Colonoscopy

Maintaining the low-residue and clear liquid diets and completing the entire course of your prep solution are important steps in bowel preparation. If you don’t like the taste of the prep solution or if it causes nausea, try drinking it very cold or on ice. It might also be helpful to use a straw to bypass some of your taste buds and to drink the solution quickly rather than slowly.

Here are some things to remember as you complete the clear liquid diet portion of your prep:

• Avoid smoothies and plant-based juices. Even when these drinks don’t contain dairy, they may have seeds from fruits and vegetables.
• It is OK to drink coffee or tea, but it must be black. No form of dairy or creamers are allowed.
• You cannot have hard candy or chew gum before your colonoscopy.
• You must not drink alcohol, even if it’s something clear, such as white wine.

It’s important to do the best you can to follow your dietary recommendations. However, the most important part of your preparation is the prep solution itself. Even if your stools become clear after your first dose of the solution, try to finish the solution. As long as you get enough down to start having frequent watery or clear bowel movements, the prep should be adequate to complete your exam.

Following the medication instructions we provide is essential. We have compiled medication guidance in the attached PDF. Please review this document as well as the bullet points below:

• If you have diabetes, preparing for a procedure may require some temporary changes in your diet. Please contact the doctor who manages your diabetes for advice regarding any needed changes in your diabetes medicine the day before and the day of your test. If you have an insulin pump, please discuss it with your diabetes doctor before your procedure.
• If you take medications known as GLP-1s for diabetes or weight loss, you need to stop them before your procedure. Your prescriber can offer guidance. Please review our list of medications and detailed instructions.
• If you take a blood-thinning medication (anticoagulant or antiplatets), special instructions may apply. Please call 617-754-8888 if you have not heard from one of our GI nurses about these medications.
• If you take aspirin, nonsteroidal anti-inflammatories (NSAIDs) or other pain medications, you may take them as usual.
• If you have been taking multivitamins with iron before your exam, please stop taking them for seven days before having a colonoscopy. If your stool is quite black when taking iron, it might be best to postpone your colonoscopy. We can reschedule for a time when you have stopped the iron for a full week and your stools are brown.
• On the morning of your procedure, you can take any approved daily medications with a small sip of water.

The usual prep for a colonoscopy includes eating a short-term, low-residue diet. It limits high-fiber foods and focuses on foods that are easy to digest. Then the day before your colonoscopy, you consume only a clear liquid diet. You also drink a prep solution the night before your procedure. Several solutions are available. Read detailed instructions for your colonoscopy with each prep solution.

If you have chronic constipation or you’ve had trouble with preparing for procedures in the past, your doctor may recommend double or extended colonoscopy. These preps involve a longer low-residue diet than standard colonoscopy prep. They also include two days on the clear liquid diet and two days of prep solution. You should only complete the double prep course if your care team instructs you to.

There are some steps that everyone should take:

Insurance Referrals

Make sure you have an insurance referral or authorization for your procedure if your insurance company requires one. If you have questions, please call our office or the customer service number on your insurance card.

If You Might Be Pregnant

If you could be pregnant, please consult your primary care or Ob/Gyn doctor. Your provider can advise you on the best timing for your GI procedure and the best approach to anesthesia and sedation.

Arrange a Ride Home Before the Day of Your Test

Make arrangements to have a family member, friend or responsible adult take you home after your procedure. This is very important because we don’t allow you to drive after the exam.

Your driver must meet you in the procedure area of the GI unit when you’re ready for discharge. If your procedure is at our Boston campus, free 20-minute parking is available.

If you take a cab, use a ride share app or use the MBTA RIDE program, you must have a responsible adult ride home with you (in addition to the driver). We strictly enforce this policy for your safety. We only consider exceptions if you plan to have your procedure without sedation. Discuss this with your doctor in advance.

If you have trouble finding someone to accompany you home, consider contacting your local Council on Aging or Senior Center. Many communities run a volunteer medical escort program, and they can tell you if this option is available in your area. You’ll need to schedule this service in advance.

