but some sites also said blue dyes were not allowed. When I went to pick up the Gavilyte (the gallon of prep solution) the pharmacist said to get generic simethicone because green dyes were not allowed either. It seems like the only really safe color is yellow, so I would recommend just getting yellow everything (Gatorade, Jell-O, gummy bears). I think orange is okay as long as it only has yellow dye on the ingredients list.

Low-fiber Diet:

Three days before the procedure you’re supposed to go on a low-fiber diet. This means no seeds, no skins, and no whole grains. I wasn’t sure how I was going to do this because I typically eat a lot of fiber and vegetables and I’m on a gluten free diet. I saw the yes and no lists and went “What the heck am I supposed to eat?” The lists aren’t that exhaustive and the staff on the help line didn’t know anything beyond what was on the lists, so I had to do some Googling around to figure out which of my regular foods were acceptable and which weren’t.

This is what I ate for three days before the colonoscopy:

• Corn Flakes with almond milk for breakfast (oat milk has fiber so that’s out)
• Boiled potatoes with skins removed (skins come off easy after boiling) with vegan butter
• Boiled carrots with skins removed (I used baby carrots because I didn’t want to peel carrots)
• White rice with avocado (avocado wasn’t on my list but I found it on another) or cucumber (with skin and seeds removed) and soy sauce
• Canned chicken or tuna with mayo
• Creamy peanut butter with Rice Krispies (I just take a spoonful of pb and eat the cereal dry so it sticks to it)
• Frosted Flakes for a sweet snack/dessert
• Chocolate is okay I think (it didn’t really mention it on the yes or no lists, though it said hot chocolate is okay so I extrapolated from that)
• Honeydew or cantaloupe for fruit

I did see some sites mention bananas, so they might be okay, but they do have small seeds… they are soft, though. I didn’t end up eating them because I wasn’t sure, but I had them on hand in case I ran out of other food.

There were no non-whole-grain gluten free breads available in my area (all had at least brown rice flour in them), so I substituted those with approved cereals (Rice Krispies with PB instead of PB toast).

Day Before:

The day before the procedure you’re supposed to fast and drink water every hour. You’re allowed to have yellow Gatorade, yellow Jell-O, or yellow gummy bears. I did have Jell-O and gummy bears for lunch and it was really comforting to be able to follow that habit of eating something. I took two doses of Miralax in yellow Gatorade because I was worried about the prep solution not working.

The fast was actually kind of tough for me… I wasn’t hungry because I was drinking so much water, but I had a headache for most of that day (I don’t know if it was from too much water or lack of calories). It went away part-way through drinking the prep solution and I felt a clarity, energy, and lack of brain fog that I haven’t felt in a long time… I could see why some people like to do fasts or cleanses periodically.

My instructions said to take 2 Dulcolax at 4pm and start drinking the Gavilyte-C at 6pm.

The prep solution was rough… on first taste, it tasted like salty vodka. I wasn’t sure if I was going to be able to drink 8 cups of it, but I was determined not to lose my slot because 1, the doctor I got assigned looked really good, 2, the timing was perfect, and 3, I had to go to so many appointments, do so much preparation, and deal with so much waiting and worrying to get up to that point.

I read a comic book (Love Hina) and listened to relaxing music (Nintendo music at first and then Drake lol). I found the best way to get through the prep solution was to take as many sips of it as I could of it in a row and then chase it with water before the taste could settle into the front of my mouth. I measured out 8-ounce glasses with a pouring measuring cup and put it into a pint glass (at first I used a mini pint glass, but I found using a larger glass helps because it already looks half empty). My prep was 8 cups at night and 8 cups in the morning.

I wore a digital watch and wrote down the time I finished each cup (1 – 6:30, 2 – 6:45, etc) so I could keep track of the time, since you’re supposed to drink one cup every 15-30 minutes. At first I was taking a break between each cup, but once I realized I was taking at the longer end of the suggested time, I started drinking the next one right after. I think it started to work at about the fourth cup. The sixth cup was the hardest for me—I started feeling really bloated and my stomach hurt. I waited until I was able to continue and just kept drinking. The mantra I started repeating in my head was “If you can, you should.” I’m not good at drinking fast and didn’t finish until 11pm (5 hours… eek! I think the ideal is like 2), so I was up all night going to the bathroom.

