Colonoscopy Bowel Prep

You will receive a phone call from the surgical staff the day before your procedure discussing your arrival time at the facility. This is commonly 1-2 hours prior to your estimated procedure time. They will advise you about other instructions at the time of the phone call. 

The Joint Commission requires that physicians perform a "History and Physical" within 30 days prior to elective procedures. If your procedure is rescheduled to a later date, you may be asked to return to the clinic for an updated physical. 

Special Instructions: 
*You may continue Aspirin. 
*All other blood thinners are held. Some Examples Include: Plavix/Clopidogrel, Pradaxa/Dabigatran, Coumadin/Warfarin, Effient/Prasugrel, Lovenox, Eliquis/Apixaban, Xarelto/Rivaroxaban 
*If you are taking weight loss medications these need to be held 2 weeks prior to procedure. 
* If you take oral diabetes medications (pills) or diuretics: Do not take these medications the morning of your test. Bring your diabetes medications with you. 
*If you take insulin, please contact the health care provider who manages your diabetes for instructions. 
*You should take your usual morning medications (other than those noted earlier), with a sip of water. This is especially important for blood pressure and heart medications. 
*Bring a list of all medications you are taking and any allergies you have 
-Bring your Health insurance cards, photo ID
 -Please leave jewelry and valuables at home 
-Wear loose fitting and comfortable clothes

Miralax (2L) Bowel Preparation 
Good bowel preparation is vital for adequate colon evaluation. Skin irritation around the anus can be prevented by applying diaper ointment (zinc oxide) to the skin around the anus before starting your bowel preparation. Soak in a warm bath after passing stool, softly pat skin dry with a cloth and reapply ointment as needed. 

Items to Purchase Over the Counter: 
1. Gatorade one 64 ounce bottle or two 32 ounce bottles 
2. Four Dulcolax Laxative tablets 5mg (generic name- bisacodyl) 
3. Miralax Bottle - 238 gram size 

The Day Before Your Procedure:
Diet: After awakening, clear liquids only (list of clear liquids below). Drink at least 8 ounces of clear liquids every hour after awakening until midnight to avoid dehydration. No Alcohol. 
Clear Liquid Diet List: Water Sports Drink Ginger Ales Mountain Dew Lemon-Lime Soda Apple Juice White Grape Juice Kool-Aid Lemonade Coffee (no milk or creamer) Tea Broth (no noodles) Jell-O (without fruit or topping) Popsicles

2:00 PM Take 4 Dulcolax (bisocodyl) tablets.  
6:00PM Mix the entire bottle of Miralax into the 64 ounces of cold Gatorade. A large pitcher is helpful. Shake or stir the solution until fully dissolved. Drink 8 ounces (1 cup) every 30 minutes until 48 oz of the solution is gone. The solution may taste better if kept cold. 
It is better to drink the whole glass of solution rapidly, rather than sipping it slowly. By the time you drink your last glass of solution, your stools should be liquid. Feeling bloated or nauseated is common. These feelings are temporary and should disappear once the bowel movements begin. If you feel nauseated or vomit, wait 30 minutes before drinking more fluid, start with small sips of solution. Walking may help decrease the nausea. 

Day of Your Procedure:
*Four to six hours before your procedure, drink the final 16 ounces of your prep. 
*Do not drink any other liquids or take any food after midnight. Do not drink any fluids 4 hours prior to your procedure, except approved medications with a sip of water. 
*No tobacco products. 

After your procedure 
When you are ready to go home, your nurse will discuss instructions and answer questions with you and your responsible adult. After discharge from the facility, you may have a light diet, as tolerated. Avoid alcohol and do not drive, operate machinery, or make legal decisions. A responsible person should stay with you after you leave the hospital while you recover from the effects of the sedation, approximately 12 hours. 

If biopsies are taken, you may have some blood in your stools after your procedure. 

The day following you procedure: 
Resume normal activities and diet. 

Results of colonoscopy: 
 Your initial results will be given to you the day of your procedure. If biopsies are taken during your procedure, they will be sent to a pathologist for diagnosis. After Dr. Schroeder receives the pathology report you will be informed of results by our office. 

 Although complications after colonoscopy are rare, they can be serious and life-threatening. It is important for you to be aware of early signs that something may be wrong. 

 Report to the ER or contact a physician immediately if you have any of the following, or other concerns: 
 * Pain in your abdomen
 * Fever, chills, persistent vomiting 
 * Excessive rectal bleeding 
 * Chest pain or shortness of breath   

 What is a Colonoscopy? 
A colonoscopy is an examination of the lining of the colon. Often during the colonoscopy, other minor procedures, such as a polyp removal or biopsy will be performed. Please note that biopsies are taken for many reasons and do not necessarily imply cancer. 

Screening Colonoscopy: 
Patients with NO GI symptoms are referred for the following reasons: 
 • Age 50 and above with no risk factors. 
 • Family history (first-degree relative) of colon cancer meeting guideline requirements. 

 Surveillance Colonoscopy: 
Considered a screening, patients have no current symptoms but have a previously treated diagnosis of colon polyp or cancer. 
• A surveillance colonoscopy is a high-risk screening. 

 Diagnostic Colonoscopy: 
Patients are referred for a diagnostic colonoscopy for the following reasons: 
 • Blood in stool/hemopositive stool. 
 • Bleeding from rectum. 
 Iron deficiency anemia of unknown cause. 
• Change in bowel habits. (Diarrhea,constipation) 
• Persistent abdominal pain/anal pain. 
• Numerous other GI-related symptoms. 
 • Repeat endoscopy for incomplete removal of a polyp 

General Insurance Information:
Please note: Insurance companies and policies pay differently. Therefore, it is the patient's responsibility to check with his or her own insurance company to see if the colonoscopy will be covered. Because of the variation among payment policies, our staff cannot answer specific questions about whether your procedure will be covered. These are general guidelines to help you understand how your colonoscopy will be categorized. 

Some insurance companies will change the classification from a screening colonoscopy to a diagnostic colonoscopy if biopsies are taken at the time of the colonoscopy. This can happen despite original documentation, by your provider, that the colonoscopy is being completed for screening purposes. Please check with your insurance company prior to your procedure to see if this is the case. 

The guidelines for eligibility for screening colonoscopies has recently been a topic for debate. Some insurance companies will cover screening colonoscopies before the age of 50, some will deny coverage. Please check with your insurance company to ensure you meet their coverage requirements if you are having a screening or surveillance colonoscopy before the age of 50. 

Physicians are unable to change documentation or previous diagnosis to change a colonoscopy from a surveillance or diagnostic colonoscopy to a screening colonoscopy. This is considered insurance fraud and is punishable by law with fines and/or jail time. If you are contacted by an insurance representative who makes this suggestion, please document the name, date, and phone number of the insurance representative and contact our office.