10/17/03 12:05 PM
Loc: Seattle, WA
The following is an excerpt from Jill Sklar's book, The First Year Crohn's Disease and Ulcerative Colitis (Marlowe 2002), which is available here on helpforibs.com or at any major bookstore. Jill hereby gives this as her contribution to humanity:
The colonoscopy is a very versatile and useful procedure that is used for many purposes including examining for cancer, locating and excising polyps and securing biopsies that can be later examined for CD or UC. In the past, it was done on patients who were fully awake but less sadistic methods are used now, leaving most patients to ask if the procedure has started when it is already done.
As you probably have heard, the worst part is the prep, an amazing statement given that there are at least a half a dozen ways that the prep is done. The goal of the preps is to strip away any fecal matter from the intestines, thus thoroughly cleansing the intestinal walls for a better view for the endoscopist. All of the preps involve ingesting a substance that then causes intense peristaltic waves and quick evacuation of the bowels, usually taking one to three hours.
Perhaps one of the older preparation ways is the use of a product called Go-Litely, which should probably be named Go Hard and Hurtfully. This involves drinking a glass of barely palatable salty liquid every few minutes until the only thing coming out of you resembles water; a gallon is the usual amount prescribed. A variation of that is Nu-Litely, a less salty, less cumbersome but no more palatable concoction that works in the same manner. Some doctors prescribe different mixes of castor oil, citrate magnesium, Ducolax tablets or suppositories and Fleets enemas to be taken at various times in the two days leading up to the big day. Another relatively new product is Fleets phosphosoda, an intensely briny tasting liquid. The label says that the patient can mix three tablespoons of the liquid with three ounces of water; for a usual colonoscopy prep, a dose the night before and another the morning of the test usually does the trick. The X prep is similar in that it involves drinking about two doses of two ounces of the nasty tasting prep liquid. Finally, the newest prep, Visicol, allows the patient to skip the bad taste by swallowing pills chased with an eight-ounce glass of clear liquid. On the day before the test and the morning of the test, the patient has to swallow three pills every 15 minutes over an hour and a half, with the last dose being two pills; the total of pills swallowed is 40.
There are drawbacks to every prep, chiefly swallowing things that will make you feel queasy. Because this prep is primarily done at home there are a few things you can do to make it more comfortable for yourself. Remember, these are tips and suggestions; I am not a doctor and although I have survived this test more times than any doctor I know, you should always follow the directives that your doctor gives to you regarding medication and bowel cleansing solutions.
We'll start with a shopping list. Since you will be headed to the store to pick up the bottles and boxes of prep materials, pick up the following as you will need them if you don't already have them:
1.Kleenex brand Cottonelle toilet paper infused with both aloe and vitamin E or a box of baby wipes infused with aloe (the quilted wipes provide that extra degree of comfort but may not be advisable if you have a septic system).
2. Hemorrhoidal cream such as Anusol HC or any other one with HC on the label. The HC stands for hydrocortisone, a topical steroid that helps reduce swelling and itching.
3. KY Jelly or Vaseline.
4. Plenty of reading material. I prefer to read magazines that I never read as it certainly provides a diversion so I pick up such paragons of journalism such as The National Enquirer, The Star, The Sun or the Weekly World News. Any other reading material that you would consider fun or distracting is a plus here as well.
5. Scented candles or fragrant bath oil in a pleasing, relaxing scent.
6. A heating pad or hot water bottle.
7. Lots of your favorite clear liquid food items (avoid all with red or purple dyes as the dye can mistaken for inflammation) such as Canada Dry, Jell-O, Italian ice, popsicles, chicken or beef broth. Also, be sure to pick up some electrolyte containing liquids such as Gatorade or Pedialyte.
First, I have a little rule of what ever goes in must come out, kind of like Newton's law but with a little digestive twist – call it Jill's law. The older preps used to dictate a diet devoid of roughage and fat followed for three days before the test, with a clear liquid diet on the last day. Why? Because these things tend to hang out in the colon the longest. With less in there, it made the prep a little easier. People were told to eat baked chicken, baked fish or scrambled egg whites for protein; oils or fats less than two tablespoons for the whole day, which meant no cheese, egg yolks or fried foods; doses of soluble fiber such as plain pasta, white rice, baked potatoes and white bread; sweets like angel food cake or vanilla wafers; and plenty of clear liquids such as broth, weak tea or coffee without cream, soda pop and clear juices such as apple juice or white grape juice. The last part, the clear liquids, was all a person could have the day before. But some doctors theorized that the newer preps could do the job without the diet, still stripping everything in their path.
