Navigating Colonoscopy Prep: Knowing Your Options

Written by Melissa Schenkman, MPH, MSJ

What is the first thing that comes to mind when someone tells you they are getting a colonoscopy? Or better yet, if your doctor tells you, it’s your turn to get one?

 Aside from the image of running to the restroom, it’s most likely the idea of drinking bottles of a horrible tasting liquid “cocktail” to prep your colon in order to have the test.

 This has been the case for traditional prep methods like the well-known and humorously named, Golytely. The thought of getting that down or any other terrible tasting liquid and keeping it down is daunting, and sadly it keeps many people from putting off this life-saving test. One reason there is need for alternative methods for colonoscopy prep.

According to our partners at Fight Colorectal Cancer, colorectal cancer is now the #1 cause of cancer death in men and the #2 cause of cancer death in women among adults under age 50.

Yet, the CDC finds that 68% of colorectal cancer deaths could be prevented with increased screening. And the gold standard test for screening for colorectal cancer is a colonoscopy.

So, how can we make the leap from fear of drinking prep to drinking it and getting that critically important colonoscopy that gives us the chance to live a longer life?

We sat down with leading gastroenterologist, Vanessa Costilla, MD, who has performed more than 7,000 colonoscopies to get her advice on our options for colonoscopy prep, ways of tailoring it towards our individual health needs, and other preparation considerations that should be on our radar before the big day.

Understanding Traditional Prep Methods

Traditional colonoscopy prep, like Golytely, works as a laxative by drawing a large amount of water into the colon, clearing the stool from your large and small intestine. By making your entire colon squeaky clean, your gastroenterologist can have a clear view and much more easily find any polyps and cancers that have grown in the colon or rectum.

This colonoscopy prep process involves two different sittings where you drink a 16-ounce cup filled with a mixture of Golytely and the amount of water needed to get to the 16-ounce fill line.

In order to make the taste better, patients are allowed to do something as simple as squeeze lemon or to add some Gatorade (any flavor but red or purple, which are big no’s before a colonoscopy), crystal light, sugar-free Kool-Aid, or other juices recommended by your doctor to the mix. You can also bite on a lemon or lime wedge in between sips to change your taste, which can make it more tolerable.

One thing that makes for a better experience is refrigerating your Golytely (or any other liquid colonoscopy prep) ahead of time because it improves the taste when cold.

Your first Golytely cocktail is followed by having to drink two, 16-ounce glasses of water.

About an hour later ‘fireworks’ start to go off figuratively speaking and you begin going to the bathroom repeatedly, cleaning out your colon.

A few hours later you repeat the whole process again with another bottle of Golytely mixed with water followed by drinking two, 16-ounce glasses of water, all of which needs to be finished four hours before you have to leave home to go to the procedure.

While Golytely is considered the top of the line because it works the best in cleaning out your colon, it has one of the worst reputations among patients when it comes to comfort level.

Common challenges patients face with traditional colonoscopy prep, like Golytely, Suprep, and Colyte, are:

•  A terrible taste that can makes it difficult to swallow (which is why you drink it slowly)

• Having to drink a large volume of liquid in one sitting

• Some nausea from the taste

• Dehydration (from repeatedly using the bathroom)

Modern alternatives: Oral medications and newer preps

Fortunately, colonoscopy prep options are evolving to provide greater comfort and less worry for patients.

“The great news is there are so many colonoscopy prep options now,” Costilla told us.

There is a colonoscopy prep, named CLINPIQ, that gives you the ability to drink less total volume of liquid than traditional colonoscopy preps while still achieving a clean colon.

“CLINPIQ is two, 6-ounce bottles. You drink one, 6-ounce bottle, then we want you to really hydrate after that first bottle—so lots of water and whatever clear liquids you want—then you wait a few hours and drink another 6-ounce bottle of CLINPIQ. So, it's 12 ounces of colonoscopy prep total,” Costilla explained.

“Patients love it. It's so much easier for them to think ‘Okay, I just got to drink this shot, and I can wait a few hours, drink some things I like, and then I'll have another one.”

Another very exciting option she shared even comes with food! Yes, it’s for real. The Happy Colon Prep kit, which Costilla has been using a lot for patients, was actually designed by a fellow gastroenterologist, Dr. Jeff Scott in Oklahoma. He worked on perfecting it for years, especially the low-residue type of foods he could provide patients with, so they wouldn’t be hungry but still have a successful prep.

“It's a prep kit that comes with all of your prep materials and food, solid food that you get to have the day before. So, very low-residue food, like mac and cheese and some chips, that you can have while prepping. The way he designed it, it’s still quite a bit of volume, but the way you drink it is kind of like small volumes throughout the day,” Costilla explained.

