Midwest Digestive Center

COLONOSCOPY BOWEL PREPARATION

Please read the instructions at least 2 weeks prior to the procedure to ensure you follow the directions. If you do not follow these directions, your procedure will be CANCELED.

BOWEL PREPARATION: To complete a successful colonoscopy, the bowel must be clean so that the physician can clearly view the colon. The preparation is specially designed to help cleanse the colon to allow the best examination. At the end of your bowel cleanse, the stool should be similar to the color of urine, clear and yellow.

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Medication Instructions:

1. If you take insulin, medications for diabetes, you must call the doctor who orders those medications for instructions on altering the dosage before your colonoscopy. Preferred Timing for holding diabetes medications: Farxiga: 3 days prior to procedure. Metformin: A day prior to procedure.
2. Seven days prior to your colonoscopy, do not take Advil, Motrin, Alka Seltzer, Arthritis pills, Aleve, Ibuprofen.
3. Three days before procedure, hold Iron supplements, multivitamins, vitamin E, loperamide (Imodium) or bismuth subsalicylate , Kaopectate, or Pepto-Bismol, all fiber supplements such as Metamucil, Citrucel, Konsyl, or Perdiem.
4. If you are taking any Blood Thinners viz; Ticlid (ticlopidine hydrochloride), Eliquis (apixaban), Coumadin (Warfarin), Plavix (Clopidogrel), Effient (Prasugrel), Agrylin (anagrelide), Xarelto (rivaroxaban) and Pradaxa (dabigatran) the decision to hold these medications before your colonoscopy procedure has to be discussed with the prescribing physician such as your cardiologist, pulmonologist, or PCP for their written approval to be sent to the gastroenterologist ahead of time. Your procedure may be canceled if the blood thinners are not held before the procedure, and any other appropriate treatment not addressed when the blood thinners are held. Preferred Timing for holding the anticoagulants, anti platelet medications: Plavix (clopidogrel): 5 days prior to procedure. Newer oral anticoagulants (Apixaban, Xarelto, Pradaxa, Prasugrel): 2 days prior to procedure and Warfarin (Coumadin): 4-days prior to procedure.
5. The day before your colonoscopy you are allowed to take your regular medication.
6. Thirty minutes to an hour before you leave from your home for the procedure, you can take your blood pressure and heart medications with a few sips of water, preferably, less than 1 cup of water.
7. YOU ARE NOT ALLOWED TO DRIVE FOR 24 HOURS AFTER THE PROCEDURE SINCE YOU WOULD HAVE RECEIVED SEDATION. You need a responsible person to be present with you at check-in before your procedure and preferably remain in the endoscopy area until you are discharged. You are not allowed to drive, take a taxi or bus, or leave the Endoscopy Center alone. If you do not have a responsible driver (family member or friend) to accompany you to take you home, your procedure will be canceled.

MiraLAX & Dulcolax Bowel Preparation for Colonoscopy

Bowel preparation is done to clear the bowel of all solid and liquid fecal matter. The main bowel cleansing is on the day prior to colonoscopy. The end result after a through colon cleansing is to completely get rid of all solid and liquid stool so the stool output is clear light yellow color similar to the transparent clear urine. Your procedure can be canceled if the stool is not clear and transparent.You may have special instructions from the physician’s office for starting earlier, up to a week before, to take additional laxatives, on an as needed basis. Please follow these instructions. You will need the following items from the pharmacy: All the Laxatives are over the counter, you don’t need any prescriptions. (There may be store brands of these products that cost less. Ask your pharmacist to help you find what you need).

1. 1. 1 238 gm of MiraLAX powder
   2. 4 Dulcolax tablets
   3. 64 oz bottle of Gatorade (no red, purple or orange) or Gatorade G2 or Zero if you are a diabetic. Do not use carbonated beverages.
   4. 4 oz Milk of Magnesia.

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2- Days before your procedure: Take 2 Dulcolax tablets at bed time.

THE DAY BEFORE YOUR COLONOSCOPY

Drink only clear liquids.Do not eat any solid food, milk or milk products. Drink at least 6-8 glasses of clear liquids prior to starting bowel preparation with MiraLAX.

You may have clear liquids like:

• Water, Apple Juice, White Grape Juice, White Cranberry Juice, Coconut water, Lemonade (No Pulp), Popsicles
• Italian Ice, Gatorade, Clear Broth/Bouillon (Vegetable, Beef or Chicken)
• Jell-O, Kool Aid, Black Coffee or Tea (No Milk or Cream), Coke, Pepsi, Root Beer, Sprite (Regular or Diet)

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Follow the schedule given below: You may need to get to the toilet right away. You will have many bowel movements after you start taking the laxative preparation.

For some individuals with a tendency for constipation, or infrequent bowel movements, you may not have a bowel movement right away. You may discuss ahead with your gastroenterologist for taking additional laxatives or a four liter (a gallon- 476gm) MiraLAX or PEG electrolyte preparation by prescription or other choices of low volume laxative preparations as covered by your insurance that can be prescribed during your consultation or when scheduling your colonoscopy. During your bowel preparation the night before your procedure, If you are having solid stool or liquid brown stool, you need to contact the physician on call to get instructions because your procedure will not be able to be completed unless the stool output is clear and transparent similar to the color of normal urine, without any solid particles.

The day before procedure: Mix the 238gm (the entire Canister) MiraLAX powder and 64oz of Gatorade in a large pitcher, then, divide the mixture into two portions, using the 32oz bottle container of Gatorade or zero Gatorade. You can keep it in the refrigerator. Do not add ICE.4:00 PM or the convenient time suited to your schedule the evening before your procedure:Drink 32oz of the mixed solution by drinking an 8oz glass of bowel preparation every 15 minutes for a total of four glasses within 1 to 1.5 hours.Bedtime: Take 2 Dulcolax tablets with clear liquids. You may continue to drink clear liquids till midnight.Day of the procedure: 6 hours before you leave for the hospitalDrink the other 32oz of the mixed solution by drinking an 8oz glass of bowel preparation every 15 minutes for a total of four glasses within 1 to 1.5 hours.If your last bowel movement after completing the second half of your MiraLAX Gatorade mixture is not clear and transparent, you may take 1oz (2 tablespoons= 30 ml) of Milk of Magnesia with a glass of water.Nothing by mouth for four hours before you leave for your procedure.

**If you have any difficulty drinking the MiraLAX/Gatorade mixture, have nausea, vomiting, cramping, severe abdominal pain, dizziness, fainting, chest pain, shortness of breath, or if the bowel movements are not clear, please call the on call Doctor at 630-325-8684.

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