What you need to do

Important health considerations

One of the best ways to reduce anxiety about having a colonoscopy is to have a plan.

Although the procedure takes less than half an hour, the preparation involves several things that can’t be left until the last minute.

Don’t wait until the day before the procedure to read the bowel preparation instructions.

Review the instructions about the colonoscopy process at least two weeks ahead of time to ensure that you know what to do with your diet and medications, especially if you have diabetes, hypertension, heart, kidney, or vascular problems, require blood thinners, or have other serious medical problems.

Providing information about your health to your colonoscopist well ahead of the colonoscopy, understanding the information about your bowel preparation, and following the specific plan provided to you by your colonoscopist are your primary responsibilities throughout the entire colonoscopy process.

Before scheduling your colonoscopy, you need to discuss with your colonoscopist how fasting, dehydration, and potential removal of pieces or parts of your bowel may affect any underlying medical conditions and medications.

Only under your colonoscopist's instruction should you stop or change the dose of certain medications and supplements, such as anti-platelet agents, aspirin and other anti-inflammatories, blood thinners, diabetes medications and hypertension medications.

Even over-the-counter medications, herbal supplements and vitamins can impact the potential risk of colonoscopy.

These things need to be fully discussed with your colonoscopist and thought about well ahead of a colonoscopy.

Modifiable Bowel Cancer Australia Screening Surveillance


Public or Private?

When your GP refers you for a colonoscopy, you can choose to have the examination in a public or private facility.

Regardless of where you have your colonoscopy performed, the examination will be conducted in a private area.

If you have private health insurance and are planning to have your colonoscopy as a private patient, you should talk with your colonoscopist about where the procedure will take place and whether there will be any gap or out-of-pocket cost for you to pay to the colonoscopist or ancillary staff for the procedure.

You should also check with your health fund before the procedure to find out what your health insurance will cover.

Speak with the colonoscopist if you have concerns as to where and how the procedure will be done.


Choosing your colonoscopist

Make sure your colonoscopy will be done by an experienced colonoscopist who is interested in constant improvement in the quality of colonoscopy that he or she provides.

Questions to ask your prospective colonoscopist to help ensure a high-quality procedure:
 

1. What is your adenoma detection rate? 
    (should be ≥25% overall or ≥30% for male patients and ≥20% for female patients)

2. What is your caecal intubation rate? 
    (should be ≥95% for screening colonoscopies and ≥90% overall)

3. Do you use split-dosing of bowel preparations? 
    (Effective bowel preparation requires that at least half the preparation is ingested on the day of 
colonoscopy)


Checks of the colonoscopy report after the procedure:

1. Does the report include photographs of the caecum?
   (This demonstrates that the full extent of the bowel was examined)

2. Is the quality of the bowel preparation described?
    (The preparation must be adequate to ensure effective examination)


What you can expect from your colonoscopist:

  • A valid indication for the procedure
  • the colonoscopist is well trained in the procedure and meets agreed standards for competence
  • there will be skilful and thorough examination of all parts of the large bowel
  • risk factors (e.g. anticoagulant therapy, presence of severe co-morbidities) will be identified well before colonoscopy and action taken to minimise risk
  • you will be given a clear explanation of what is involved in the procedure and have an opportunity to ask for more information and that this information will be provided before starting your bowel preparation
  • clear information about the details of the bowel preparation protocol, including the importance of maintaining hydration will be provided
  • the type of bowel preparation selected for you was based on your personal risk factors (e.g. age, renal impairment) and your personal preference
  • the procedure will be performed safely and with minimal discomfort
  • verbal and written information about the results of the procedure are given to you
  • verbal and written instructions about what to do if problems occur after discharge are provided
  • information about follow-up review is given

Meeting your colonoscopist
 
A detailed conversation with your colonoscopist should help answer any outstanding questions or concerns.
 
For your safety, it is important to discuss your medical history and conditions, as well as the medications you are taking with your colonoscopist, so they can determine the bowel preparation that is best for you.
 
Several different types of bowel preparations are currently available, so be sure to ask your colonoscopist about the various options and the risks and benefits of each.
 
When your colonoscopist settles on a preparation for you, discuss how it works, how you’re supposed to take it, and any other questions you have about the process.
 
Certain medications, including over-the-counter items, may need to be adjusted prior to colonoscopy, because they can make the procedure more hazardous or increase your risk if polyps need to be removed.
 
If you are taking iron tablets, aspirin or anti-arthritis drugs, or any blood thinning medications (e.g. Warfarin), it is essential that you tell your colonoscopist.
 
Special arrangements may be necessary if you have diabetes or heart valve disease or have a pacemaker implanted, so it is important to discuss this with your colonoscopist before the colonoscopy is organised.

