How To Clean Out For A Colonoscopy

This information will help you get ready for your colonoscopy using polyethylene glycol (MiraLAX^®).

A colonoscopy is a test that lets your doctor see inside your colon (large intestine). Your doctor will use a colonoscope (flexible tube with a camera on the end) to see the inside of your colon on a video monitor. During your procedure, your doctor can:

Remove a small sample of tissue (biopsy) for testing
Remove a polyp (growth of tissue)
Take photos of the inside of your colon

Before your procedure, you must follow these instructions carefully. You will need to do a bowel preparation to empty your colon before your procedure. It's very important that your colon is empty for your colonoscopy. If there's stool (poop) inside your colon, your doctor may not be able to see polyps or other problems inside your colon and you may have to repeat the procedure. If you have any questions, contact your doctor's office.

1 Week Before Your Procedure

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely and report concerns to your healthcare providers, if needed. Make sure to plan this before the day of your procedure.

If you don't have a responsible care partner to take you home, call one of the agencies below. They'll send someone to go home with you. There's usually a charge for this service, and you'll need to provide transportation. It's OK to use a taxi or car service, but you must still have a responsible care partner with you.

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop taking. We have included some common examples below.

Anticoagulants (blood thinners)

If you take a blood thinner, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it. Examples are listed in the "Common anticoagulants (blood thinners)" table. There are others, so check with your doctor if you're not sure.

Common anticoagulants (blood thinners)
apixaban (Eliquis^®) cilostazol (Pletal^®) clopidogrel (Plavix^®) dalteparin (Fragmin^®)	enoxaparin (Lovenox^®) fondaparinux (Arixtra^®) heparin	rivaroxaban (Xarelto^®) tinzaparin (Innohep^®) warfarin (Coumadin^®)

Medications for diabetes

If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the day before and the morning of your procedure. Tell your doctor you will be drinking a sugar-free clear liquid diet the day before your procedure.

If you take metformin (such as Glucophage^®or Glumetza^®) or a medication that contains metformin (such as Janumet^®), don't take it the day before or the day of your procedure.

Tell your doctor if you have an AICD

Tell your Memorial Sloan Kettering (MSK) doctor if you have an automatic implantable cardioverter-defibrillator (AICD).

Get a letter from your doctor, if needed

If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist (heart doctor) before your procedure. A clearance letter is a letter that says you can safely have the procedure.
If you've had chest pain, dizziness, trouble breathing that's new or worse, or have fainted in the last 6 weeks, you need to be examined by your doctor, and get a clearance letter from your doctor before your procedure.

Your MSK doctor's office must have your clearance letter at least 1 day before your procedure.

Buy supplies

You will need to buy the following supplies for your bowel preparation:

4 (5 mg) tablets of bisacodyl (Dulcolax^®). These are usually sold as a box of 10 tablets.
1 (238 gram) bottle of polyethylene glycol (MiraLAX ^®).
64 ounces of any clear liquid that isn't red, purple, or orange. You will need to mix this with the MiraLAX. Keep it at room temperature.
- A sports drink like Gatorade^® or Powerade^® is a good choice. Sports drinks will help replace electrolytes that you will lose during the bowel preparation.
- If you have diabetes, be sure to get sugar-free clear liquids.

Some people may need other supplies. To see if you need any other supplies, answer the questions below:

Do you tend to be constipated (have fewer bowel movements than what's normal for you) or have fewer than 3 bowel movements per week?
Do you take narcotic (opioid) medications such as fentanyl (Duragesic^®, Subsys^®) morphine (DepoDur^®, Duramorph^®), hydrocodone (Vicodin^®) or oxycodone (Oxycontin^®, Percocet^®)? If you're not sure, ask your healthcare provider.
Have you had a colonoscopy with a poor prep in the past? This means that during your colonoscopy, your healthcare provider still saw stool in your colon.

If you answered yes to any of the questions, you must also buy the following supplies:

3 (17 gram) doses of MiraLAX (for a total of 51 grams).
- You can buy 1 additional small bottle (119 grams) or the packets.
More liquids for a full liquid diet.
- Examples of what you can drink are listed in the section called "2 Days Before Your Procedure."

5 Days Before Your Procedure

Stop taking iron supplements

If you take an iron supplement, you'll need to stop taking it 5 days before your procedure. Iron supplements can cause color changes in your stool, which can make it harder for your doctor to see your colon clearly.

3 Days Before Your Procedure

Avoid certain foods

You should follow a low-fiber diet starting 3 days before your colonoscopy. During this time, do not eat:

Raw (fresh) fruits and vegetables
Whole kernel corn, including canned corn
Whole grains (such as oatmeal, brown rice, quinoa, or wheat bread)
Seeds (such as poppy or sesame)
Nuts

Talk with your endoscopy nurse

A few days before your procedure, you'll get a call from an endoscopy nurse. They will review the instructions in this guide with you and ask you questions about your medical history. The nurse will also review your medications and tell you which to take the morning of your procedure.

