There will probably never be a TV reality show on how to survive colonoscopy prep, but before enduring my first one, I was pretty convinced there needed to be. I kept hearing from family and friends about how I was in for a night of a thousand horrors. Maybe I would survive my emptying, and maybe I wouldn’t.
That was two colonoscopy preps ago. I had my first when I was 50, and my second one, a couple of weeks ago. I’m 55 years old now, and my next one will come up in five years. According to the American Cancer Society, I’ll get to do these every five years until I am 75, and if I’m in really good health, I might get to do them until I’m 85. If you’re of average risk, the ACA recommends that you start getting these at age 45.
And I can tell you that while a colonoscopy — a medical procedure in which a doctor checks your bowels and looks for signs of colon cancer — is never going to be mistaken for a day at an amusement park, it’s really not so bad.
Granted, I’m no doctor or medical expert. Just a beleaguered writer whose doctor’s notes said that he had “excellent bowel preparation,” a phrase I’m now considering adding to my resume or LinkedIn profile. Still, if you have a colonoscopy coming up, I think I can help you through this. You just need to remember these handy-dandy rules.
1. Attitude is everything.
It’s easy to understand why a lot of people detest colonoscopy prep. There are a lot of instructions to follow, including enduring an all-liquid diet for over 24 hours. Then, in the midst of this ordeal and in the middle of the night, you have to drink a terrible-tasting polyethylene glycol-electrolyte solution, though because nobody can say that, we all say that we’re consuming a “colonoscopy prep drink.” You’ll also be drinking a lot of water (32 ounces) around the same time. This is nobody’s idea of fun.
But, still, if you dread your colonoscopy prep, you will hate it. With the right attitude, you may find that you merely dislike it.
“I’ve been a GI nurse for over 12 years, and the vast majority of people will say, ‘Wow, that was a piece of cake,’” said Courtney Holtz, a registered nurse and an assistant director of ambulatory nursing in the gastroenterology and hepatology division at the University of Rochester Medical Center in Rochester, New York.
That Holtz meets patients who thought their colonoscopy prep was akin to a dessert is likely due to all of the negative hype and knowing looks you’ll get from family and friends who have been through it. In some ways, everybody complaining about the colonoscopy experience may help you, because you’ll be bracing yourself for a worst-case scenario that never comes.
Holtz also said that it’s important to not lose sight of why you’re doing this — to catch colon cancer early, so it can be treated and you can be cured: “A few hours of pooping is much easier than dealing with advanced colon cancer treatment.”
According to the American Cancer Society, there will be an estimated 154,270 cases of colon cancer this year, and an estimated 52,900 people will die from it. Excluding the various skin cancers, colon cancer is the third most common form of cancer diagnosed in both men and women. But colon cancer deaths have been coming down considerably over the years, thanks to colonoscopy screenings.
2. Preparation for your all-liquid diet is key.
If you’re going to get through your all-liquid diet day without feeling miserable, you’ll want to do your grocery shopping at least one day before the liquid diet (or even a few days before, if you can). It’s going to be a bummer if you’re looking forward to Jell-O or sorbet and then realize that, whoops, you don’t have any. I’ve learned that the hard way.
“Clear liquids include sport drinks, such as Gatorade, clear fruit juices without the pulp, carbonated beverages, Jell-O, popsicles, hard candy and soup bouillons,” said Dr. James Cox, an assistant professor and director of clinical skills development and physician communication at Burnett School of Medicine at Texas Christian University in Fort Worth, Texas.
(Dang. I had no idea I was allowed to have hard candy ― though you aren’t allowed to have any red, blue or purple flavors, so that does remove a lot of your options.)
Cox said that on the all-liquid diet day you will likely crave solid food, but you shouldn’t feel hungry, and while I can’t speak for everybody’s stomach, I think he’s right. I’m a big man who enjoys eating, but with the right planning, you shouldn’t feel too deprived. Not if you’re drinking high-calorie drinks like lemonade and munching on popsicles and sorbet (but, again, there are certain flavors you’ll need to stay away from, like anything with red food dye, since it stains the colon and looks like blood).
In fact, my all-liquid diet day was, in some ways, pretty enjoyable. I usually drink diet soda because I try to stay away from the calories. (Yeah, yeah, I know that diet sodas aren’t the healthiest thing.) But on my recent all-liquid diet day, I had three 20-ounce Sprites, each with 240 calories, without an ounce of guilt. (Yeah, yeah, I also know that’s a lot of sugar I consumed. I’m no nutritionist, and I’m not suggesting you do this every day.)
Those calories are important, Cox said, if you’re not interested in feeling hungry all day.
