How to cleanse your bowel for a colonoscopy: This is how to use CLENPIQ (Bowel Preparation)!

Are you having a colonoscopy soon? If so, your doctor may have already told you to cleanse your colon before it. Today we are going to talk about the medicine called `CLENPIQ®` that is used for this. There is nothing to worry about, we will clearly talk about how to do this properly.

What is CLENPIQ®? Why use it?

Simply put, CLENPIQ® is a medicine that cleanses your large intestine (or colon). It contains sodium picosulfate, magnesium oxide, and citric acid. These ingredients work together to cleanse your colon and prepare it for a colonoscopy. Strictly speaking, it is a laxative, which means it helps you move stools out.

Why is it so important to cleanse the stomach thoroughly?

Imagine, your doctor (a `Gastroenterologist` - a doctor who specializes in the stomach and intestines) has to look inside your large intestine . Then, if there are any food particles or waste inside the intestine, he will not be able to see it clearly. When the intestine is well cleaned, it is like driving a car on a clear day, the doctor can see everything clearly. Otherwise, if the intestine is dirty, it is like driving a car in a heavy rain and cannot see anything.

When your colon is cleansed in this way, your doctor can take a closer look at the inside of your colon. This can also help detect any polyps, which can sometimes turn into cancer. That's why it's so important to do this colon cleanse properly.

How to use CLENPIQ®? Follow these instructions exactly!

This colon cleanser, called `CLENPIQ®`, usually comes in a single-dose liquid, in a small bottle. You will need to take two bottles of this. One the day before the test, and the other on the day of the test. The most important thing is to follow the instructions given to you exactly. Especially if you are a patient of the Cleveland Clinic, if you do not follow the instructions exactly, you may not be able to have your colonoscopy. So you need to be very careful about this.

These tips are essential for a successful colonoscopy!

• In order for your doctor to see inside your intestines clearly, your stomach needs to be completely empty.
• Follow the instructions given by your gastroenterologist exactly as written.
• Do not eat any solid foods the day before your colonoscopy. Only drink clear liquids. Continue drinking clear liquids until three hours before your colonoscopy.
• Get your bowel preparation kit at least five days before your colonoscopy.

About preparing a vehicle on the day of a colonoscopy

When you come for your colonoscopy, you need to have a responsible adult with you who can drive a car. This person should stay outside from the time you enter the examination room until you are discharged. You will not be allowed to leave alone after the examination. If there is no one to take you home, you may not have your examination. So plan ahead for this as well.

Things to be careful about when taking the medicine you take!

For your safety, some medications may need to be stopped or the dosage adjusted before the test. It is very important to discuss this with your doctor to be sure.

• Blood thinners : If you are taking these medications, talk to your doctor at least two weeks before the test to find out how to adjust your dosage. Examples include: clopidogrel (Plavix®), warfarin (Coumadin®), ticlopidine hydrochloride (Ticlid®), anagrelide (Agrylin®), rivaroxaban (Xarelto®), dabigatran (Pradaxa®), apixaban (Eliquis®), and prasugrel (Effient®).
• Insulin and diabetes medication: If you are taking these medications, be sure to talk to your doctor about adjusting your medication dosage before your colonoscopy. Do not take your diabetes medication after the morning of the test. If you are taking insulin (such as insulin glargine injection (Lantus®), insulin lispro (Humalog®), long-acting insulin such as insulin isophane (HumulinN®, NovolinN®, ReliOn®), or 70/30 insulin), take half of your usual dose the day before your test.
• Weight management medication: If you are taking weight management medication, you may need to adjust the dose or stop taking it a few days or a week early. Talk to your doctor for more advice. Some weight management medications that may need to be stopped include: canagliflozin (Invokana®), dapagliflozin (Farxiga®, Forxiga®), dulaglutide (Trulicity®), empagliflozin (Jardiance®), ertugliflozin (- Steglatro®), `exenatide (exenatide - Byetta®, Bydureon®), `liraglutide (liraglutide - Victoza®, Saxenda®), `lixisenatide (lixisenatide - Adylyxin®), `semaglutide (semaglutide - Ozempic®, Wegovy®, Rybelsus®)` and `tirzepatide (tirzepatide - Mounjaro®, Zepbound®)`.
• Iron pills: Stop taking iron pills a week before your colonoscopy.

Medications such as aspirin, antibiotics , and diuretics can be taken with a sip of water on the day of the test. However, if you are unsure about which medications you can and cannot continue taking, be sure to ask your doctor.