I, however, still believe in the old diet. As a patient who has more colonoscopies than I care to remember, the diet helps to eliminate the bulk of the feces prior to prep, leaving less to evacuate. It also makes the liquid fast easier to tolerate for me. I also add a Ducolax tablet two nights before the blessed event to help get some of the heavy lifting out of the way first. My feeling is that if I can get the prep done in one dose, I have eliminated some of the misery. I also add clear electrolyte beverages like Gatorade or Pedialyte to the diet, sipping them almost constantly in the two days before the test. This will help to boost some of your electrolyte levels as many electrolytes are lost during the prep, leaving some people to feel cold, shaky and faint. I am not a fan of Gatorade but I love the Pedialyte as it tastes almost like Kool-Aid. I mix a bit of the orange flavor with Canada Dry ginger ale and crushed ice, a sort-of pre-colonoscopy cocktail.
For swallowing the nasty prep liquids, the rules for swallowing yucky things apply again; only this time, you may have more options than you do in a hospital setting. With the Go-Litely and Nu-Litely, you can add a little Crystal Lite for a bit of flavor. Lemons or limes dipped in sugar and tucked into the cheek counterbalance the salty flavor as well as can hard candy. Some people also swear by having the liquid as cold as possible. If you do this, be aware that you might have a sudden, sharp headache more commonly known as brain freeze.
Do not stray away from the bathroom. In fact, have it as stocked as it can be. You will need KY Jelly or Vaseline, the hemorrhoidal cream, the special toilet paper or baby wipes, reading material, bedtime clothing, a bath towel, the aromatherapy tools and anything else you can think of to add to your comfort. One friend of mine hauls in her television for the event.
You may feel somewhat nauseous and this is natural. Use cold cloths on your forehead or splash cold water on your face to fend off vomiting. Pacing helps as well but don't go too far from the bathroom because soon you will have an urge to go that you have never known before.
Before you begin to empty out, it helps a bit to coat your anus with the KY Jelly or Vaseline. The velocity of which your intestinal contents exit pared with the volume of the intestinal contents and the fact that some unabsorbed digestive enzymes will find their way out can make for a very sore anus and rectum. To ward this off a bit, it helps to thoroughly coat the anus and anal canal with the petroleum products. As the emptying begins, use the gentle wipes and flush often.
As the bowel evacuation subsides, you may feel cold and weak with muscle cramps. At this time, I usually draw a hot bath filled with scented bath crystals or oils and surround it with scented candles. This is soothing. If I still feel the urge to go, I am two steps from the toilet and a bath towel is always nearby. Before getting into my nightgown, I use a little soothing hemorrhoidal cream.
Following the first part of the prep, most doctors allow their patients to continue drinking clear liquids until midnight. This is important as the bowel cleanse solutions often draw in water from the body; paired with the diarrhea during the prep, this can make you dehydrated. Try to shoot for at least 24 ounces if you can. Also, if you are particularly nervous, a glass or white wine or a shot of vodka both count as clear liquids in my book and can help you to sleep.
On the day of the test, you will be asked to disrobe. Women may have to take a pregnancy test. An IV will be inserted in your arm before you are wheeled into the endoscopy suite. Draping will cover your body and your doctor will place a sedative in your IV. Usually, the painkiller Demerol is used with the sedative Valium and Versed, a short-term amnesia drug. Another option is to use a short-term anesthesia, administered by an anesthesiologist. While you are out, your doctor will insert the endoscopic tool and examine the colon, taking biopsies as well.
The next thing you should remember is waking up in recovery. You may be given juice to drink. When you are able to stand up, you can get dressed. The doctor who performed the test will discuss his or her findings with you and with the person who drove you to the test before you are allowed to leave. You may be woozy the rest of the day but you should recover by the next day.
If you experience sharp pain or a lot of bleeding, you should call the doctor. Rarely, a perforation of the intestines can occur.
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!