MIRALAX COLONOSCOPY INSTRUCTION
509-663-8711
or 1-800-726-8808
Please read and follow these instructions carefully.
Procedure Date:_______________________ Check-In Time:______________ Dr.____________________________
MEDICATIONS
4 DAYS PRIOR
3 DAYS PRIOR
Please contact the
Anticoagulation
Clinic or the
physician who
manages your
blood thinning
medication for
instructions.
Obtain prep over the
counter:
• Miralax (one 238g
bottle)
• Two 5 mg Dulcolax
(bisacodyl) tablets.
• 64 oz. of Gatorade
Meals and Snacks:
Continue the low fiber
diet.
Ride home:
You MUST have a
responsible adult
accompany you to
your appointment.
NOTE: Before you
stop taking your
coumadin / warfarin,
please contact
the doctor who
prescribed them.
5 days prior to
your procedure:
Stop all Iron (ferrous
sulfate)
supplements multi
vitamins
are ok. Please
also stop all fish oil
and other herbal
medications.
Diabetic patients:
see enclosed
instructions.
7:00am:
Begin a low fiber diet
(see attached low
fiber diet sheet)
No nuts, seeds or
popcorn from now
until after your
procedure.
Cancellations:
Please cancel your
appt if you will not be
able to make it
2 DAYS PRIOR
o Confluence Health x
Wenatchee Valley Hospital & Clinics
820 N. Chelan Avenue
Hospital side, 4th floor
Please use the elevators near the Bistro
o Moses Lake Clinic, 840 Hill Avenue
o Omak Clinic, 916 Koala Drive
1 DAY PRIOR
Meals and Snacks:
Continue the low fiber
diet.
Begin a clear liquid diet.
(See attached clear
liquid diet sheet)
Hydrate:
Drink at least 4-6 (8 oz.)
glasses of water or clear
liquids throughout the
Diabetics: Please
see the enclosed
instructions.
day.
If you show up
without one, your
appointment will be
cancelled.
Tips for Preparation
3 Vaseline and/or Tucks medicated pads help relieve anal
soreness during bowel preparation.
3 Refrigerating the Miralax, and using a straw, may make it easier
to drink. 3 If you become nauseated at any time during the prep, slow down
the rate of drinking to 8 ounces of Miralax every 30-60 min
Before 10am:
Mix Miralax in 64
oz. of Gatorade and
refrigerate.
Throughout the day
drink 4-6 (8 oz.) glasses
of water or clear liquids.
The more you drink the
better your prep will be.
4 PM:
Take both (bisacodyl)
Dulcolax tablets.
6:00 PM:
Begin drinking 8 oz.
of Miralax every 15
minutes until you finish
48 ounces.
PROCEDURE DAY
Early morning:
Take your usual
prescribed medication
(especially blood
pressure medication)
with a sip of water. –
except diabetics.
3 hours before leaving
home:
Drink 8 oz. of Miralax/
Gatorade every 15
minutes until you finish
16 more ounces. At
this point, you will have
finished a total of 64
ounces. If your stool
is not a clear or light
yellow fluid, please call
the office ASAP.
Within 2 hours of
check-in time:
nothing by mouth
If you get nauseated…
slow down!
3 Please follow these instructions instead of any instructions that
may have come with the Miralax. Form 46865 8/15
The Colonoscopy Experience Step-By-Step
1. Preparing for your colonoscopy:
• Plan for the prep time: Plan for a few hours the evening before and morning of your
procedure to drink the prep and evacuate your bowels. Plan to be in a personal space,
close to a bathroom. Diarrhea and urgency will usually begin 15 minutes to 4 hours after
you begin your prep.
• Take the day off: It is recommended that you take the day off work on the day of your
procedure. You should not make any important decisions for the rest of the day following
the procedure. You should not drive for the rest of the day.
• Pick up your prep at least three to five days before your procedure.
• If you have had trouble with IV placement please arrive an additional 15 minutes early.
2.Billing:
• Please note that screening colonoscopies are often not subject to deductibles, copays or co-insurance. We will always try to bill a screening colonoscopy as a screening
colonoscopy.
• However, if a polyp needs to be removed or biopsies need to be done during the
colonoscopy, then by law we are obligated to use the code for “colonoscopy with
polypectomy” or “colonoscopy with biopsy.” In such cases, deductibles, co-pays and coinsurance may apply. Please consult with your insurance company for details.
3. Before your procedure:
You will be informed of the procedure risks and sign a consent form. You will go over your
health history and medications upon admissions. You will put on a hospital gown and an IV will
be placed in your arm for fluids and medication.
