How to properly cleanse the bowel before a colonoscopy? (Bowel Preparation)

Are you having a colonoscopy soon? Then you probably know how important it is to clean your bowel beforehand. If you don't clean your bowel properly, the entire procedure can go wrong. So today, let's talk about how to do this bowel preparation, what medications are used for it, and what you need to be aware of.

What are these Golytely and Nulytely?

Simply put, `(Golytely)`, `(Nulytely)`, `(Trilyte)` and `(Colyte)` are brand names for several types of medications that are used to cleanse your large intestine, that is, your colon, before a `(Colonoscopy)` test. These medications mainly contain a chemical compound called `(Polyethylene Glycol 3350)` and electrolytes that the body needs.

This medicine works by diluting your stool and making it easier to pass. Then the large intestine empties completely. Those salts (Electrolytes) are added, so that when you have a bowel movement, not only water but also necessary salts are lost from the body, preventing conditions like dehydration. Very important, right?

Why is bowel preparation so important?

Imagine, your gastroenterologist needs to see the inside of your large intestine clearly. Only then can he or she be able to determine if there are any polyps, the beginnings of cancer, or any other problems.

If the stomach is properly cleansed, examining the doctor is like driving a car on a clear day. There are no obstacles. But if the stomach is not properly cleansed, it is like driving on a muddy road on a rainy day. Nothing can be seen clearly.

If that happens, the test results may not be accurate, and you may have to repeat the test. That is why it is essential to do this `(Bowel Preparation)` correctly.

How to use this medicine?

These medicines like `(Golytely)` and `(Nulytely)` come in the form of a powder in a large jug. All you have to do is add the prescribed amount of water to the jug the day before your `(Colonoscopy)` and dissolve it well. You should read the instructions on the medicine packet carefully and follow them exactly. You should drink the liquid that forms when you add water.

If you follow the instructions exactly, your colon should be completely clean by the time you finish drinking all the medicine in the mug. In some hospitals, like the Cleveland Clinic, if you don't follow these instructions exactly, you may not even have to have a colonoscopy. So, don't take this for granted, okay?

Key preparation tips for a successful colonoscopy

Be sure to keep these things in mind:

• Your colon should be completely empty.Only then will the doctor be able to see clearly. Follow the instructions given by your gastroenterologist exactly.
• Do not eat any solid food the day before your colonoscopy. Only clear liquids are allowed. We will discuss what those are later.
• Get your bowel preparation kit from the pharmacy at least five days before your colonoscopy.

Colonoscopy one-day travel

This is also very important. When you go in for a colonoscopy, you need to have a responsible adult driver with you. He or she should stay in the waiting room until you are finished with the test. You definitely can't go home alone after the test. If you don't have someone to drive you, there's a good chance you won't have the test.

Be careful with medications!

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

• Blood thinners: If you are taking any of these medications, such as Clopidogrel (Plavix®), Warfarin (Coumadin®), Ticlopidine Hydrochloride (Ticlid®), Anagrelide (Agrylin®), Rivaroxaban (Xarelto®), Dabigatran (Pradaxa®), Apixaban (Eliquis®), and Prasugrel (Effient®), be sure to consult your doctor about these medications at least two weeks before the test .
• Insulin and diabetes medication: Talk to your doctor about how to adjust your dose in the days leading up to your colonoscopy. Do not take your diabetes medication the morning of your test. If you take insulin, such as insulin glargine injection (Lantus®), insulin lispro (Humalog®), long-acting insulin isophane (Humulin®, Novolin®, ReliOn®), or 70/30 insulin, you should take half of your usual dose the day before your test.
• Weight management medication: If you are taking any weight management medication, you may need to adjust the dosage or stop taking it a few days/weeks before the test. Talk to the doctor who prescribed the medication for advice. Other medications to stop are (Canagliflozin (Invokana®)), (Dapagliflozin (Farxiga®, Forxiga®)), (Dulaglutide (Trulicity®)), (Empagliflozin (Jardiance®)), (Ertugliflozin (Steglatro®)), (Exenatide (Byetta®, Bydureon®)), (Liraglutide (Victoza®), Saxenda®))`, `(Lixisenatide (Adylyxin®))`, `(Semaglutide (Ozempic®, Wegovy®, Rybelsus®))` and `(Tirzepatide (Mounjaro®, Zepbound®))`.
• Iron pills:Stop taking these a week before your colonoscopy.

Medications such as aspirin, antibiotics, or diuretics can be taken with a sip of water on the morning of the test.

However, if you're unsure about which medications you can continue to take and which you should stop, be sure to ask your doctor.

Three days before the colonoscopy...

You should stop eating high-fiber foods from this time on, as these take longer to digest and can interfere with bowel movements.

Here are some such dishes:

• Popcorn
• Nuts (like beans, chickpeas)
• Grains (flaxseeds, sunflower seeds, quinoa)
• Multigrain bread
• Nuts
• Lettuce/vegetables (eaten raw)
• Fresh and dried fruits

The day before the colonoscopy...