You’re also allowed to have chicken or beef broth. “Broth and clear fruit juices are more calorie-dense liquids, which can help patients feel fuller and more satiated,” said Jen Gassett, a registered nurse and assistant professor of professional practice in nursing at TCU.
Gassett also said that “popsicles and Jell-O can make it feel like you’re eating somewhat more solid foods.”
3. Find something enjoyable to pass the time, especially at night.
Granted, you can time your colonoscopy later in the day, so you can get a fairly good night’s sleep, but Cox doesn’t think that’s a great idea.
“I highly recommend doing the colonoscopy as early as possible in the morning,” Cox said. “The goal is to wake up, have someone drive you to the procedure, do the colonoscopy and then go to breakfast. If you have to wait the entire morning to do the procedure, the television or other media sites will invariably show food commercials, which can be difficult to endure.”
In my case, at least with my second colonoscopy, I woke up at 1:20 a.m. in preparation for a 7:30 a.m. colonoscopy procedure.
I had to climb out of bed around the same time a morning news TV host wakes up in order to give me time to drink the bitter colonoscopy prep drink, which, yes, tastes like [editorial note: censored, in case any children are reading this]. I also had to consume 32 ounces of water.
I drank it all down as fast as I was able to get it over with, but Holtz doesn’t recommend that.
“My advice is to pace yourself,” she said. “It’s important to finish your prep, but you don’t need to chug. It’s not a race.”
Cox suggests watching a movie or reading a good book while you’re drinking your colonoscopy prep. “You might as well do something fun,” he said.
I opted for TV. If you have a TV app on your phone, sitting on your toilet watching old sitcoms and ”Columbo” episodes isn’t the worst way to spend a night. You can also dictate emails or complain about your colonoscopy in social media posts. The point is, live your life, do something you enjoy and make the colonoscopy prep as secondary in your evening as possible.
4. Anticipate other needs you may have, like bathroom comfort and post-procedure arrangements.
Remember: attitude. This is not a night of torture. It’s also not a trip to the spa, but tell yourself that this is going to be a fun night in which you are going to watch TV, read, find solidarity with friends on Facebook ― whatever you’re doing, it’s going to be a hoot. Keep telling yourself that. You may eventually start to believe it.
But it also might behoove you to prepare a little extra, if you’re really worried.
- Think about nausea. If this isn’t your first colonoscopy rodeo, and you were nauseous in the past, Holtz said, “you can ask your doctor to prescribe you an antiemetic called Zofran to have on hand in case.” If this is your first colonoscopy, you probably won’t need to do that, Holtz suggested. “Most people tolerate the prep just fine without it,” Holtz said.
- Think about flavor. “If you need to drink the big prescription jug called GoLYTELY, or something similar, buy flavor-enhancing drops to add in,” Holtz recommended. But she added to make sure they’re not red, purple or blue.
- Think about your bottom. “Have baby wipes or flushable wet wipes on hand. With all those trips to the bathroom, your bum will thank you,” Holtz said.
- You may be able to opt out of the colonoscopy prep drink. Talk to your doctor, of course. “Colonoscopy prep regimens are improving, and there are several different options available,” Gassett said. “If you can’t tolerate the flavored drinks, there is a pill version of the colon prep that may be a good fit for patients. Patients can discuss options with their provider to find a bowel prep regimen that is both tolerable and effective in preparing for their colonoscopy.”
- You don’t have to do this completely alone. “Don’t hesitate to call the on-call doctor the night before the procedure if you are having trouble,” Cox said. “The doctor can help you through the preparation and give you some hints on how to finish depending on your individual needs.”
- Plan for post-procedure. You do need somebody to take you to the hospital and back. I had to enlist my 23-year-old daughter and 82-year-old father to take over driving duties. Not only should you think about logistics but maybe have a back-up plan if your first plan goes south.
5. Remember why you’re doing this and look forward to it being over.
“Psychologically, know that you are doing the best possible test for screening for colon cancer. Colonoscopies save lives,” Cox said. “Take solace in that fact as you finish the preparation and dream of the food you will eat the next day.”
Seriously, promising yourself a really delicious breakfast can make a lot of what you’re doing almost worth it. And similar to having an annual checkup or eating fruit instead of Froot Loops, getting a colonoscopy is a smart thing to do for your well-being. If you’re like me, and you feel like you spent too many years scarfing down jelly doughnuts and not exercising enough, pat yourself on the back for finally making a smart health decision.
“I think remembering why you need to prep for a colonoscopy helps put the experience into perspective,” Gassett said. “Is it going to be pleasant? No. But could this possibly save your life? Absolutely.”