4. During your procedure:
You will be placed on your left side. You will be given medication through your IV to help you
relax and make you more comfortable and drowsy. The doctor will insert the scope into your
rectum to look at the lining of your rectum and colon. Air will be inserted into your colon to allow
the doctor to better visualize the lining of your large intestine. Your body will want to expel the
air, do not try to hold in the air as this may cause discomfort. Feel free to expel as much air
as possible. You may feel mild cramping during the procedure. If it becomes worse you will
be able to tell the doctor and more medication can be given. Most patients do not remember
part or all of the procedure due to the medications. The procedure lasts approximately 30-60
minutes. You will then be taken to the recovery area.
5. After your procedure:
You will remain in the recovery area until you are ready for discharge (usually after 30 minutes).
You may feel bloating or mild abdominal cramping. Expelling air in your colon will help you
feel more comfortable. You will be discharged when you are alert and stable. The doctor or
nurse will speak to you about your plan of care. Remember you must have an escort to drive
or accompany you home. You may return to work the morning after your colonoscopy (Not the
evening of the colonoscopy).
Important Information About Your Colonoscopy Procedure
Escort:
You MUST have a responsible adult escort with you when you leave our unit.
• For legal and regulatory reasons, if you arrive at our unit without an escort, your procedure will
be cancelled. After the procedure, your escort may drive you home, or you may take a taxi or
bus with your escort. You may NOT take a taxi or bus home alone, and you may NOT walk home
alone.
Drink all the prep:
• It is very important that you finish all of the prep, even if you experience diarrhea or your bowel
movements are clear. If you are using Go-Lytely, this means drinking a total of four liters, even
though sometimes the instructions that come with the packaging state that you can stop drinking
if your stools are “clear.” Mucus from your small bowel continues to enter the colon and can affect
cleanliness if you stop the prep early. If you are only able to drink and keep down less than half
of the bowel prep it is unlikely that you will have a sufficiently clean colon. If this happens to you,
please call us the morning of your procedure so we may reschedule you with a different prep.
Adhere to the low-fiber diet:
• Although some patients dislike the 4-day low-fiber diet, it is important to follow the low-fiber diet
because fiber left over in the colon can severely limit the effectiveness of colonoscopy. If you
become constipated on the low-fiber diet, we suggest you take a standard 17g dose of Miralax
(available over-the-counter) every day as needed.
If you live far away:
• If you live more than 2 hours away, have been scheduled for an early morning colonoscopy and
will be traveling a long distance on the morning of the procedure, it may be logistically difficult
to drink some of the prep on the morning of the procedure. In that case, you should drink all of
the prep the night before the colonoscopy, starting at 6 p.m. You will not need to drink any prep
on the morning of the colonoscopy. However, please note that medical studies have shown that
even though taking all of the prep the night before the colonoscopy leads to an adequate bowel
preparation in most cases, splitting the bowel preparation (i.e. taking some of the G0-Lytley or
Miralax the night before and the rest of the it on the morning of the procedure, as we recommend)
generally leads to a superior bowel preparation.
What is conscious sedation?
Colonoscopy is generally done with “moderate sedation” also called “conscious sedation”. The
medication will be given through an IV. Our goal is to keep you comfortable throughout the procedure,
not unconscious. Most patients are very drowsy or even asleep during the procedure. Some patients
remain awake, but relaxed. Because the sedatives impair memory, most patients do not remember all
or part of their procedure.
Understanding Colonoscopy
During colonoscopy a long, thin, flexible tube is passed into your rectum. A camera on the end allows
the doctor to examine your colon on a monitor. If polyps or abnormal tissue are found, the doctor
can use tools on the end of the scope to remove or take biopsies of the polyp(s) or area(s). This
Form 49344 07/14
is an outpatient procedure. Colonoscopy is used as a cancer screening test and also to evaluate
gastrointestinal symptoms such as bleeding, abdominal pain and changes in stool or bowel habits.
Complications are extremely rare during colonoscopy, but can include bleeding; perforation, heart and
lung problems associated with the sedation or anesthesia, and missed colon lesions.
Benefits of Colon Screening
Colon cancer is one of the most common types of cancer in men and women, and is a leading
cause of death in the United States. The good news is that colon cancer and precancerous polyps
can often be detected early through routine screening. Colonoscopy is the test of choice among
gastroenterologists for the early detection and prevention of colon cancer. Colon cancer often
develops from precancerous polyps. Colonoscopy screening allows diagnosis and removal of polyps
to occur promptly and this can significantly decrease your risk of colon cancer. If colon cancer is
found early, it is highly treatable.
Understanding Polyps
Colon polyps are small growths on the inside of the large intestine. Polyps can be found in other
areas of the gastrointestinal tract, but are most common in the colon. Some polyps are precancerous,
meaning they have the potential to cause cancer if not removed. Most of the time, colon polyps do
not cause symptoms, so you may not know you have them. Colonoscopy is the most accurate test for
detecting polyps, but it is not a perfect test. Due to the corners and “blind spots” in the colon, even for
competently performed colonoscopy there may be a 5 to 10 percent miss rate for polyps.