On this day, you cannot eat any solid foods. You can only drink clear liquids.

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

Here are some things you can and can't drink:

| Things to Drink (Clear Liquids) | Things Not to Drink |

| :-------------------------------------------------------------------- | :---------------------------------------------------- |

| Water | Milk and milk products |

| Clear soups (chicken/beef/vegetables in water without chunks, without oil) | Creamy soups |

| Clear fruit juice (e.g. apple, grape - not dark colored, without pieces) | Dark fruit juice (e.g. tomato, orange with pieces) |

| Tea, coffee (without milk, creamer) | Alcohol |

| Clear jelly (no red, purple, orange) | Red, purple, orange jelly, ice cream, sodas |

| Clear soda (e.g. Sprite, 7Up) | |

| Ice popsicles (no milk, no chunks, no red/purple/orange) | |

Please note: Brand names are registered trademarks.

How to take Golytely, Nulytely, Trilyte or Colyte?

The medicine solution should be prepared the evening before the ``(Colonoscopy)``. Make it and store it in the refrigerator before drinking. You can add the flavor pack that comes with the medicine package. But do not add ice, sugar, or anything else to the solution.

You should drink this medicine in two parts:

Part One: Around 6:00 PM the day before the colonoscopy

• Drink an 8-ounce (about 240 ml) glass of water every 15 minutes (until half of the liquid is gone).
• Put the remaining medicine back in the fridge.

Part Two: Six Hours Before the Colonoscopy

• Drink an 8-ounce glass every 15 minutes (until half of the remaining medicine is gone).
• You can drink clear liquids up to three hours before the test.

Some people have slow bowel movements, so they may need different advice. If you have this condition, ask your doctor:

• Conditions that require special care.
• If a previous `(Bowel Prep)` was not done properly, and the results were not good.
• If you had any problems with anesthesia during a previous examination.

Are there any side effects to these medications?

These stomach-cleansing medications containing `(Polyethylene Glycol)` are generally safe and have good results. However, some people may experience minor side effects.

• Bloating
• Stomach ache `(Cramping)`
• Nausea or vomiting
• A burning sensation around the anus.

These usually subside once you finish taking the medication and your stomach is empty. But if they are severe, tell your doctor.

What should I do if I have constipation?

You can also take some laxatives a few days before the cleanse. That way, by the time the cleanse is over, constipation will have been reduced to a great extent. Ask your doctor for advice on this as well.

What if the results of a previous colon cleanse (prep results) were not good?

Be sure to let your doctor know. You may need additional instructions or a different type of bowel prep.

What if I have motility issues?

Some medical conditions (such as Parkinson's disease, multiple sclerosis (MS)), or people who use a wheelchair can slow bowel emptying. Some medications (such as narcotics, gabapentin , and anticholinergic medications) can also cause this condition. Tell your doctor about your medical history and any medications you take. You may need more time to empty your bowels and additional laxatives.

What if I have difficulty drinking large amounts of liquid at once?

Start taking the medicine two to three hours before it's time to start. That way, you can take more time to take the medicine.

What if I can't finish all the stomach-cleansing medicine?

If you are unable to take the full dose of medication, your colonoscopy will likely have to be postponed because your bowel will not be properly cleansed.

I have had bariatric surgery. Do I need to do the full prep as well?

Yes. Gastric bypass surgery affects the stomach and small intestine. The length of the large intestine does not change. You may need to drink smaller amounts, more slowly. But you still need to do a full bowel prep. It takes a little longer.

What if I am on dialysis?

Before booking your colonoscopy, be sure to see your nephrologist for specific advice. Dialysis patients usually take a bowel cleansing medication like Golytely and have the test done on the same day as their dialysis (colonoscopy in the morning, dialysis in the evening).

How do you know exactly what "clear liquid" is?

Simple. If you put that liquid in a glass and can see through it, it's a "clear liquid."

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

No. An adult must be with you when you enter the `(Colonoscopy)`. They must remain there until you leave the `(Endoscopy)` unit after the examination. You can only use a taxi service if this adult guardian accompanies you from the time you enter, until the examination is completed, and then goes home with you in the same taxi.

Can't I just "sleep" here for a bit and then drive off by myself?

Absolutely not. You must have a responsible adult with you when you go in. That person must stay at the Endoscopy center during the test and drive you home. You must not drive for the rest of the day after the test.

Finally, the most important thing (Take-Home Message)

Bowel preparation is the key to a successful colonoscopy. When your colon is clear, your doctor can more easily detect even the smallest polyps or other problems.

Remember, instructions may vary slightly from hospital to hospital, depending on the type of bowel cleansing medication you are using. So, read the instructions carefully and follow them exactly.

If you have any questions about the timing or method of taking your medication, don't hesitate to ask your doctor or nurse. Don't forget that if you don't follow the instructions exactly, your colonoscopy may be delayed. Let's do this for your own health, right?

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