How To Prepare for Your Colonoscopy Using SUPREP® Bowel Prep Kit

This information will help you get ready for your colonoscopy using a Suprep Bowel Prep Kit. Your doctor will give you a prescription for the kit.

Follow the instructions in this resource carefully. If you have any questions, contact your doctor’s office.

About your colonoscopy

A colonoscopy is an exam of your colon (large intestine). It’s done by a gastroenterologist (GAS-troh-EN-teh-RAH-loh-jist). A gastroenterologist is a doctor who treats problems with digestion. A gastroenterologist is also called a GI specialist.

The GI specialist will use a colonoscope to see the inside of your colon. A colonoscope is a flexible tube with a camera on the end. The images will appear on a video monitor.

During your procedure, the GI specialist can:

• Do a biopsy (take small tissue samples) to check for cancer cells.
• Remove polyps (growth of tissue).
• Take photos of the inside of your colon.

Your colon must be empty for your colonoscopy. Your GI specialist may not be able to see polyps or other problems if there’s stool (poop) inside your colon. If this happens, you may need to have another colonoscopy.

You will get anesthesia before your colonoscopy starts. Anesthesia is medicine to make you sleep during your procedure.

What to do 1 week before your procedure

Ask about your medicines

You may need to stop taking some of your usual medicines before your procedure. Talk with your healthcare provider about which medicines are safe for you to stop taking.

We’ve included some common examples below, but there are others. Make sure your care team knows all the prescription and over-the-counter medicines you take. A prescription medicine is one you can only get with a prescription from a healthcare provider. An over-the-counter medicine is one you can buy without a prescription.

‌ It is very important to take your medicines the right way in the days leading up to your procedure. If you don’t, we may need to reschedule your procedure.
 

Anticoagulants (blood thinners)

Blood thinners are medicines that affect the way your blood clots. If you take a blood thinner, ask the healthcare provider who prescribed it what to do before your procedure.

We’ve listed some examples of common blood thinners below. There are others, so be sure your care team knows all the medicines you take. Do not stop taking your blood thinner without talking with a member of your care team.

Medicines for diabetes

If you take insulin or other medicines for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medicine what to do the day before and the morning of your procedure.

Do not take these medicines the day before or the day of your procedure:

• Metformin, such as Glucophage® or Glumetza®.
• Medicine that contains metformin, such as Janumet®.

Weight loss medicines

If you take medicine for weight loss (such as a GLP-1 medicine), talk with the healthcare provider who scheduled your procedure. Ask them what to do before your procedure. You may need to stop taking it, follow different eating and drinking instructions before your procedure, or both. Follow your healthcare provider’s instructions.

We’ve listed some examples of medicines that cause weight loss below. There are others, so be sure your care team knows all the medicines you take. Some of these are meant to be used to help manage diabetes but are sometimes prescribed just for weight loss.

Get clearance letters from your doctor, if needed

You may need to get clearance letters from your doctor before your procedure. A clearance letter is a letter that says you can safely have the procedure. Your MSK doctor’s office must have your clearance letter at least 1 day before your procedure.

Clearance letter for an automatic implantable cardioverter-defibrillator (AICD)

Tell your MSK healthcare provider if you have an AICD. If you do, you will need a clearance letter from your cardiologist (heart doctor).

Clearance letter for other symptoms

You’ll need a clearance letter from your doctor if you have had any of these during the last 6 weeks:

• Chest pain.
• Trouble breathing that’s new or has gotten worse.
• Fainting.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you.

Buy supplies

You will need to buy a Suprep Bowel Prep Kit. Your doctor will give you a prescription for this.

Clear liquids

You will also need to buy clear liquids (liquids you can see through). You’ll drink these while you’re following a clear liquid diet the day before your procedure. Sports drinks, such as Gatorade^® or Powerade^®, are a good choice. They help replace electrolytes that you lose during bowel prep.

Read the “Clear liquid diet” table in this resource for more examples of clear liquids.

Do not buy clear liquids that are red, purple, or orange. If you have diabetes, be sure to get sugar-free clear liquids.

You’ll need to buy extra supplies if you answer yes to any (1 or more) of the following questions:

If you answered yes to any of these questions, you’ll need to buy MiraLAX^®. You can buy a box of 10 (17-gram) packets or a (119-gram) bottle of powder. If you have any questions, talk to your GI specialist.

You’ll also need to buy more liquids for a full liquid diet. Read the section “What to do 2 days before your colonoscopy” for examples of what you can drink.

What to do 5 days before your procedure

Stop taking iron supplements

If you take an iron supplement, stop taking it 5 days before your procedure. Iron supplements can cause color changes in your stool. This can make it harder for your doctor to see your colon clearly.