If you’re sick, you may keep your scheduled appointment as long as you’re not vomiting and don’t have a fever or cough with sputum or phlegm.

Please call the Digestive Disease Center at 617-754-8888 first thing in the morning if you think you need to reschedule. Our office opens at 8:00 am. If you have other questions or concerns, we’re happy to answer them, as well.

At BIDMC, your procedure will take place at one of three locations across campus. On East Campus, you will either be on the third floor or fourth floor of the Stoneman Building, which can be accessed at 330 Brookline Avenue. On the West Campus, you will come to the West Procedural Center (WPC) on the first floor of the Farr Building which can be accessed at 185 Pilgrim Rd. You will be provided the location at the time of scheduling, and it will be included in pre-appointment reminders. If you are unclear on where to go the day of your procedure, please call our scheduling line at 617-754-8888.

Please arrive one hour before your endoscopy appointment, unless we tell you otherwise. There is on-site parking and a 15-minute drop-off zone.

Once you reach the procedure unit, a team member will greet you. We'll help you check in and direct you to our waiting area. Someone from our team will then escort you to the admitting area. There, a nurse will review your medications and medical history.

If you are receiving monitored anesthesia for this procedure, a member of the anesthesia team will visit you. We do everything possible to keep your procedure on schedule. Please be aware that unexpected delays are possible.

To prepare you for your exam, we place an IV in your arm. Then, our team will transport you to the procedure room. Before you are sedated or receive anesthesia, your physician will talk with you about the procedure.

We will ask you to sign consent forms agreeing to have the test. Once we give you sedation or anesthesia, it takes effect within a few minutes. Feel free to bring a music device with ear buds on the day of your procedure.

After Your Test

After your procedure, you stay in our recovery area for about 30 minutes. A nurse monitors your recovery and goes over discharge instructions before you head home with your driver or a responsible adult.

As you recover from sedation, you should not go back to work or school, and you should not make any important decisions. If you normally care for children or disabled individuals, be sure to get help with these responsibilities the day of your test. You can resume all activities the next day unless your doctor tells you otherwise.

Colonoscopy should not hurt. This procedure can be performed with different levels of sedation or no sedation at all.

It is most commonly performed using moderate sedation, which is a light sedation administered by the gastroenterologist and nursing team. A deeper sedation is performed by an anesthesiologist. No sedation is also an option. In this case, you are awake and aware throughout the procedure. You may feel some pressure during the procedure but in most cases it can be performed with minimal to no discomfort. Please discuss your options for sedation with your physicians, and you can determine together what would be best for you.

Even if your stools become clear after the first dose, you should still attempt to take the entire course. However, as long as you get enough down to start having frequent watery/clear bowel movements, the prep should be adequate.

The low residue diet is recommended as one part of your overall preparation for colonoscopy. Following the low residue diet provides added assurance that your preparation will be adequate. The most important aspect of the preparation is the laxative solution itself, which you have been instructed to drink.

Whether you complete this solution as instructed is what will determine the success of your preparation. Do your best to follow our dietary recommendations, but if for some reason you can't, we probably won't need to reschedule you.

Every patient's case is different. We strongly recommend that you discuss your diet and colonoscopy prep with your primary care physician or gastroenterologist prior to scheduling your colonoscopy.

Preparing for a procedure may involve some temporary changes in your diet. Please contact the doctor who manages your diabetes for advice regarding any changes that are needed in your diabetes medicine the day before and the day of your test. If you have an insulin pump, please discuss management with your diabetes doctor before your procedure.

You CAN:

• Have coffee and tea but it must be black. No forms of dairy or creamers are permitted during the clear liquid portion of the bowel prep.

You CANNOT:

• Chew gum or have hard candies during the clear liquid portion of your prep.
• Consume alcohols, even if they are clear alcohols such as vodka or white wine.
• Consume smoothies or juices. Even if they do not contain dairy, the liquid may have seeds and fiber from the fruits and vegetables which can cause issues with the bowel preparation.