Gastroenterology s and Answers

• What is a laxative and which one will I take to prepare for my test?
• Can I take my routine medications on the morning of my test?
• I have an artificial joint. My orthopedic surgeon said I need?
• What happens if I start vomiting after drinking the laxative?
• Why do I have to stop drinking 4 hours before my colonoscopy?
• What if my hemorrhoids bleed during the prep?
• Ooops, I just read my instructions. I accidentally ate breakfast.
• I am having my period. Can I still have my colonoscopy?
• Do I have to drink all of my colon prep?
• How can I tell if my colon is clean enough?
• I am a diabetic. What precautions should I take?
• Why does my driver need to stay in the lobby during my entire test?
• I am usually very constipated. What if the prep doesn't work?
• When will I get the results from my colonoscopy?
• What happens if bowel movements do not start after drinking the laxative?
• What do I do about my diabetic medications?
• I am a diabectic and I'm worried about my blood sugar dropping too low.
• Why is it so important to have a clean colon?
• Why do I have to wake up so early to do another dose of laxative?
• How will my primary care physician know the results?
• What happens after my procedure? Will I still have diarrhea?
• What if I forgot to stop my blood thinners?
• What clear liquids are allowed?
• I am a diabetic, what can I do if my blood sugar is too high?
• I am very sensitive to laxatives.
• How long will it take for the preparation to start working?
• I have a heart problem, and I need antibiotics before tests.
• Can I take over-the-counter medications with my colon prep?
• Will I miss work the day before my procedure?
• How do I prepare for a colonoscopy?

What is a laxative and which one will I take to prepare for my test?

A laxative is a medication which pulls water into your colon and causes your colon to squeeze and clean itself out. You will take Ducolax® (bisacody) laxative tablets and MiraLAX® laxative powder mixed with Crystal Light®. This combination will allow your colon to make a large amount of liquidy diarrhea.

Can I take my routine medications on the morning of my test?

If you are scheduled for a morning procedure, do not take any medication EXCEPT for blood pressure, heart and seizure unless you are otherwise instructed by our physician or your primary care physician. If you are scheduled for an afternoon exam you may take your routine medicaiton EXCEPT the medications that you were instructed to hold. Pain medicaiton should not be taken within six hours of any procedure.

I have an artificial joint. My orthopedic surgeon said I need?

No. The American Society for Gastrointestinal Endoscopy, has concluded that antibiotic use for patients with artificial joints is not recommended.

If your surgeon advises you to take antibiotics anyway before and/or after the procedure, he or she may choose to provide you with a prescription for the medication of their choice.

What happens if I start vomiting after drinking the laxative?

Wait 1 to 2 hours to allow your stomach to settle. Start drinking the solution at a slower pace. Instead of drinking a glass every 10 to 15 minutes, drink a glass every 20 to 30 minutes. This will take longer, but hopefully should keep you from vomiting the rest of the solution. If you continue to vomit, call our office to receive further instructions from your physician.

Why do I have to stop drinking 4 hours before my colonoscopy?

We ask that you stop clear liquids four hours prior to your colonoscopy to allow your stomach to empty before you receive sedation. Liquids in your stomach can be inhaled into your lungs when you are sedated, causing serious complications.

What if my hemorrhoids bleed during the prep?

If you use hemorrhoid cream, it would be a good idea to use that before starting the laxative prep. If you have a very small amount of bleeding, try to finish the prep so your procedure can still be performed. If you are having a large amount of bleeding, stop your prep and call our office or call the emergency room.

Ooops, I just read my instructions. I accidentally ate breakfast.

Usually, you can really push a lot of fluids and your bowel preparation will work. This may not be the case if you are a person who usually has constipation. You may require a little extra laxative to completely clean out.

I am having my period. Can I still have my colonoscopy?

This will not interfere with your procedure at all, nor will wearing a pad or using a tampon.

Do I have to drink all of my colon prep?

Yes, we want your colon as clean as possible so that your physician can see all of the colon. This allows your physician to find (and possibly treat) the smallest and flattest polyps.

How can I tell if my colon is clean enough?

If your diarrhea is near-clear or only a light color, then you can be confident that your colon is clean enough for an excellent examination. If your diarrhea is dark colored with solid material mixed in, then you probably need to take more preparation.

I am a diabetic. What precautions should I take?

If you are a diabetic we will give you special instructions when your procedure is scheduled. You will need to let us know about ALL of your diabetic medications. You should check your blood sugar frequently during the day before and the day of the procedure. Since you will be on clear liquids, your blood sugar will tend to drop faster than normal. To avoid this be sure to include some liquids with regular sugar in your diet. It may also be helpful to have some glucose tablets on hand in case your blood sugar drops and it is past your cut off time for fluids.

Why does my driver need to stay in the lobby during my entire test?

Your driver must stay in the lobby for your safety. You will be sedated and not able to make decisions for yourself. You cannot drive yourself home after the procedure; therefore, we want your driver available as soon as you are ready, so you can go safely home.

I am usually very constipated. What if the prep doesn't work?

Be sure to tell your physician or the nurse so that an extended prep can be used. Often placing patients on 2 days of clear liquids and doing 2 preparations will result in a clean colon. Otherwise, the colon may not be clean and the examination may need to be repeated.

When will I get the results from my colonoscopy?

After the procedure, you and your driver(s), will receive some early results of the procedure. Often, the physician who did your procedure will be the one to discuss the results.

