I've heard the preparation for a colonoscopy is terrible. Can you tell me what is involved? I know that the bowel must be cleaned before the test. How is this done? Please be specific.

Carol

Before a colonoscopy can be done, a patient's lower bowels must be prepared to enable doctors to get a clear view of the complete colon. Generally, the preparation for colonoscopy begins the day before the exam. On that day, it is recommended that patients limit their intake to clear liquids. The exact starting time for this restriction may vary depending on your gastroenterologist -- some restrict patients to clear liquids the entire day, while others recommend clear liquids only later in the afternoon.

On the afternoon before the colonoscopy, the patient also begins drinking a large quantity (about one gallon) of a special purging solution (Golytely, Nulytely) designed to clean out the intestinal tract. Many patients find that it is hard to drink the entire gallon, but every effort should be made to finish it. Generally, the best way to approach this is to drink a cup of the solution every 10-15 minutes. Bowel movements will soon start and should become clear by the morning of the exam. The morning of the colonoscopy, before arriving at the hospital for the procedure, the patient will usually use two enemas (Fleet, for example) to clean out residual stool debris.

Although the preparation for colonoscopy is certainly not the most pleasant of experiences, it also should not be a terrible ordeal. The newer types of purging solutions are flavored (cherry, for example), which may make them more palatable. In some cases, gastroenterologists may substitute a drink called Fleet Phospho-Soda. Patients have to drink far less of this. However, the downside is that the preparation is generally not as good and some of the colon may not be seen adequately. In addition, Fleet Phospho-Soda is dangerous to use in certain patients (including those with heart or kidney failure) because it can upset the balance of fluids and electrolytes in the body.

Before your colonoscopy, you should discuss your concerns about the prep with your gastroenterologist so that you can be reassured and have all your questions answered.