Use the space below to write them down.

Use this space to write down your medications

2 Days Before Your Procedure

Don't start your clear liquid diet until the day before your procedure if you:

Aren't usually constipated
Don't take narcotic (opioid) medications
Haven't had a colonoscopy with poor prep in the past

Avoid raw fruits and vegetables, whole kernel corn, grains, seeds, and nuts. Skip to the next section "The Day Before Your Procedure."

If you're usually constipated, take narcotic medications, or have had a colonoscopy with a poor prep in the past:

Take 1 capful (17 grams) of MiraLAX mixed with 8 ounces of liquid at breakfast, lunch, and dinner.
Follow a full liquid diet. On a full liquid diet, you may eat and drink the following:
- Yogurt (without any pieces of fruit)
- Fruit juices without pulp
- Soda
- Broth or cream soups that have been strained so there are no vegetable pieces
- Nutritional supplements
- Ice cream and fruit ices (without any pieces of fruit)

The Day Before Your Procedure

Prepare your MiraLAX bowel preparation

On the morning of the day before your procedure, mix all 238 grams of the MiraLAX powder with 64 ounces of a room temperature clear liquid until the MiraLAX powder dissolves.

Once the MiraLAX is dissolved, you can put the mixture in the refrigerator. Many people find it tastes better when it's chilled.

Don't mix the MiraLAX earlier than the morning of the day before your procedure.

Follow a clear liquid diet

You will need to follow a clear liquid diet the day before your procedure. Examples of clear liquids are listed in the table in this section.

Don't eat any solid foods.
Don't drink anything red, purple, or orange.
Make sure to drink plenty of liquids other than just water, coffee, and tea. This helps to make sure that you get enough calories and is an important part of your colonoscopy preparation. Try to drink at least 1 (8-ounce) glass of liquid every hour while you're awake.
If you have diabetes, you should drink only sugar-free clear liquids and check your blood sugar level often. If you have any questions, talk with your healthcare provider.

Clear Liquid Diet
	Drink	Do Not Drink
Soups	Clear broth, bouillon, or consommé	Any products with particles of dried food or seasoning
Sweets	Gelatin, such as Jell-O^® Flavored ices Hard candies, such as Life Savers^®	Anything red, purple, or orange
Drinks	Clear fruit juices, such as apple, white cranberry, lemonade, or white grape Soda, such as 7-Up^®, Sprite^®, ginger ale, or seltzer Gatorade^® Black coffee Tea Water	Juices with pulp Nectars Milk or cream Alcoholic beverages Anything red, purple, or orange

Note the time of your procedure

A staff member will call you after noon the day before your procedure. The staff member will tell you what time you should arrive for your procedure. If you're scheduled for your procedure on a Monday, you will be called on the Friday before. If you don't receive a call, call your doctor's office.

If you need to cancel your procedure, call the doctor who scheduled it for you.

Start your bowel preparation

Step 1: At 4:00 pm on the day before your procedure, take 2 bisacodyl (5mg) tablets by mouth with a glass of water.

Step 2: At 4:15 pm, start drinking the MiraLAX mixture.

At 4:15 pm , drink 1 (8-ounce) glass of the mixture.
At 4:30 pm , drink 1 (8-ounce) glass of the mixture.
At 4:45 pm , drink 1 (8-ounce) glass of the mixture.
At 5:00 pm , drink 1 (8-ounce) glass of the mixture.

You will drink 4 glasses of the mixture in total.

When you're finished, half of the MiraLAX mixture will be left. Save the rest of it in the refrigerator for the second half of your preparation.
Bowel movements usually begin within 1 hour of drinking the first dose, but it may take longer for some people.
- Don't worry if you don't start having bowel movements after drinking the first half of the MiraLAX. Continue to drink liquids and start the second half of the MiraLAX as instructed.
Put petroleum jelly (Vaseline^®) or A & D^® ointment on the skin around your anus after every bowel movement. This helps prevent irritation.
Continue to drink clear liquids to stay hydrated and flush out your colon.

Step 3 (If you were told to arrive for your procedure before 11:00 am):

If you were told to arrive for your procedure before 11:00 am, follow these instructions the night before your procedure:

At 11:00 pm , take 2 bisacodyl tablets by mouth with a glass of water. Then, start drinking the second half of the MiraLAX mixture.

At 11:15 pm , drink 1 (8-ounce) glass of the mixture.
At 11:30 pm , drink 1 (8-ounce) glass of the mixture.
At 11:45 pm , drink 1 (8-ounce) glass of the mixture.
At 12:00 am (midnight), drink 1 (8-ounce) glass of the mixture.

Be sure to finish the entire MiraLAX mixture.

You can continue to drink clear liquids until 4 hours before your scheduled arrival time.
Don't eat anything until after your procedure.