How to control your diet three days before a colonoscopy

You should stop eating these high-fiber foods three days before your colonoscopy:

• Popcorn
• Beans
• Nuts (e.g. flax seeds , sunflower seeds, quinoa)
• Multigrain bread
• Nuts (like cashews, peanuts )
• Salad/vegetables
• Fresh and dried fruit

What should you do the day before a colonoscopy?

You should only drink clear liquids the day before your colonoscopy. Do not eat any solid foods.

You can continue to drink clear liquids up to three hours before your colonoscopy.

What is this "clear liquid"?

Simply put, if you can see through a glass, it is a clear liquid. Examples include water, salt water, sugar water (colorless), clear soup (no chunks), clear fruit juice (e.g. apple juice, grape juice - no dark color), jelly (colorless or light), tea/coffee (no milk, cream). Avoid drinking dark colored liquids (e.g. dark red, purple).

Exactly how to take CLENPIQ®

You will not be taking this bowel preparation all at once, but in two doses, several hours apart. The most important thing is to finish the entire dose exactly as directed. Otherwise, your test may need to be postponed to another day.

You can refrigerate the two bottles of CLENPIQ® the evening before your colonoscopy. But never add ice, sugar, or any other sweeteners to it.

First time: 6:00 PM the day before the colonoscopy

• Drink one bottle of `CLENPIQ®` completely.
• ThenOver the next three hours, drink at least five additional 8-ounce (240 ml) glasses of clear liquids.

Second time: On the day of the colonoscopy, six hours before the test

• Drink the second bottle of CLENPIQ® completely.
• Then , within the next hour, drink at least four additional 8-ounce glasses of clear liquids.
• You can continue to drink clear liquids up to three hours before the test.

Will some people need special advice?

Some people's bowel movements may be a little slower. These people may need different instructions. If you have these conditions, ask your doctor for personalized bowel prep instructions.

• If you have any medical conditions that require special care.
• If the previous bowel prep was not done properly (`poor bowel prep results`) or if it was unsuccessful (`failed bowel prep`).
• If you have experienced any discomfort during anesthesia in the past.

What if you have questions like this?

Some problems may arise during a bowel cleanse. Let's see what to do if that happens.

What if you have constipation?

You can also take a laxative a few days before the cleanse. This will help reduce your constipation during the cleanse.

What if the last time you cleansed your stomach didn't go well?

Be sure to talk to your doctor. You will likely need additional advice on how to cleanse your stomach.

What if you have conditions that cause intestinal motility issues?

Some medical conditions and medications can slow bowel emptying or cause constipation. People with conditions like Parkinson's disease, multiple sclerosis (MS), or those who use a wheelchair can have this type of slow bowel movement. Also, medications like narcotics, gabapentin, and anticholinergic medications can affect this. Talk to your doctor about your medical history and any medications you are currently taking. You may need extra time to empty your bowels and additional laxatives.

What if it's hard to drink a lot of fluids?

Start cleansing your stomach two to three hours in advance. This will give you more time to finish the entire medication.

What if I can't completely cleanse my stomach?

If you are unable to finish your bowel cleansing medication, your colonoscopy will likely have to be postponed due to poor prep quality.

If you have had weight loss surgery (`Bariatric Surgery`), do you need to take the entire medication?

Yes. Gastric bypass surgery involves your stomach and small intestine. It does not change the length of your colon. You may need to drink small amounts of fluids, but you must finish the entire colon cleanse. This may take a little longer.

What if someone is on dialysis?

Please speak to your nephrologist for specific advice before having your test. Typically, dialysis patients take a bowel cleansing medication called Golytely and have the test done on the same day as their dialysis (colonoscopy in the morning, dialysis in the evening).

Can I use Uber®, Lyft®, a taxi, or a bus to get home?

An adult must be with you from the time you enter the colonoscopy until you are discharged. You can only take a hired ride home if this adult companion accompanies you from the time you enter the colonoscopy area until you are discharged, and then takes you home in the same taxi.

Can't I just "sleep" here for a while and then drive myself?

No, you can't. You must have an adult with you when you come for the test. Your responsible adult must stay at the endoscopy center during the test and then drive you home. You cannot drive for the rest of the day after the test.

Finally, things to remember

It is very important to clean your colon before a colonoscopy. Follow your gastroenterologist's instructions exactly. When your colon is clear, they can easily find polyps and other abnormalities. If you have any questions about using CLENPIQ®, ask your doctor before you start taking it. Then you can handle it without any problems.

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