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Colonoscopy Bowel Preparation Instructions
Gatorade Prep
Your procedure is scheduled on _______________________ with Dr. ___________________________
at ________________________________________________________________________________
Please arrive at _______________ a.m./p.m. for your procedure at ___________________ a.m./p.m.
PLEASE READ ALL INSTRUCTIONS ON THE DAY YOU RECEIVE THEM
Your doctor has referred you for a colonoscopy. A colonoscopy allows a doctor to look inside the entire large intestine. The procedure enables the physician to
see things such as inflamed tissue, abnormal growths, and ulcers. It is most often used to look for early signs of cancer in the colon and rectum. It is also used
to look for causes of unexplained changes in bowel habits and to evaluate symptoms like abdominal pain, rectal bleeding, and weight loss.
Bowel preparation (cleansing) is needed to perform an effective colonoscopy. Any stool remaining in the colon can hide lesions and result in the need to repeat
the colonoscopy. It is critical that you follow the instructions as directed.
Every effort will be made to keep your appointment at the scheduled time; however, unexpected delays and emergencies may occur and your wait time may be
prolonged. We give each patient the attention needed for his or her procedure. Thank you for your understanding.
If you need an interpreter provided, please contact our office.
If you must cancel, please call as soon as possible: □ (402) 504-3880 □ (402) 397-7057
IF YOU ARE AFFECTED BY ANY OF THE CONDITIONS LISTED BELOW, PLEASE FOLLOW THESE INSTRUCTIONS.
DIABETES Consume sugared items when on clear liquid diet. Check your blood sugar frequently while taking the prep solution and the
morning of your procedure. Typically, we recommend that you do not take your oral hypoglycemic or insulin the morning of
your procedure. Please refer to your specific instructions at the end of this form. Bring it with you to use after your procedure.
HEART VALVE REPLACE- The American Heart Association no longer recommends antibiotics for colonoscopy.
MENT or HISTORY OF
ENDOCARDITIS
ASPIRIN Please discuss with your referring physician or cardiologist as it is our preference you discontinue Aspirin three (3) days prior to
your colonoscopy. Contact our office if after discussing with your physician it is determined you should not hold this
medicine.
PLAVIX, HEPARIN, Please discuss with your referring physician or cardiologist as it is our preference you discontinue Plavix, Ticlid, or Aggrenox
LOVENOX, TICLID, five (5) days prior to your colonoscopy. Please discuss with your referring physician or cardiologist if you are taking Heparin or
AGGRENOX Lovenox as it is our preference you hold one (1) day prior to the colonoscopy. Contact our office if after discussing with
your physician it is determined you should not hold these medicines.
COUMADIN, WARFARIN Please discuss with your referring physician or cardiologist as it is our preference you discontinue Coumadin/Warfarin three (3)
days prior to the colonoscopy. Contact our office if after discussing with your physician it is determined you should not
hold this medicine.
NSAIDs Non-steroidal anti-inflammatory drugs (i.e., Advil, Aleve, Motrin, or any products containing ibuprofen) should be discontinued
two (2) days prior to colonoscopy.
#021 – Gatorade Prep Revised 12.12.09
PREP INSTRUCTIONS FOR COLONOSCOPY
GATORADE PREP
FIVE (5) DAYS BEFORE
1. Become familiar with all prep instructions and feel free to contact our office with any questions.
2. After discussing with referring physician or cardiologist, and if approved, remember to stop medications noted previously on needed day before
procedure. Be sure to let us know if you have had coronary artery stents placed in the last year. (May need to delay routine colonoscopy
with recent stent placement.)
3. Stop herbals, vitamins, stool bulking agents (i.e. Metamucil or Citrucel) and iron supplements.
TWO (2) DAYS BEFORE COLONOSCOPY
1. Purchase these over-the-counter laxatives:
• Dulcolax 5mg tablets (will need 4 tablets)
• Miralax bottle 238 grams (over-the-counter only)
2. Purchase Gatorade (64 ounces) of lemonade or other clear Gatorade (avoid red, purple or blue) or you can purchase two 32 ounce bottles.
THE DAY BEFORE THE COLONOSCOPY
1. NO SOLID FOOD; NO ALCOHOL
2. Clear liquids all day – Drink at lleast 8 ounces of clear liquids every hour from 11:00 a.m. to 5:00 p.m.
• As a rule – if you can see through it, you can drink it. Always avoid red, purple or blue colored liquids, Jell-O or popsicles.