“People love it because they still get their little cookie at 3 pm and then they can have another cookie at 8pm, and it all comes in this kit. So, you can check your boxes as you're drinking all the different portions of the prep.”

It's important to note, that there is a growing body of evidence in scientific research that keeping a clear-liquid diet the day before a colonoscopy may be unnecessary, and that eating some low-residue foods (ones heavy on starch and protein) still allows for a clear view of the colon.

Innovative approaches to prep

Another new prep on the market that has an innovative approach is called Suflave.

It’s a MiraLax-based prep (a stool-softening laxative known for working naturally with the water in your body without any harsh side effects). Costilla has heard the taste is better than some of the other colonoscopy preps on the market.

Also, patients who are averse to drinking large volumes can alternatively do colonoscopy prep in pill form.

One of the most widely used pills is the medication, SUTAB. It works well, Costilla notes, you just have to keep in mind that it’s a large number of pills to take, but you do not have to drink your bowel prep then.

Tailoring prep to individual needs

Personalizing colonoscopy prep is so important given the many specific needs that patients have.

This is another way in which innovative approaches to colonoscopy prep is making a positive difference in colorectal cancer prevention.

In fact, Costilla will often prescribe a type of prep based on what health condition a patient has. She has found that being able to have preps that cater to specific patient needs has made a huge difference in making a colonoscopy prep and screening successful.

Some patients’ bodies cannot handle the sheer volume of two, 16-ounce glasses of mixes of Golytely and water; plus, a total of four additional glasses of water during their colonoscopy prep, CLINPIQ is a great option to offer. It’s two-bottle process gives you the ability to drink less total volume of liquid than traditional colonoscopy preps while still achieving a clean colon.

Vanessa Costilla, MD, is a gastroenterologist at UMC Gastroenterology in Lubbock, Texas. She is double board-certified in internal medicine and gastroenterology. Costilla has performed more than 7,000 colonoscopies.

“For example, people who have short gastric bypass or sleeve gastrectomy cannot handle the volume of a Golytely prep because their stomach is so short. They're just going to end up with a poor prep because they're either going to vomit or they're going to not finish it,” Costilla said.

This is where the alternative colonoscopy prep, CLINPIQ, works beautifully. It’s a two-bottle process of a total of 12 ounces of prep as opposed to the total 32-ounces of prep mixed with water in traditional colonoscopy preps, like Golytely, while still achieving a clean colon.

Another condition that traditional colonoscopy preps are a challenge for, but newer colonoscopy preps are no match for is diverticulosis. It’s a condition in which small pockets develop in the lining of your intestines, most commonly in the large intestine.  

This makes colonoscopy prep notoriously difficult for these patients, Costilla explained, because stool can get stuck in the diverticula (pockets), and it does not come out easily with the prep.

That’s another reason she loves how well the Happy Colon Prep kit works. For patients with diverticulosis, it cleans those pockets right out.

Preparation considerations beyond medication

As important as doing your colonoscopy prep exactly as prescribed is, so too is following the instructions your doctor gives you for modifying your diet in the week leading up to your colonoscopy.

“A lot of us tend to wait to the last minute to start looking at the instructions. I would say look at your instructions a week before your procedure because your dietary modifications need to happen about a week before you start your actual prep,” Costilla recommended.

While normally healthcare providers encourage you to eat a high-fiber diet, for a colonoscopy you have to transition to a lower-fiber or low-residue diet, which means decreasing fruit and vegetable intake because of what their breakdown during digestion leaves behind.

“It just makes it easier to clean out your colon when you don't have a bunch of corn or celery, or sunflower seeds floating in your colon,” Costilla said.

One thing she has seen come up recently is the need for additional colonoscopy prep considerations and instructions when patients are taking the weight loss medications, Majaro and Ozempic.

Both medications slow down your gut, which can make it harder to clean out your colon.

“We are actually now telling our patients to hold those medications a week before their procedure. If they have started holding less than seven days before the procedure, it will not make it very easy for us to clean out their colon,” she said.  

Communicating with your healthcare provider

At YMyHealth, we want to encourage everyone to discuss colonoscopy prep options with your doctor before your procedure.

While traditional colonoscopy prep was designed to be ‘one size fits all,’ it is not, and we are incredibly fortunate to live in a time with so many options available to us.

“It’s important for patients to know and learn about these alternatives because you certainly do not read about these in normal magazines or will necessarily see them advertised on social media. The only way you are going to hear about them is through discussions with your healthcare providers,” Costilla said.

Talk with your doctor and advocate for using an alternative colonoscopy prep based on your personal preferences and health considerations.

“There's lots of different options, and I think it's important for patients to really ask about that,” Costilla said. “Let your physician know, ‘I really rather try a different prep.’”

Subscribe to the YMyHealth newsletter to stay up to date on everything that’s health-related for millennials!