The Day of Your Procedure

Step 3 (If you were told to arrive for your procedure at 11:00 am or later):

If you were told to arrive for your procedure at 11:00 am or later, follow these instructions the morning of your procedure:

At 6:00 am , take 2 bisacodyl tablets by mouth with a glass of water. Then, start drinking the second half of the MiraLAX mixture.

At 6:15 am , drink 1 (8-ounce) glass of the mixture.
At 6:30 am , drink 1 (8-ounce) glass of the mixture.
At 6:45 am , drink 1 (8-ounce) glass of the mixture.
At 7:00 am , drink 1 (8-ounce) glass of the mixture.

Be sure to finish the entire MiraLAX mixture.

You can continue to drink clear liquids until 4 hours before your scheduled arrival time.
Don't eat anything until after your procedure.

Things to remember

Take only the medications you were instructed to take the morning of your procedure. Take them with a few sips of water.
Don't apply any lotions, creams, or powder to your chest or arms.
Remove any jewelry, including body piercings.
Leave all valuables, such as credit cards and jewelry, at home. We don't have lockers to store your valuables in.
If you wear contacts, wear your glasses instead.

What to bring

A list of the medications you take at home
If you have an implanted pacemaker or cardioverter-defibrillator (AICD), bring your wallet card with you.
Your rescue inhaler (such as albuterol (Proventil^®, Ventolin^®) for asthma), if you have one
A case for your glasses
Your Health Care Proxy form, if you have completed one

Where to go

Your procedure will take place at one of these locations:

Endoscopy Suite at Memorial Hospital (MSK's main hospital)
1275 York Avenue (between East 67^th and East 68^th Streets)
New York, NY 10065
Take the M elevator to the 2^nd Floor. Enter the Endoscopy Suite through the glass doors.
MSK Monmouth
480 Red Hill Road
Middletown, NJ 07748

What to expect

Once you arrive, you will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having procedures on the same day.

When it's time to change for your procedure, you will get a hospital gown, robe, and nonskid socks to wear.

You will meet with your doctor before your procedure. They will explain the procedure to you and answer any questions you may have.

You will meet with your anesthesiologist. They will review your medical history with you and talk with you about the kind of anesthesia (medication to make you sleep) you will receive.

Once it's time for your procedure, you will be brought into the procedure room and helped onto the exam table. You will lie on your left side with your knees bent.

Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. You will get anesthesia through your IV, which will make you fall asleep. Once you're asleep, your doctor will begin the procedure.

Your doctor will place a colonoscope into your rectum. The colonoscope is connected to a video monitor. This lets your doctor to see the inside of your colon. Your doctor will use air and fluid to move the colonoscope through your colon while looking for anything unusual on the video monitor.

The procedure usually takes less than 60 minutes (1 hour).

Frequently Asked Questions (FAQs)

I'm taking the prep and started having loose, watery stool before I finished it. Do I still need to take the rest of the prep?

Yes. You must drink all the prep to fully clean out your colon for a safe and complete colonoscopy.

I feel like throwing up (nausea) or did throw up (vomit) after taking the bowel prep. What should I do?

Many people may feel nauseous while drinking the bowel prep. To help with this, try mixing the MiraLAX powder with clear liquids you like drinking.

If you feel like vomiting, you should drink slowly, and take a break. This means you should stop drinking the liquid for 30 to 45 minutes to let your stomach empty. While you take a break, put your prep liquid in the fridge. After your break, try to slowly drink the prep again. Use a straw if you have one.

If you do vomit, take a 30 to 45 minute break. If you have anti-nausea medication at home, you can take 1 dose before starting the prep again. You can drink any clear liquids you like to drink to stay hydrated. It's important that you drink all the prep liquid to fully clean out your colon for a safe and complete colonoscopy.

After Your Procedure

Your nurse will continue to monitor your heart, breathing, and blood pressure. Many people feel bloated and have stomach cramps after a colonoscopy. This is normal and goes away by passing gas.

Once you're fully awake, your nurse will remove your IV. If you have someone waiting with you, your nurse will explain your discharge instructions to both of you before you go home.

At home

You may begin eating light foods as soon as you're discharged. Avoid spicy, greasy, and fried foods at first. Work your way up to your normal diet. If your doctor wants you to limit your diet for a period of time, they will tell you.
You can go back to doing your usual activities 24 hours after your procedure.
Don't drink alcoholic beverages for 24 hours after your procedure.

If you had a biopsy, it's normal to have a small amount of bleeding from your rectum. There should be no more than a few drops of blood, and the bleeding should stop within 24 hours after your procedure.

After a colonoscopy, it's normal for your bowel movements to be irregular or different from your usual habits. This may last for up to a week after your procedure.

When to Call Your Healthcare Provider

Call your healthcare provider if you have any of the following:

A fever of 101° F (38.3° C) or higher
Serious stomach pain or bloating
Bleeding from your rectum that lasts more than 24 hours
Bleeding between bowel movements
Weakness, faintness, or nausea
Heavy bleeding from your rectum