Many times biopsies or samples are sent to the pathology lab for microscope studies. These results are usually back to the physician in a week. The physician will call or mail you a letter with the results the following week. Therefore, if you do not hear back from the doctor within two weeks of your procedure, you should call your physicians office.

What happens if bowel movements do not start after drinking the laxative?

If it has been longer than four hours, drink your second dose of laxative solution. If bowl movements begin and run clear, no further laxative will be needed. If your bowel movements continue to be dark colored liquid with stool, you will need to purchase another bottle of MiraLAX® for use on the morning of the procedure.

What do I do about my diabetic medications?

If you take oral medications (pills), you may take your morning medication, but hold your evening dose on the day before your procedure. If you are taking insulin you will need to speak with one of our nurses to receive your individual instructions. If you haven't talked with a nurse within five days of your procedure please call our nurses number that is listed on the back of the instruction sheet.

Can I have alcohol while I am doing my prep?No, you may not have alcohol while you are doing your prep, or on the day of the procedure. Alcohol is dehydrating and dangerous to mix with sedation.

I am a diabetic and I'm worried about my blood sugar dropping too low.

You will need to monitor your blood sugar throughout the day. Remember, that the liquid that you drink is all the nourishment you are getting.

Make sure that the drinks you are drinking contain sugar in addition to your diet drinks. Keep your instant glucose handy, drink a glass of liquid that contains sugar, or dissolve a piece of hard candy slowly in your mouth. DO NOT CHEW. Remember nothing red or purple. Check you blood sugar in 45 minutes to an hour and repeat the sugar drink, candy or instant glucose if needed. If it does not come up or continues to drop, contact your physician or go to the Emergency Room.

Why is it so important to have a clean colon?

A clean colon will allow the doctor to carefully examine all of your colon and remove or treat or biopsy any small or flat polyps. If areas of your colon are not completely clean, small areas may be missed which could potentially have pre-cancerous polyps or tumors. Also, if large sections of the colon are unclean then methane gas may still be in the colon. This can be dangerous because electricity is often used to treat polyps.

Why do I have to wake up so early to do another dose of laxative?

Most patients cannot tolerate 64 ounces of liquid all at one time. By dividing the laxative into two smaller doses, this allows any left over material in your colon to be removed with the second dose. This results in a better cleansing and a better examination.

How will my primary care physician know the results?

As long as your physician knows who your primary care physician (PCP) is and is your "doctor of record", then your PCP will be sent a copy of your procedure note the same day of your procedure.

What happens after my procedure? Will I still have diarrhea?

Most patients feel gassy abdominal cramping after the procedure. While in the recovery area waking up from the procedure, you will be asked to push out air from the colon. You may still have a small amount of leakage and you may want to wear protection for your clothes. If you eat greasy or fried foods after your procedure you may still experience diarrhea. We recommend a low-fat solid meal soon after the procedure to prevent diarrhea.

What if I forgot to stop my blood thinners?

You will need to call our office to reschedule your procedure.

What clear liquids are allowed?

A clear liquid is defined as anything that you can see through when you hold the liquid up to a light. This includes soft drinks, coffee, tea, Jell-O, popsicles, bouillon or broth, apple juice, or white grape juice. DO NOT drink anything that is red or purple because it may look like blood during the procedure.

I am a diabetic, what can I do if my blood sugar is too high?

Drink sugar free drinks. Do not take insulin to bring it down unless you use a sliding scale insulin. Be sure to check your blood sugar in an hour to see if it is going down. If it is too high or does not go down contact your physician or go to the Emergency Room.

I am very sensitive to laxatives.

If by sensitivity you mean you develop a sore bottom: It's a good idea to pre-treat your bottom with something that will protect it even before the bowel movements begin. Desitin® is a good choice. Use wet wipes instead of toilet tissue.

If by sensitivity you mean that a little bit of medication really gets your bowels moving: Then you may want to buy some underwear protection and stay very close to the bathroom. People who have a history of having accidents are more likely to have accidents during their bowel preparation.

How long will it take for the preparation to start working?

Everyone is different. Some people begin having their bowels move within one hour of drinking all of their preparation. Some people are very sensitive to laxatives and will have accidents. This is especially true for patients who have had accidents in the past with routine "GI bugs". Other patients may not have their bowels move for four hours. These patients usually require a little extra laxative preparation in order to get their colon clean.

I have a heart problem, and I need antibiotics before tests.

No. For decades we have administered IV or oral antibiotics prior to performing some colonoscopic procedures, but practices have changed.

In April 2007 the American Heart Association update its guidelines. The new guidelines state that "the administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo GU or GI tract procedures, including diagnostic esophagogastroduodenoscopy and colonoscopy." This means that most patients do not need antibiotics before scoping procedures.

Can I take over-the-counter medications with my colon prep?

Most over-the-counter medications are alright to take EXCEPT: aspirin, Motrin®, Advil®,ibuprofen, Aleve®, naprosyn, Naproxen or iron supplements. Tylenol® (Acetaminophen) will not interfere with your colonoscopy.

Will I miss work the day before my procedure?

If you work the day shift you can work. If you work the evening shift you may have to miss work. You will begin taking your laxative in the afternoon around 3:00 p.m.

How do I prepare for a colonoscopy?

You will be on clear liquids the day before the procedure and take laxative to cleanse your colon.