• Clear fruit juices (white grape and apple juice)
• Water, Tea, or Coffee (without cream)
• Kool-Aid or PowerAde
• Clear soup, broth or bouillon
• Popsicles
• Hard candies
• Soda Pop (7-Up, Sprite, regular or diet Pepsi/Coke, Ginger Ale, Orange Soda)
• Jell-O
For Diabetic Patients: Please consume clear liquids that are not sugar free which will give you calories to assist with your blood sugar levels.
3. At 3:00 p.m.
• Take four (4) 5mg Dulcolax tablets with water
4. At 5:00 p.m.
Mix the entire bottle of MIRALAX into the 64 ounces of GATORADE. (Or put half the bottle in each 32 ounce bottle.) Shake the solution until fully
dissolved. Drink an 8 ounce glass every 30 minutes until the solution is gone.
THE DAY OF COLONOSCOPY
1. You may take any necessary medications before 6:00 a.m.
2. REMEMBER: The preparation is very important. An adequate clean out allows for the best evaluation of your entire colon. During the prep, using
baby wipes may ease some of your discomfort.
3. You may continue to drink Gatorade or clear liquids until five (5) hours before your procedure.
THE EVENING OF COLONOSCOPY
1. AFTER YOUR PROCEDURE IS COMPLETED, DRINK 8 OUNCES OF LIQUID SIX TIMES BEFORE RETIRING FOR THE NIGHT.
2. You will not be able to drive, operate machinery, make important decisions or return to work for the rest of the day.
3. You may resume normal activities the next day unless the doctor states otherwise.
FREQUENTLY ASKED QUESTIONS
Question: What if I feel like I am going to vomit if I drink another glass of prep, OR, what if I start to vomit while drinking the prep?
Answer: Stop prep for 30-45 minutes until symptoms subside, then resume. If prescribed Reglan, take as directed.
Question: What if I drink all of the prep and I do not have a bowel movement?
Answer: Wait one (1) hour. If still no stool, you will need a Fleets enema. This can be purchased over-the-counter at any pharmacy. If still no results,
call the doctor who will be performing your colonoscopy.
Question: What if I have rectal discomfort?
Answer: You may apply a petroleum based product or diaper rash ointment to the rectal area if you experience discomfort from frequent stools.
Question: Does my driver have to stay with me during the procedure?
Answer: If your driver does not wish to remain in the lobby, a contact number can be given to the nursing staff. Typically, the driver can return two (2)
hours after they drop you off.
Question: Can I eat after my procedure?
Answer: Usually you may resume your normal diet unless otherwise instructed.
Question: Will I be asleep for my procedure?
Answer: You will be given what is known as “conscious” or “twilight” sedation. These medications are designed to decrease your awareness and can
affect your ability to remember the event. If you routinely take any medications for sleep, pain, anxiety or mood, please contact our office as
this could decrease the effectiveness of your sedation.
If you have additional questions, please contact our office.
What to Bring:
o Completed forms from Midwest Endoscopy Services or Lakeside Endoscopy Center if your procedure is at one of those locations.
o The first and last name of all doctors you want to receive a copy of your procedure report.
o Someone to drive you home. Sedation is usually given during your procedure. If you have not arranged for someone to drive you home, your
procedure may be cancelled. You will not be able to drive, operate machinery, make important decisions or return to work for the rest of the day. You
may resume normal activities the next day unless the doctor states otherwise.
o Insurance cards. If your insurance has changed since your appointment was scheduled, please contact us immediately. Many insurance carriers and
managed care organizations require preauthorization or pre-certification. To obtain coverage for these procedures, we recommend you contact your
insurance company.
What to Wear
Wear comfortable, loose fitting clothing. Wear flat shoes or tennis shoes. Please leave jewelry and valuables at home.
SPECIAL INSTRUCTIONS:_________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
IF YOU ARE SCHEDULED FOR A SCREENING COLONOSCOPY:
Please keep in mind that not all insurance companies pay for screening colonoscopies. If you present for a screening colonoscopy
and a medical condition is found requiring therapy, it may not be considered a screening colonoscopy and this could result in higher
out of pocket expenses.
For example: If a polyp is found, the polyp becomes the primary diagnosis versus screening.
Please contact your insurance company before your procedure so you will know what your policy states regarding:
Screening Colonoscopies vs. Medical Colonoscopies
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