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.

About Your Colonoscopy

A colonoscopy is an exam of your colon (large intestine). It’s done by a gastroenterologist (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. This is a flexible tube with a camera on the end. The images will appear on a video monitor.

During your procedure, your healthcare provider 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. You may need to have the procedure again if this happens.

Follow these instructions carefully. If you have any questions, contact your doctor’s office.

1 Week Before Your Colonoscopy

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your healthcare provider about which medications are safe for you to stop taking. We’ve included some common examples below.

Anticoagulants (blood thinners)

Blood thinners are medications 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.

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

Diabetes medications

Ask the healthcare provider who prescribes your diabetes medication what to do the day before and morning of your procedure. Tell them you will be following a sugar-free, clear liquid diet the day before your procedure.

Do not take the following medications the day before or day of your procedure:

• Metformin (such as Glucophage® or Glumetza®).
• Medication that has metformin in it (such as Janumet®).

Get a letter from your doctor, if needed

You may need to get a clearance letter 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.

Automatic implantable cardioverter-defibrillator (AICD)

Tell your MSK doctor if you have an AICD. You will need a clearance letter from your cardiologist (heart doctor).

Other symptoms

You will 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

Suprep Bowel Prep Kit

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

Clear liquids

You will also need to buy clear liquids. You will drink these while you’re following a clear liquid diet the day before your procedure.

Clear liquids are liquids you can see through. Sports drinks, such as Gatorade^® or Powerade^®, are a good choice. They help replace electrolytes that you lose during bowel preparation. 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.

Extra supplies, if needed

You may need to buy extra supplies if you answer yes to any of the following questions:

If you answered yes to any of these questions, you will need to buy MiraLAX^®. You can buy a box of 10 (17-gram) packets or a (119-gram) bottle of powder.

You will also need to buy more liquids for a full liquid diet. Read the section “2 Days Before Your Colonoscopy” for examples of what you can drink.

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.

3 Days Before Your Procedure

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 the resource 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. They will also ask you questions about your medical history.

The nurse will also go over your medications and tell you which medications to take the morning of your procedure.

2 Days Before Your Procedure

Keep following a low-fiber diet unless you:

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

If any of those apply to you, stop following the low-fiber diet and follow these instructions:

• Take 1 (17-gram) dose of MiraLAX 3 times a day. 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. 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.

1 Day Before Your Procedure

Starting the day before your procedure, do not eat anything. Follow a clear liquid diet.

Follow a clear liquid diet

You’ll need to follow a clear liquid diet the day before your surgery. 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.
• Try to drink at least 1 (8-ounce) cup of clear liquid every hour you’re awake.
• Drink different types of clear liquids. Do not just drink water, coffee, and tea.

For people with diabetes

Ask the healthcare provider who manages your diabetes what to do while you’re on a clear liquid diet. If you take insulin or another medication for diabetes, ask if you need to take a different dose. Ask them if you should drink sugar-free clear liquids.

Make sure to check your blood sugar level often while you’re following a clear liquid diet. If you have any questions, talk with your healthcare provider.

Note the time of your procedure

A staff member from the Admitting Office will call you after noon 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 office of the doctor who scheduled it for you.

Suprep bowel preparation

You will drink a large amount of liquid for your Suprep bowel preparation. 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 doctor if you vomit (throw up) or feel pain in your abdomen. Feeling uncomfortable is normal, but feeling pain is not.

Start drinking the first part of your Suprep bowel preparation 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. You will need:

• Your 6-ounce bottle of Suprep liquid.
• A mixing container. This will come with your Suprep 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.

To make your mixture:

Repeat these steps for the second part of your Suprep bowel preparation. The time you start drinking the second part of your Suprep bowel preparation depends on your scheduled arrival time.

• If your scheduled arrival time is before 11 a.m., start at 8 p.m. the night before your procedure.
• If your scheduled arrival time is after 11 a.m., start tomorrow. Follow the instructions in the section “The Day of Your Procedure.”

The Day of Your Procedure

If your scheduled arrival time is 11 a.m. or later, start part 2 of your Suprep bowel prep 5 hours before. You can drink clear liquids until 4 hours before your scheduled arrival time. Do not eat anything until after your procedure.

The following table will help you figure out when to start drinking part 2 of your Suprep. To read the table, first find your arrival time. The time you need to start drinking Suprep part 2 is listed in the column next to this.

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

For example:

• If your arrival time is 11:15 a.m., start part 2 at 6:15 a.m.
• If your arrival time is 11:30 a.m., start part 2 at 6:30 a.m.
• If your arrival time is 11:45 a.m., start part 2 at 6:45 p.m.

Things to remember

• You can drink clear liquids until 4 hours before your scheduled arrival time. Do not eat anything until after your procedure.
• Take only the medications 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.

What to bring

• 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 park

MSK’s parking garage is located on East 66^th Street between York and First Avenues. For questions about prices, call 212-639-2338.

To reach the garage, enter East 66^th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that goes from the garage into the hospital.

There are also garages located on East 69^th Street between First and Second Avenues, East 67^th Street between York and First Avenues, and East 65^th Street between First and Second Avenues.

Paid valet parking is available at the David H. Koch Center for Cancer Care.

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.

MSK Monmouth
480 Red Hill Road
Middletown, NJ 07748

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 medications you took after midnight and what time you took them. This includes prescription and over-the-counter medications, patches, and creams.

Your nurse will place an intravenous (IV) catheter into one of your veins, usually in your arm or hand. You may get fluids through the IV before your procedure.

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. They will go over your medical history with you. They will talk with you about the kind of anesthesia (medication to make you sleep) you will get.

Inside the procedure room

A staff member will bring you into the procedure room when it’s time for your colonoscopy. They’ll attach you to equipment to monitor your heart, breathing, and blood pressure. You will also get oxygen through a thin tube that rests below your nose.

You will lay on your left side with your knees bent. You will get anesthesia through your IV, which will make you fall asleep.

Once you’re asleep, your GI specialist will do your colonoscopy. This may take about 40 to 60 minutes.

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 of 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.