I would recommend not trying to sleep in your bed during prep night… I did leak a bit (I was really tired and it was cold…). Next time I would make a pad out of easily washable blankets on the floor and try to sleep on that. Trying to sleep in child’s pose with my feet under my butt helped me rest without completely falling asleep. With Gavilyte, the urges come on suddenly and it feels (and eventually looks and sounds) like peeing out your butt (painless, but urgent).

I didn’t get really clear until about 2am. The morning drink was much easier because I was used to it and it was extra cold from sitting in the fridge all night (next time I would mix the solution in the morning or at noon instead of at 5pm). I got bored and wrote down some tasting notes: banana, bubblegum, and raspberry (lol). The chemical taste gets less noticeable the more of it you drink.

I got through 5 cups of it in the morning before I had to stop because it was 3 hours before the procedure (if you take anything by mouth after that you could aspirate, so no water past that point). I hung around for three hours and then went to the hospital. Intake was pretty easy and simple. The nurse took a little while placing the IV, but not too bad. You’re usually a bit dehydrated after colonoscopy prep so it can be tricky for nurses to find a good vein.

Like I said earlier, we had a bit of a hard time trying to negotiate anesthetic because of the time constraints, the noise in the room, and the masks, but the gastroenterologist said he would give me Benadryl to try and head off any allergic reaction and Versed for anxiety and keep the fentanyl on the side in case it was needed (apparently it was needed, as I found out from the report online later).

I barely felt anything after I got the sedative… everything was black and warm and comfortable. I’d say I was ¾ unconscious. I didn’t open my eyes to see the screen or anything. I could very dimly feel the instrument going in and out, but it was just like when you’re lying in bed and you scratch your butthole. I didn’t feel it going through my actual colon at all.

Eventually, I woke up in the recovery room, had some apple juice, got dressed, and was wheeled out to my partner. As we drove home, I kept falling asleep, having short rapid dreams, and waking up again. After we got home, I fell asleep for an hour or two and then woke up, watched an episode of His Dark Materials season 3, and had some Gatorade and a small meal. I texted with my mom and sister and took a shower. It shows how quick the recovery is that you have energy to take a shower the same day.

I had a little bit of gas for about three days afterwards but no rectal pain or bleeding. It may be helpful to have simethicone/Gas-X on hand for gas and Balneol for discomfort. Don’t worry if you don’t have a bowel movement right away. I didn’t poop for five days after (the average is 2-3 days, so my system is on the slow side). I was hoping that cleaning everything out would resolve my issues but I was constipated again the next week and had to resume the daily Miralax. It was a good test to see what would happen, but next time I would just get back on Miralax the day after the procedure.

People say the prep is the worst part but I disagree, I think the anxiety is the worst part. For a month in advance I was worried about the nature of the procedure, what the results would be, whether the prep would work, and whether there would be complications like bowel perforation (it happens to less than 1% of patients, but I was still worried about it). After I got there, I was worried about having a reaction to the anesthesia or the doctor not going the whole way through (he mentioned doing no pain meds with sigmoidoscopy and I was like “No! Not after I did the full prep!”).

I was kind of surprised that they didn’t have any alternatives to fentanyl on hand… I guess it must be really routine for colonoscopy. It is a little odd because I know two people who are allergic to it and I’ve heard of others who can’t have it because of addiction, so I wouldn’t think it would be that uncommon for people to request an alternative.

The pain of the prep was at worst a 7/10 (it mostly hovered around 4-5) and I’ve had periods that were 8/10 and sickness that was 9/10 or 10/10, so I didn’t think it was that bad relatively. Luckily my whole procedure was pretty simple and uncomplicated, the prep was plenty strong enough even for me, and I didn’t end up having any issues with the drugs, so it all worked out.

If you think you need a colonoscopy, I’d say go for it! Think of it like a colon cleanse. It’s unpleasant, but I’d say it’s about a 5/10 on the awful scale. It’s worth it to have peace of mind. It could save you a lot of pain down the road if they can nip polyps in the butt!