Let's learn about bowel cleansing before a colonoscopy? (MoviPrep® Bowel Preparation)

Are you scheduled for a colonoscopy soon? If so, it is imperative that you thoroughly cleanse your colon before doing so. Today we are going to talk about the medicine used for this called MoviPrep®, and how to properly prepare for it. Don't worry, if you follow these steps exactly, you will be able to pass the test without any problems and easily.

What is MoviPrep®? Why is a bowel cleanse so important?

Simply put, MoviPrep® is a medicine that cleanses your colon, or large intestine. It mainly contains Polyethylene Glycol (PEG) and Ascorbic Acid, which is Vitamin C. What this PEG does is draw water into your intestines, making your stool easier to pass. The Ascorbic Acid also draws water into your intestines, making your stool move faster and easier to pass.

Now, why is this colon cleanse so important? Imagine that the doctor is going to look inside your colon with a small camera. It's like driving a car down a road. If your colon is well cleansed, it's like driving down a road on a clear, sunny day. Everything is clear. Then the doctor can clearly see if there are any polyps or cancer cells growing on the walls of your colon. But if your colon is not well cleansed, it's like driving down a muddy road on a stormy day. Nothing is visible. That's why, for your colonoscopy to be successful, it is essential that your colon is completely empty and clean. You need to follow your doctor's instructions exactly. Otherwise, the test may have to be stopped.

How to use MoviPrep®?

MoviPrep® comes in a box. It contains two pouches of the medicine and a mixing container. All you have to do is put one sachet in this container and add water to it to dissolve it. Usually, you give one of these solutions to drink the night before the test and the other in the morning of the test. However, the exact instructions for how to do it are in the separate instruction leaflet that your doctor will give you. You need to read it carefully and do it exactly as it is.

Be sure to remember these things before the test!

These are the most important things to remember for a successful colonoscopy:

• Your bowel needs to be completely empty so that the doctor can see inside your bowel clearly. Therefore, follow the instructions given by your gastroenterologist exactly.
• Do not eat any solid foods for the entire day before your colonoscopy. Only clear liquids are allowed. We will talk about that in more detail.
• Get your bowel preparation kit from the pharmacy at least five days before your colonoscopy. That way, you can prepare everything without any fuss.

Be especially careful about traffic on test day!

This is something that many people overlook. When you come for a colonoscopy, you need to have a responsible driver with you. That person must stay in the hospital from the time you are admitted until you are released. You will not be allowed to go home alone after the test. If there is no one to accompany you, you may not have the test. Also, for the rest of the day after the test, you are not allowed to drive any vehicle (such as a bicycle, car, scooter) or leave the institution alone. This is because the medication given for the test may make you feel a little sluggish and drowsy.

Be aware of the medications you take!

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 these medications, for example, clopidogrel (brand name: Plavix®), warfarin (brand name: Coumadin®), ticlopidine hydrochloride (brand name: Ticlid®), anagrelide (brand name: Agrylin®), rivaroxaban (brand name: Xarelto®), dabigatran (brand name: Pradaxa®), apixaban (brand name: Eliquis®), and prasugrel (brand name: Effient®). If you are taking medication, you should definitely talk to your doctor at least two weeks before the test and ask if you should stop taking the medication or reduce the dosage.
• Insulin and diabetes medication: If you are taking diabetes medication, do not take it after midnight on the day of the test. If you are taking insulin, such as insulin glargine injection (brand name: Lantus®), insulin lispro (brand name: Humalog®), long-acting insulin such as insulin isophane (brand names: HumulinN®, NovolinN®, ReliOn®), or 70/30 insulin, you should take half the dose you normally take the day before the test. However, you should consult your diabetes doctor and follow his or her instructions.
• Weight management medication:If you are taking any medication to lose weight, you may need to stop taking it a few days or a week in advance or change the dosage. Ask your doctor about this as well. Some medications that may need to be stopped include: Canagliflozin (brand name: Invokana®), Dapagliflozin (brand names: Farxiga®, Forxiga®), Dulaglutide (brand name: Trulicity®), Empagliflozin (brand name: Jardiance®), Ertugliflozin (brand name: Steglatro®), Exenatide (brand names: Byetta®, Bydureon®), Liraglutide (brand names: Victoza®, Saxenda®), Lixisenatide Lixisenatide (brand name: Adylyxin®), Semaglutide (brand names: Ozempic®, Wegovy®, Rybelsus®) and Tirzepatide (brand names: Mounjaro®, Zepbound®).
• Iron pills: If you are taking iron pills, you should stop them a week before your colonoscopy.

If you are taking medications like aspirin, antibiotics, or diuretics, you can take them with a sip of water on the day of the test. However, if you are unsure about which medications you can continue to take and which you should stop, be sure to ask your doctor.

Stop eating these foods three days before your colonoscopy!