Billing issues:
• Please note that screening colonoscopies are often not subject to deductibles, co-pays or coinsurance. We will always try to bill a screening colonoscopy as a screening colonoscopy.
• However, if a polyp needs to be removed or biopsies need to be done during the colonoscopy,
then by law we are obligated to use the code for “colonoscopy with polypectomy” or “colonoscopy
with biopsy”; in such cases, deductibles, co-pays and co-insurance may apply. Please consult
with your insurance company for details.
• Contact your insurance company to check benefit coverage prior to coming in for the exam.
• Please bring your insurance card to each visit. If you have a copay, it is due at the time of service.
LOW FIBER DIET
Food Group
OK to Eat
Do NOT Eat
Milk,
Dairy Products
•Milk, cream, chocolate milk, hot
chocolate, milk-based drinks
•Cheese, cottage cheese
•Broth
•Yogurt, sour cream
•Custard or pudding
•Ice cream or frozen desserts
•Cream sauces
•Soups without seeds or beans
•Yogurt with granola, seeds, nuts or fruit with skin in
them
Breads, Grains
•Breads and grains made from
refined or white flour including:
rolls, bagels, muffins (no bran),
English muffins
•Cheerios, Rice Crispies
•Corn flakes
•Crackers
•Pasta
•Cream of Wheat
•Whole wheat or grains
with seeds including: rolls,
bagels, muffins, English
Muffins
•Oatmeal
Meat, Fish, Poultry,
Protein
•Tender beef, ground beef
•Chicken
•Pork
•Eggs
•Fish and shellfish
•Creamy peanut butter
•Lamb
•Tofu
•Tough meat with gristle
•Chunky peanut butter
•All beans, nuts, peas, lentils, legumes
Fruit
•Soft canned or cooked fruit without seeds or skins
•Soft melon
•Fruit juice without pulp
•Fruit jellies without pulp
•All other raw fruits
•All dried fruits
•Fruit juice with pulp
Vegetables and
potatoes
•Potatoes without skin
•Vegetable juice without pulp
•All raw or steamed vegetables
•Beans, peas
•Potatoes with skin
•Brussel sprouts
•Corn (!)
•Broccoli,
cauliflower
•Cabbage, onion
•Sauerkraut
•Greens or lettuce
Fats & Oils
•Butter
•Salad dressings without seeds or
nuts
•Margarine
•Oil
•Mayonnaise
•Nuts (!)
•Seeds (!)
•Coconut
•Salad dressing with
nuts or seeds
Miscellaneous
•Sugar
•Salt
•Jelly
•Honey
•Syrup
•Lemon juice
•Jam
•Marmalade
•Relishes
•Raisin Bran, All Bran
•Wheaties
•Granola
•Popcorn
•Brown rice, wild rice
•Prune juice
•Prunes
•Bananas
•Pickles
•Olives
Why do I need to eat a low fiber diet? It is very important to begin a low fiber diet 4 days before your colonoscopy.
Fiber is indigestible and stays inside the colon, making the colonoscopy less accurate.
Form 49345 8/15
CLEAR LIQUID DIET
It is especially important to avoid clear liquids with red or purple dyes.
OK to Eat
• Water
• Flavored waters (without red or purple dyes)
• Clear Broths (chicken, beef, or vegetable broth)
• Juices (without pulp and without red or purple dyes)
3Apple
3White Grape
3Lemonade without pulp
• Sodas
• Gatorade
• Tea (with sugar OK)
• Coffee (black; with sugar OK)
• Gelatin i.e. Jello (without fruit; no red or purple dyes)
• Popsicles (without fruit or cream; no red or purple dyes)
• Italian Ices (without red or purple dyes)
• Coconut water
Do NOT Eat
• Milk (no cow, soy, almond, rice, hemp milk)
• Cream
• Milkshakes
• Ice cream
• Smoothies
• Orange juice
• Grapefruit juice
• Tomato juice
• Soups other than clear broth
Why do I need to follow a clear liquid diet?
A clear liquid diet is necessary during colonoscopy preparation to provide needed fluids. Clear liquids are easy to digest and leave little
or no residue in the digestive tract. Clear liquids are liquids that you can see through. For example, coffee is a clear liquid, but coffee
with cream or milk is not. You will be starting your clear liquid diet the day before your exam after breakfast.
PRE-COLONOSCOPY ORDERS FOR DIABETIC PATIENTS
Diabetics on dietary control only:
• No changes in usual prep.
• FSBS to be checked on arrival.
Diabetics on oral hypoglycemic agents:
• Take usual diabetic medicine the morning
of the prep, then no diabetic medicines
until after the colonoscopy.
• FSBS to be checked on arrival.
Diabetics on Insulin:
• Take one half of usual insulin dose the
day before exam. Do not take insulin
the morning of the colonoscopy.
• FSBS to be checked on arrival.