It’s a reality we all eventually face, the dreaded colonoscopy. This vital test is recommended after the age of 50 and can help detect early cancers in the GI tract. Despite its potential life saving effect, many patients go out of their way to avoid the test for a variety of reasons. For some, it’s just the sheer embarrassment of having someone look “up there.” But for the IC patient, it’s often the fear of triggering a flare. We have received dozens of calls from patients who were worried that it could trigger more bladder pain. The good news is that very few IC patients have reported bladder irritation after colonoscopy but you should do some planning in advance to make it as easy and gentle as possible.
#1 – How will the test be done?
This test is usually done as an outpatient procedure in a clinic that specializes in colonoscopies using twilight anesthesia. Ask your doctor to confirm the type of anesthesia will be used. Versed is usually the drug of choice because it produces memory loss of the procedure. I always say to my doctors “I will consider this a success IF I have no memory of what you have done.”
#2 – Choosing a test date
You’ll likely need two days off at a minimum, the day (or half day) of the preparation and the day of the procedure. Try to schedule the test for a Friday so that you can recover over the weekend. Despite a doctors overly optimistic word that you might be able to go to work the next day, you may find yourself running to the restroom urgently for a few days as your body continues to pass any remaining laxative and stool softener in your gut. I wouldn’t recommend planning any trips or vacations either for at least a week after the procedure.
#3 – Tell your doctor about acid sensitivity
Most gastroenterologists are unaware of our acid sensitive bladders. Talk with your doctor about currently available solutions. The most gentle and low acid colon prep strategy is The Miralax Protocol because you can use a liquid of your choice. Patients use a combination of dulcolax tablets and miralax powder. Some IC patients, myself included, dissolve the Miralax in a clear or blue gatorade (you can’t use red or orange) while others simply prefer to use water.
If you forget to have that conversation, there’s a good chance that you’ll arrive at your local pharmacy to pick up either TriLyte, NuLytely or GoLytely, usually in a large plastic bottle that has you wondering how you will be able to drink it all. Some of these require that you drink a large volume of fluid while others use less fluid. You may also be able to pick a flavor packet of your choice. If the pharmacist automatically gives you a lemon flavor, ask what other options in available. (Don’t wait until the last minute! This is important to do in advance so that they can special order your flavor, if necessary or send you to another pharmacy.) Also ask your gastroenterologist if you can use some Prelief® to reduce any acid irritation from the commercial preps.
The prep solutions are much easier to drink when they are cold. You can also try drinking it through a straw. The only mistake I made with the Miralax protocol was to use the same flavor of gatorade in both bottles. In hindsight, I would switch up the flavor of the second bottle to add a little diversity to the routine.
I wouldn’t suggest a straight magnesium citrate solution as it is very harsh and can result in explosive diarrhea and cramping. Using a gentle formula is a must.
#4 – Diet modification
My gastroenterologist suggested that I eat less roughage in the week before the test so that I would have less to remove from my bowel the night before the test. This turned out to be a very good strategy. I cut out heavy brans and grains, as well as red meats, and chose easier to digest foods instead such as potatoes, chicken, yogurt, soups, applesauce, carrots and so forth.
The day before the test, you will be instructed to modify your diet severely to eat only “low residue foods”.. such as white bread, cereals, etc and then convert to a clear liquid diet, such as chamomile tea, peppermint tea, apple juice, sparkling water and even Jello’s and popsicles. Multiple research studies have found that peppermint can reduce spasms during colonoscopy.
#5 – Creating and protecting your bathroom time!
As you do your colon cleanse, you will need immediate restroom access. If you have two bathrooms in your home, make sure that you claim one for your exclusive use. Let your family know that they should not use that restroom that evening. Bring your iPad, books, and so forth. (You can watch a movie on your iPad. Really, I did!) A scented candle, essential oils… you get my drift. Keep the fan on and power through it. It will take a several hours for your bowel to empty but you know you’ve reached the end when you are just passing clear fluid. Yay!
#6 – Timing
With the Miralax protocol, they may ask you to do a split preparation, with one dosage of Miralax the night before and the second a few hours before the procedure. This is considered more effective at cleansing the colon but, for the patient, it can be challenging. My test was at 7am which would have required me to be up at 3am to do that. I made the choice to do my second dose at 11pm the night before so that I could get a few hours of sleep and be totally “empty” by the time I had to get into the car. Worked like a charm. I would suggest wearing a pad or Depends® in the car “just in case.” I did but had no accidents.
#7 – The procedure
Now the easy part, seriously! The prep is, by far, the most difficult part of a colonoscopy. When you arrive at your medical center, you’ll be escorted into a room, where you’ll change into a hospital gown, taken to a bed and be given an IV with a mild sedative. They will wheel you into the procedure room where you’ll meet the nurse and doctor. You’ll probably be rolled onto your side and then, bam, it’s lights out. Hopefully, your next memory will be waking up in the recovery room, hungry and ready to go home.
#8 – The recovery
Depending upon what your doctor found during the test, you’ll be given instructions for your post op recovery. Follow them closely and make sure that you report any concerns that you have with your doctor. Some patients do pass gas and experience painful cramping after the test. (I didn’t. It was a breeze!)
Most likely, you’ll be eating normally within a day and you’ll want to get back to work. Do NOT, I repeat, do NOT try to travel or do something active for a few days. I found that I had unexpected diarrhea for about three days after the procedure as my bowel passed all of the remaining laxative and stool softener. You’ll definitely want to stay home for a few days. With luck, you won’t have to do another one for ten years or more!
If you have any other tips, suggestions and/or preps to recommend to other patients, please email me at: firstname.lastname@example.org