Follow a low-fiber diet

Follow a low-fiber diet starting 3 days before your colonoscopy. During this time, do not eat:

• Raw (uncooked) fruits and vegetables.
• Whole kernel corn, including canned corn.
• Whole grains, such as oatmeal, brown rice, quinoa, or wheat bread.
• Seeds, such as poppy or sesame.
• Nuts.

Follow the instructions in Low-Fiber Diet.

Talk with an endoscopy nurse

An endoscopy nurse will call you between 8 a.m. and 6 p.m. 3 days before your procedure. They will:

• Go over the instructions in this guide with you.
• Ask you questions about your medical history.
• Go over your medicines and tell you which ones to take the morning of your procedure.

Tell the endoscopy nurse that your doctor has recommended Suprep prep for you.

What to do 2 days before your procedure

Keep following a low-fiber diet unless you:

• Are often constipated.
• Take narcotic medicines.
• Have had a colonoscopy with a poor prep in the past.

If any of those apply to you, stop following the low-fiber diet. Follow these instructions instead:

• Take 1 (17-gram) dose of MiraLAX 3 times a day.
  • Take 1 dose at breakfast.
  • Take 1 dose at lunch.
  • Take 1 dose at dinner.
• Mix 1 dose with 8 ounces of liquid each time. You can take one dose at breakfast, lunch, and dinner.
• Follow a full liquid diet. Full liquids are different from clear liquids. On a full liquid diet, you can eat and drink the following:
  • Yogurt (without any pieces of fruit).
  • Fruit juices without pulp.
  • Cream soups that have been strained so there are no vegetable pieces.
  • Nutritional supplements.
  • Ice cream and fruit ices. These must not have any pieces of fruit, nuts, fudge, or peanut butter mixed in.

Starting the day before your procedure, do not eat anything.

Follow a clear liquid diet

Follow a clear liquid diet

You will need to follow a clear liquid diet the day before your procedure. A clear liquid diet includes only liquids you can see through. You can find examples in the “Clear liquid diet” table.

When you’re on a clear liquid diet:

• Do not eat any solid foods.
• Do not drink anything red, purple, or orange.
• Try to drink at least 1 (8-ounce) cup of liquid every hour while you’re awake.
• Drink different types of clear liquids. Do not just drink water, coffee, and tea. This helps to make sure that you get enough calories. This is an important part of your colonoscopy prep.
• If you have diabetes, drink only sugar-free clear liquids and check your blood sugar level often. If you have any questions, talk with your healthcare provider.

Note the time of your procedure

A staff member will call you after noon (12 p.m.) the day before your procedure. If your procedure is scheduled for a Monday, they’ll call you on the Friday before.

The staff member will tell you what time to arrive at the hospital for your procedure. They’ll also remind you where to go. If you do not get a call by 7 p.m., call the Admissions office at 212-639-7606.

If you need to cancel your procedure, call the GI scheduling office at 212-639-5020.

Start Suprep bowel prep

You will drink a lot of liquid for your Suprep bowel prep. This may cause your abdomen (belly) to swell or feel uncomfortable. You may feel nauseous (like you’re going to throw up) or get a headache.

Call your healthcare provider if you vomit (throw up) or feel pain in your abdomen. Feeling uncomfortable during your prep is normal, but feeling pain is not.

Start drinking part 1 of your Suprep bowel prep at 5 p.m. the evening before your procedure. Start at 5 p.m. no matter what time you’re scheduled to arrive for your procedure. Follow “Steps for taking Suprep bowel prep” at the end of this resource.

If you’re scheduled to arrive before 12 p.m., start part 2 at 8 p.m. the night before your procedure.

You can drink clear liquids until 4 hours before you’re scheduled to arrive. Stop drinking no later than 4 hours before you’re scheduled to arrive.

Do not eat anything until after your procedure.

Things to remember

• Take only the medicines you were told to take the morning of your procedure. Take them with a few sips of water no later than 2 hours before you arrive at the hospital.
• If you wear contact lenses, wear your glasses instead.
• Do not wear any lotion, cream, makeup, powder, perfume, or cologne.
• Remove any jewelry, including body piercings.
• Leave valuable items at home if you do not need them. This includes extra credit cards, extra cash, and jewelry.

• Your wallet card, if you have an AICD and your card isn’t already on file with the hospital.
• Your rescue inhaler (such as albuterol for asthma), if you have one.
• A case for your glasses, if you wear them.
• Your Health Care Proxy form, if you filled one out.

Where to go

Your procedure will take place at one of these locations:

David H. Koch Center
530 East 74^th Street
New York, NY 10021
Take the elevator to the 8^th floor.

Endoscopy Suite at Memorial Hospital (MSK’s main hospital)
1275 York Avenue (between East 67^th and East 68^th Streets)
New York, NY 10065
Take the B elevator to the 2^nd floor. Turn right and enter the Surgery and Procedural Center through the glass doors.

