What to expect when you're prepping (for your colonoscopy)

How many of you cringe at scheduling a colonoscopy because the procedure (for which you're knocked out) is a total drag? Yeah, we didn't think so. It's not the procedure itself that gets you in the gut – it's the dreaded, much-maligned prep. To be transparent as we advise you to get over your fears and get screened for colorectal cancer, we chatted with Ken Flora, M.D., a gastroenterologist at The Oregon Clinic. Dr. Flora, who has been doing colonoscopies for 25 years, has plenty of firsthand knowledge regarding what works (and what doesn't). Having realistic expectations, he says, is the first step toward a successful prep.

The truth can be hard to swallow. Dr. Flora says that patients typically are concerned about having diarrhea (you will), being nauseated (you may be) and feeling hungry (it's inevitable). The good news is that this discomfort is temporary. Sure, being uncomfortable stinks. But cancer stinks more.

The two-dose prep works best. You may be someone who, years back, had to chug a full gallon of liquid laxative in one sitting. Take heart: The recommendation nowadays is to break the prep into two parts, with one course in the evening and one in the morning, six hours before your colonoscopy. Research shows that this method leads to the cleanest colon and, therefore, the most accurate look inside, says Dr. Flora, who is also the regional co-medical director of Providence Gastrointestinal Center. “Colonoscopy prep is pretty standard,” he says, “with little variation from practice to practice.”

Nausea is a common side effect. Even Dr. Flora, who recently had a colonoscopy, was nauseated by the prep. “The prep is designed to stimulate the gut to move things more frequently,” he says. “Unfortunately, it stimulates the entire GI tract, and you can have increased irritability in your stomach, too.”

If you feel nauseous, Dr. Flora advises taking a break from drinking the laxative and waiting until your stomach settles down. Usually, your stomach will settle too quickly for anti-nausea medication to even take effect. Dr. Flora recommends refrigerating your laxative mixture. “Cooling it down makes it a little more palatable,” he says.

Also, drinking it through a straw helps the liquid bypass your tongue and avoids triggering your gag reflexes. If you vomit your prep, you should call your doctor's office, as you may need to reschedule your procedure or consider alternative screenings that don't involve flushing your system. The downside, Dr. Flora says, is that other tests aren't as effective as a colonoscopy at detecting precancerous polyps.

Coming clean really is important. Better technology has brought smaller scopes to doctor's offices, but with a smaller scope comes restrictions on what it can suction out of your colon. Liquids can be cleared easily, but seeds (from, say, raspberry jam) and nut fragments – anything fibrous or indigestible – can clog the suction channel and hamper a successful examination of your colon.

A polyp can be as small as a millimeter or two. If there's a stool remnant in there, or a seed from that slice of toast you had the day before you started your prep, your doctor might not know what he's looking at. Even dietary supplements such as omega-3s, ginger or vitamin E can leave trace material in your colon that's hard to remove or see through. Follow your doctor's prep instructions, and if in doubt, call to get clarification or you may risk having to prep again.

Get clear on what you can drink. Gatorade, Powerade and Vitamin Water are the preferred liquids to mix with your prep. In addition to that mixture, you can drink clear fruit juices, such as white grape or apple, and light-colored flavors of Kool-Aid or Crystal Light. Whiskey and wine may be clear, but alcohol is not on the approved list of pre-colonoscopy beverages. You can have clear broth, popsicles, tea, coffee (no cream) and JELL-O. You also can have diet or regular soda, which may help alleviate the nausea but worsen the bloating caused by already taking in a large volume of liquid, Dr. Flora says.

There's one rule of thumb to follow with all of these: Avoid red, purple or orange liquids, as they can obscure your doctor's view of your colon during your procedure. Not clear on what's acceptable? Hold your glass up to a newspaper. Can you see the print? Good. You're in the clear.

With a successful colonoscopy and a clean bill of health – meaning no polyps were found during your screening – you won't need another colonoscopy for 10 years. If your doctor does find and removes polyps, you'll likely need to get screened in five years. Either way, you've done something remarkable for your health, so go celebrate with a generous slice of red velvet cake, some strawberry jam on a sesame seed bagel, or a cranberry juice cocktail.

Don't let fear keep you from getting screened. Check out our resources on colorectal cancer prevention.