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Guest Blog: Dr. John Saltzman Shares Thoughts on Bowel Preparation for Colonoscopy

The bowel preparation is a critically important part of the colon exam. It is also one of the most misunderstood and dreaded aspects of the colonoscopy examination. It is crucial that the bowel is cleaned of its contents in order to view the lining of the colon wall for polyps. Colonoscopy, with the detection and removal of precancerous polyps, is the most effective tool to prevent cancer in the colon. Understanding the importance of the bowel preparation and the latest information about how to achieve a good preparation is key to a successful and easy colon examination.

When a colonoscopy examination is scheduled, education about the examination including information about the bowel preparation should be provided. The first thing that should be done after scheduling the colonoscopy examination is that this information should be read in detail. There will be a lot of information that is normally included, in addition to the actual preparation. For instance, medications may need to be adjusted in advance of the colonoscopy. It is typical for patients taking iron supplements to be asked to hold this for one week in advance, as iron darkens the colon and can make it difficult to visualize the lining. Adjustments may be needed for other medications including anti-thrombotics, anti-coagulants and medications for diabetes. In addition, it is quite common for dietary recommendations to be given for several days before the procedure. A low-residue diet that avoids seeds and other indigestible food substances for 3 to 7 days before the colonoscopy may help reduce foods that are difficult to remove from the colon during the preparation. The day before the procedure, clear liquids are commonly recommended for the entire day. Adequate fluids and hydration is an important adjunct to any bowel preparation.

There are many bowel preparations currently available to clean out the colon before colonoscopy and these are very effective if taken properly. Although traditional bowel preparations involved the ingestion of a gallon of a salty-tasting fluid, most current preparations are much less volume and considerably easier to take. Some of them are available in a variety of citrus flavors and many are best when cold. In addition, most bowel preparations are split in to several parts such that some of the preparation is taken the day before the examination and the rest of the preparation is taken the day of the procedure, often early in the morning. This combination has been shown to be the most effective preparation as well as the best tolerated by patients.

An educated and well-prepared patient will have the cleanest colon during their colonoscopy. A clean colon allows for complete inspection and removal of any possible precancerous polyps and is the best way for a patient to take an active role in their healthcare and to prevent colon cancer.