Three days before the test, you should stop eating these high-fiber foods:

• Popcorn
• Beans
• Grains (e.g. flax, sunflower, quinoa)
• Multigrain bread
• Types of nuts
• Salad/vegetables
• Fresh and dried fruit

If you eat these, they can remain in the intestines and interfere with the test.

The day before the colonoscopy!

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

What are clear liquids? Simply put, if you can see the other side of a glass when you pour it, it is a clear liquid. Examples: water, light-colored tea (without milk, it is okay to add a little sugar), light-colored fruit juice (without fiber, e.g. apple juice), jelly (without pieces, light-colored), chicken broth (strained without pieces). You can drink coffee (without milk), sweet drinks (carbonated, light-colored). Do not drink dark-colored liquids (e.g. red, purple fruit juice), milk, milk-based drinks, or alcohol.

You can drink clear liquids up to three hours before the test begins.

When is bowel preparation done?

The MoviPrep® box contains a packet of medicine powder and a mixing bowl. The medicine should be mixed according to the instructions on the box. Do not mix the medicine more than 24 hours before using it. This means that it can be made the day before. It may come with a flavor pack, which is fine to add. But do not add ice, extra sugar, or other flavorings. The prepared liquid can be stored in the fridge.

How to take stomach cleansing medicine

Before making the medicine, read all the instructions carefully. You should take this medicine in two doses.

Step 1: Around 6:00 PM the day before the colonoscopy

• Drink an 8-ounce (240 ml) glass of prepared MoviPrep® liquid every 15 minutes.
• In this way, drink until half of the total amount of liquid you have prepared is gone.

You will start to feel nauseous while taking the medicine. This is normal. It is wise to stay near a toilet.

Step 2: Six hours before the colonoscopy

(For example, if your test is at 9:00 AM, this section should start at 3:00 AM)

• Drink the remaining MoviPrep® liquid, as before, an 8-ounce glass every 15 minutes.
• In this way, drink the medicine until it is completely gone.
• You can drink clear liquids up to three hours before the test.

Some people's bowels are slow, so they may need different instructions. Ask your doctor for personalized bowel prep instructions if you have any of the following conditions:

• Medical conditions that require special care.
• If the colon was not properly cleansed during a previous colonoscopy, or if the test was unsuccessful.
• If you had any discomfort with anesthesia during a previous examination.

Possible problems and solutions during bowel cleansing

How long does it take for the stomach to empty after taking MoviPrep®?

MoviPrep® usually works quickly. Most people start to have bowel movements within an hour. How long it lasts can vary from person to person.

What should I do if I have constipation?

You can take additional laxatives ( laxatives ) for a few days before the cleanse. Talk to your doctor about this. This will help reduce constipation by the time you cleanse.

My stomach didn't feel completely clean during a previous test. What should I do?

Be sure to let your doctor know about this. He or she will be able to give you additional advice or an alternative method.

What if I have motility issues due to a medical condition?

Some medical conditions (e.g., Parkinson's disease, multiple sclerosis (MS)) and some medications (e.g., narcotic pain relievers, Gabapentin) can cause delayed bowel emptying or constipation. This may be especially true if you are a wheelchair user. Tell your doctor about your medical conditions and medications. You may need to take longer to empty your bowels and take additional laxatives.

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

So, start taking your medicine two or three hours earlier. That way, you can take more time and drink the entire amount.

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

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

I have had bariatric surgery. Do I need to drink this full amount?

Weight loss surgeries like gastric bypass affect the stomach and small intestine. It doesn't change the length of your large intestine. You may be able to take less medicine at once, so you may need to take it more often. However, you should finish the entire dose of medicine.

What if I am on dialysis?

If you are on dialysis, be sure to consult your nephrologist for specific advice before scheduling your test. Dialysis patients are usually given a different type of bowel cleansing medication (e.g., Golytely). Also, the test is usually performed on the same day as dialysis (e.g., colonoscopy in the morning, dialysis in the evening).

How do you know exactly what a clear liquid is?

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

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

No. You must have an adult with you when you are admitted for the test. They must also remain in the endoscopy area until you are released. You can only use a taxi service to go home if this adult guardian accompanies you from the time you are admitted until you are released, and then takes you home in the same taxi.

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

Absolutely not. You must have an adult with you when you are admitted. That responsible adult must stay in the endoscopy center during your examination and drive you home afterward. You must not drive for the rest of the day.

Finally, things to remember (Take-Home Message)

Cleansing the colon is the key to a successful colonoscopy.

• Follow the doctor's instructions exactly.Do everything exactly as you eat, drink, stop taking your medication, and take your medicine.
• If your colon is thoroughly cleansed, it will be easier for the doctor to clearly detect things like polyps and other abnormalities.
• It is essential to have a responsible person with you when you come to the test and when you go home.
• If you have any questions or concerns about using the MoviPrep® Colon Cleansing Kit, please ask your doctor or healthcare team before you start taking the medication. Don't be afraid or embarrassed. Your clarity is the most important thing.

If you prepare in this way, you will be able to undergo a colonoscopy without any discomfort!

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