Providing consent
 
Your colonoscopist or a staff member of the facility where you are having the procedure will discuss the benefits and risks with you before you have a colonoscopy and you must give your permission before the procedure can be performed.
 
As with any invasive healthcare procedure or examination, there are risks associated with colonoscopy and with preparation for the procedure.
 
Before you can provide informed consent for colonoscopy, your colonoscopist must provide a clear and realistic explanation of the procedure, possible associated discomfort, the benefits, and a clear explanation of the risks and potential adverse events including: sedation reactions, bleeding (immediate and delayed); perforation; and missed pathology.
 
You have the right to withdraw your consent at any stage of the colonoscopy process and this should be understood by all members of your medical team.
 
Information about the risks and adverse events associated with bowel preparation for a colonoscopy can be found in the bowel preparation materials or Consumer Medicines Information (CMI) supplied by the manufacturer and from your pharmacy.
 
Support For You Bowel Cancer Australia

Scheduling your colonoscopy
 
If you can choose a day for your colonoscopy, select one that allows you to be at home the day or evening prior to the procedure so that you can be near a toilet while you complete the bowel preparation.
 
Regardless of what time of day you plan to have your colonoscopy, if your bowel is not properly cleansed the examination will have to be rescheduled.
 
The time of day the colonoscopy is performed does not impact whether you have polyps but may play a role in whether they are detected.
 
Findings from several studies suggest that having a colonoscopy in the morning results in better polyp detection rates than those performed in the afternoon.
 
Researchers believe this may be due to inadequate bowel preparation in patients who must wait until later to have the procedure done. Alternatively, it has been suggested the lower number of detections were a result of colonoscopist fatigue.
Picking up your prescription
 
Visit the pharmacy to pick up your bowel preparation as soon as your colonoscopy is scheduled.
 
Bowel preparation is a prescription medicine your colonoscopist gives you to prepare your bowel for inspection during a colonoscopy.
 
Review the instructions about the colonoscopy process at least two weeks ahead of time to ensure that you know what to do with your diet and medications, especially if you have diabetes, hypertension, heart, kidney, or vascular problems, require blood thinners or have other serious medical problems.
 
Discuss any questions or concerns you have with your colonoscopist immediately.

Arranging time off

Ensure you have the time and privacy needed to complete the bowel preparation with as little stress as possible.

Clear your schedule of any commitments and be at home when you are required to start the preparation.

If you have children or aging parents who require care, have someone else available to assist once you begin the bowel preparation and on the day of the procedure.

It is very likely you will be groggy and your reaction time slower than usual following the bowel preparation, sedation and procedure, so the best thing to do is keep activity to a minimum.


Organising transport

If you received sedation at the time of your colonoscopy, you will not be allowed to leave the colonoscopy facility or drive yourself home following the procedure.

You will not be allowed to take public transport, Uber, or a taxi home by yourself.

It may be an inconvenience, but for your own safety it is required that a friend or family member is there with you when you are discharged.

You must be accompanied and ideally that person will be able to stay with you upon your return home, to assist you as you recuperate.


Stocking up on the essentials

Once you begin your bowel preparation medication, you won’t want to leave the house and you’ll need ready access to a toilet.

You’ll also want access to a few essentials that may make the experience easier.

Go over your preparation instructions so that you know how to take the preparation and have everything you need to complete the process, which may include the following items:

  • Soft toilet paper
  • Wet wipes
  • Lotions/creams to ease anal irritation
  • Reading materials, videos, and other ways to help pass the time
  • A variety of clear liquids
    • Water
    • Chicken or beef bouillon/broth (low sodium)
    • Flavoured drink mix (lemonade, lime, orange flavours only)
    • Frozen ice-pops or Italian ice (no ice cream, sherbets, or fruit bars)
    • Fruit juices without pulp (e.g. apple, white grape, white cranberry, orange, and lemonade)
    • Jelly (lemon, lime, or orange only; no fruit or toppings)
    • Soft drinks
    • Tea or coffee (no milk or non-dairy creamer)

While taking the bowel preparation, avoid alcohol and do not drink anything coloured red or purple. Dark colouring in your bowel can lead to inaccuracies during the colonoscopy.


Bowel Preparation

Bowel preparation for a colonoscopy isn’t pleasant, but must be done correctly and completely, or the entire examination (including bowel preparation) may have to be repeated.

Bowel preparation works like a strong laxative to quickly eliminate solid waste from the digestive tract, resulting in diarrhea (and necessitating easy access to a toilet while completing the preparation process).

The exact colonoscopy preparation instructions depend on the bowel preparation your colonoscopist has selected for you, the time of your colonoscopy, any prior experience you’ve had with preparations and on your medical history.

