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Colonoscopy Preparation

woman with a bowl in the kitchen

A complete cleansing of the colon is needed for an optimal colonoscopy – one that has the highest chances of not missing a small growth or other finding. For the best preparation (“prep”) to fully cleanse the large bowel for a colonoscopy one may choose from a handful of options. Over many years and across international borders I have settled on a simple routine with significant advantages in terms of palatability, which eases compliance, and safety, for the majority of my patients.

Numerous studies have been done with varies formulations. Some that I do not advise can cause kidney damage, others have a foul taste. When companies try to create products that please patients, their studies may reveal a failure of adequate preparation – implying you may have to try again – in up to a quarter of patients, clearly an unacceptable fraction. What I recommend has a 1-2% chance of proving inadequate, typically in patients with severe medical conditions causing constipation, despite universally adjusting the process to individual needs. These great preps contribute to my adenomatous polyp detection rate (ADR) being more than double what is expected- and the best of 20 top gastroenterologists at our center, Manhattan Endoscopy Center.

If you feel your patience is wearing thin, here is the special potion: ordinary, non-prescription MiraLAX. For those who may have some experience with the product, and found its effect minimal, read on. It works in virtually everyone, but it’s a matter of quantity and allowing enough time for it to work. And for those prone to marked constipation cycles, adjunctive products may additionally be needed for best bowel preparation.

Just one last bit of background: a couple of years ago I had the good fortune to attend a medical mission to the Peruvian Andes. We brought everything we needed with us, no small feat of logistics. We measured out the “standard” dose of MiraLAX (aka PEG 3350) as used in various studies, and quickly found this cohort of patients was much more difficult to cleanse than an average American, many having “redundant” (extra-long) colons. Happily, on our return mission the next year, with 50% more MiraLAX in our instructions, every prep was excellent. Instead of splitting the prep in two we added 50% and split it into thirds, with perfect results.

Now, as mentioned, there are many good ways to prepare for colonoscopy, and some folks have their own preferences. Generally, if obviously, avoid foods that may be constipating leading up to the full prep. Be liberal with foods with the opposite effect!

A dose is typically a capful from the bottle per the label (17 grams) in 8 ounces of water or other beverage. Some patients prefer 1 1/2 doses per glass of water or even a double dose, although that’s probably better in slightly more water. Overall a dose is taken roughly every 15 minutes, or more or less frequently as permitted by any sort of abdominal bloating or discomfort. For the average patient I recommend roughly 24 doses of MiraLAX, easily done by buying a 30 does bottle for about $20. This can be mixed with water, chicken broth (which has the advantage of some extra sodium), Jell-O, or plain water. By making a strong mint tea the vaguely mineral taste of the MiraLAX can be masked.

Granted, it works best to split the preparation overnight, which has implications for the timing of your procedure. 50 – 70% of the doses should be taken before going to sleep the night before the procedure, and the balance in the morning of the procedure, though it must be consumed at least three and half hours before the scheduled procedure time. This has to do with anesthesia safety as well as allowing enough time for full benefit of the preparation.

So, to summarize, and easy, more or less tasteless, and comfortable bowel clans that yields excellent results for most patients is sitting on the shelf at the local drugstore. Approximately 24 doses of MiraLAX split overnight should yield excellent ball preparation results for the ordinary patient. Patients with special medical considerations such as kidney disease and other metabolic disturbances of course must check with their own physician as to specific recommendations.


For more information about getting a colonoscopy or to schedule your colon cancer screening with experienced Manhattan gastroenterology doctor, Anthony Borcich, M.D., contact our office or get started by filling out the schedule appointment form on this page. Dr. Borcich has more than 30 years of experience in performing colonoscopies and is known for his compassionate care and personalized approach.

 

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