MSK Monmouth
480 Red Hill Road
Middletown, NJ 07748

Visit www.msk.org/parking for information about parking at these locations.

What to expect when you arrive

Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or similar names may be having a procedure on the same day.

When it’s time for your procedure, you’ll get a hospital gown and nonskid socks to wear.

Meet with a nurse

You’ll meet with a nurse before your procedure. Tell them the dose of any medicines you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the procedure room.

Meet with your GI specialist

You will talk with your GI specialist before your procedure. They will explain the procedure and answer your questions.

Meet with an anesthesiologist

You will also meet with an anesthesiologist (A-nes-THEE-zee-AH-loh-jist). An anesthesiologist is a doctor with special training in anesthesia. They will give you anesthesia during your procedure. They will also:

• Review your medical history with you.
• Ask if you’ve had any problems with anesthesia in the past. This includes nausea (feeling like you’re going to throw up) or pain.
• Talk with you about your comfort and safety during your procedure.
• Talk with you about the kind of anesthesia you’ll get.
• Answer questions you have about anesthesia.

What to do after your procedure

In the Post-Anesthesia Care Unit (PACU)

You will be in the PACU when you wake up after your procedure. A nurse will keep track of your heart, breathing, and blood pressure. You may feel bloated and have stomach cramps after you wake up. This is normal and goes away, usually within 15 minutes, by passing gas.

The nurse will take out your IV before you leave the hospital. Your care team will tell you when it’s safe to leave. You will need a responsible care partner to go with you.

At home

• You can eat all your usual foods after your procedure, unless your doctor gives you other instructions.
• Do not drink alcohol for 24 hours after your procedure.
• You can go back to doing your usual activities 24 hours after your procedure.

If you had a biopsy, it’s normal to have a small amount of bleeding from your rectum. There should not be more than a few drops of blood. The bleeding should stop within 24 hours after your procedure.

After a colonoscopy, it’s normal for your bowel movements to be irregular or different from usual. This may last for up to a week after your procedure.

When to call your healthcare provider

Call your healthcare provider if you have any of the following:

• A fever of 101 °F (38.3 °C) or higher.
• Very bad stomach pain or hardness.
• Bleeding from your rectum that lasts more than 24 hours.
• Bleeding between bowel movements.
• Weakness, faintness, or nausea.
• Heavy bleeding from your rectum.

Contact information

If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9 a.m. to 5 p.m. After 5 p.m., during the weekend, and on holidays, call 212-639-2000. Ask for the GI specialist on call.

Steps for taking Suprep bowel prep

To make the Suprep bowel prep mixture, you will need:

• Your (6-ounce) bottle of Suprep liquid.
• A mixing container. This will come with your Suprep bowel prep kit.
• 42 ounces of water. If you’re using bottled water, use 3 16-ounce water bottles. If you do, you will have 6 ounces of water left over. If you’re not using bottled water, you will need a measuring cup.
• Something to mix with, such as a wooden spoon.

Follow these steps to make the mixture for each part of Suprep bowel prep:

When to take each part of Suprep bowel prep

Part 1

Start drinking part 1 of your Suprep bowel prep at 5 p.m. the evening before your procedure. Start at 5 p.m. no matter what time you’re scheduled to arrive for your procedure.

Follow “Steps for taking Suprep bowel prep” above.

Part 2

The time you start taking part 2 of your Suprep bowel prep depends on when you’re scheduled to arrive.

• If you’re scheduled to arrive before 12 p.m. (noon), start dose 2 at 8 p.m. the night before.
• If you’re scheduled to arrive at 12 p.m. (noon) or later, start part 2 the day of your procedure.

Follow “Steps for taking Suprep bowel prep” above.

You must finish all 48 ounces of water at least 4 hours before your colonoscopy.

You can drink clear liquids until 4 hours before you’re scheduled to arrive. Stop drinking no later than 4 hours before you’re scheduled to arrive.

This table will help you figure out when to start drinking part 2 of your Suprep.

To read the table:

• First find your scheduled arrival time in the column on the left.
• In the same row, find when to start drinking Suprep part 2 in the middle column.
• In the same row, find the time you need to stop drinking all liquids in the column on the right.

If your scheduled arrival time ends in :15, :30, or :45, add that onto the hour listed in the table. For example:

• If you’re scheduled to arrive at 12:15 p.m.:
  • Start drinking part 2 at 6:15 a.m.
  • Stop drinking all liquids by 8:15 a.m.
• If you’re scheduled to arrive at 12:30 p.m.:
  • Start drinking part 2 at 6:30 a.m.
  • Stop drinking all liquids by 8:30 a.m.
• If you’re scheduled to arrive at 12:45 p.m.:
  • Start drinking part 2 at 6:45 a.m.
  • Stop drinking all liquids by 8:45 a.m.