Some of the most commonly prescribed bowel preparations are:

Click on the above links to access Consumer Medicine Information (CMI) which provides further detail and important facts to know before, during and after taking your preparation. While a CMI is written by the pharmaceutical manufacturer, the content is defined by legislation to ensure it is accurate, unbiased and easy to use.

The afternoon or evening before the colonoscopy (typically 12-18 hours prior), you will drink a liquid that triggers bowel-clearing diarrhoea.

You will be given instructions that will explain what you should and should not do in preparation for the colonoscopy.

You will also get a list of what you can and cannot eat or drink.

A few days before the colonoscopy procedure you should start eating a low-fibre (low residue) diet: no wholegrains, nuts, seeds, dried fruit, or raw fruits or vegetables. Fruit juices, white bread, refined breakfast cereals, meat and dairy foods are allowed. Dark colouring in your bowel can lead to inaccuracies during the colonoscopy, so avoid drinking or eating anything coloured red or purple.
 
The day before the colonoscopy procedure, you should not eat any solid foods. Instead consume only clear liquids like clear broth or bouillon, black coffee or tea, clear juice, sports drinks, popsicles, etc.
 
The day of the colonoscopy, as on the previous day, drink clear liquid foods only. Drink plenty of liquids to stay hydrated, even if you don’t feel especially thirsty.
 
Don’t eat or drink anything two hours before the procedure.

Bowel preparation is an essential part of a successful colonoscopy, so you need to make sure that you completely understand the instructions provided concerning your bowel preparation.

If your bowel is not free of all waste (stool) before the procedure, polyps and lesions can be missed; the colonoscopy may take longer (increasing risk of complications); or the whole process may need to be repeated or rescheduled. 

Helpful tips 

  • Prepare the bowel preparations exactly as directed
  • Carefully follow package insert or colonoscopist's instructions for use, exact dose and timing
  • Plan for episodes of watery, diarrhoea-like bowel motions
  • Increase clear fluid intake to avoid dehydration
In general, these preparations are safe, and most people have few problems with their use.
 
Tell your colonoscopist or pharmacist as soon as possible if you do not feel well while you are taking the bowel preparation.

Split dosing

The exact colonoscopy preparation instructions depend on the bowel preparation your colonoscopist has selected for you, the time of your colonoscopy, and any previous experience you’ve had with preparations.

Different bowel preparations flush out the bowel using different methods and vary in the active ingredient they use, how they taste, how much liquid is involved, and in how they’re dosed.

The preferred method is known as split dosing.

You take half the prep the night before the procedure and the other half about six hours before the procedure.

It may clean the bowel more thoroughly compared to taking all the preparation the day before the procedure.

No matter what preparation you take, follow the instructions provided with the preparation as well as those given to you by your colonoscopist, and remember to cease taking any medications that may increase the risk of bleeding if a polyp is removed, as per your colonoscopist’s instructions.


Staying comfortable

Once the preparation begins to work, it’s best to stay in the bathroom if possible due to the urgency and frequency of needing to use the toilet.

Wear loose comfortable clothes and keep items close at hand that you might like to use, including your phone, laptop, magazine, books, or office work, as well as plenty to drink.

To avoid chafing, use disposable baby wipes or water to rinse, instead of toilet paper.

Eventually the colour of your diarrhea will begin to get lighter, which is one indicator that the bowel is getting cleaner. However, finish the preparation as instructed and drink plenty of clear fluids to remain hydrated.

If the bowel preparation is still working in the morning when you go for your colonoscopy, don’t be embarrassed to ask for a bathroom when you arrive. People ask this all the time and staff are used to it.


Potential Problems

Some minor side effects are common during the preparation including nausea, bloating, and abdominal distention.

If you chilled the preparation prior to drinking it, you could experience some shaking chills from consuming so much cold liquid in a short time period.

These minor types of side effects call for holding off on the preparation for a bit, then trying to restart after the symptoms pass. If you can’t restart, call the colonoscopist for recommendations.

More serious side effects include dizziness, fever, or severe headache.

They could indicate dehydration or allergic reaction and should result in an immediate call to the colonoscopist.

You can find other more serious side effects that have been reported in the Consumer Medicine Information provided by the manufacturers of the bowel preparations.

Review this information when you get your prescription and contact your colonoscopist with any questions or concerns.

If you’re worried about a potential side effect, call your colonoscopist.

Remember to listen to your body during the bowel preparation process.

Persistent or severe side effects shouldn’t be ignored.

If you can't finish the bowel preparation, let the colonoscopist’s office know as soon as possible.

It’s better to cancel and reschedule the appointment than to have an incomplete colonoscopy because your bowel wasn't sufficiently clean. 

Helpline Bowel Cancer Australia