How to Prepare for Your Colonoscopy using Sutab® Bowel Prep Kit

This information will help you get ready for your colonoscopy using a Sutab Bowel Prep Kit.

What is a colonoscopy and why is it done?

A colonoscopy is an exam of the inside 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. They’re 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 colonoscopy, your 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. You may need to have another colonoscopy if this happens.

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

What is Sutab bowel prep?

Sutab is a split-dose medication that empties your bowels before your colonoscopy. Split-dose means the medication comes in 2 doses. Each dose of Sutab is 12 tablets. Your Sutab kit will also have an empty 16-ounce container for water.

Follow the instructions in this resource carefully. If you have any questions, contact your GI specialist.

What To Do 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.

Medications for Diabetes

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

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

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

Get Clearance Letters From Your Doctor, if Needed

A clearance letter is a letter from your doctor that says it’s safe for you to have a procedure.

You may need to get one or more clearance letters before your colonoscopy. Your MSK healthcare provider will tell you if you do. They must have your clearance letter at least 1 day before your colonoscopy.

Clearance Letter for an Automatic Implantable Cardioverter-Defibrillator (AICD)

Tell your MSK healthcare provider if you have an AICD. 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’ve had any of these during the last 6 weeks:

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

Buy Supplies To Use With Your Sutab Bowel Prep Kit

You will need to buy a Sutab bowel preparation kit at your local pharmacy. 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 colonoscopy.

Clear liquids are liquids you can see through. Sports drinks, such as Gatorade^® or Powerade^®, are a good choice. They help replace electrolytes you’ll lose during your bowel prep. Read the “Clear liquid diet” table 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 need to buy extra supplies if you answer yes to any (1 or more) of these questions:

If you answered yes to any of these questions, you may 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 will 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 Colonoscopy

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.

What To Do 3 Days Before Your Colonoscopy

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 seeds.
• 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.

Tell the endoscopy nurse that your doctor has recommended the Sutab prep for you. They will also go over your medications and tell you which medications to take the morning of your procedure.

What To Do 2 Days Before Your Colonoscopy

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 instead:

• Take 1 (17-gram) dose of MiraLAX 3 times a day:
  • One dose at breakfast.
  • One dose at lunch.
  • One dose at dinner.

Mix 1 dose with 8 ounces of liquid each time.

• 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.

What To Do 1 Day Before Your Colonoscopy

Starting the day before your colonoscopy, 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 colonoscopy. A clear liquid diet includes only liquids you can see through (see Table 1). Clear liquids are different from full liquids.

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 (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 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.

Start Sutab Bowel Prep

Sutab comes in 2 (12 tablet) doses. The tablets may make your abdomen (belly) swell or feel uncomfortable. This is normal. You may also feel nauseous (like you’re going to throw up) or distention (a bloated, hard abdomen).

If you feel nausea, bloating, or cramping while you’re taking the tablets, slow down or stop drinking the water. Only keep drinking the water after these feelings stop.

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

Steps for Taking Sutab Bowel Prep

Follow these steps when taking each dose of Sutab bowel prep:

When To Take Each Dose of Sutab Bowel Prep

Dose 1

Start taking dose 1 around 4 p.m. the day before your colonoscopy. Follow “Steps for Taking Sutab Bowel Prep.”

Dose 2 (if You’re Scheduled To Arrive at or Before 12 p.m.)

If you’re scheduled to arrive at or before 12 p.m. (noon), start dose 2 at 11 p.m. the night before. Follow “Steps for Taking Sutab Bowel Prep.”

You can continue to drink clear liquids until 4 hours before your scheduled arrival time. Do not eat anything until after your procedure.

What To Do The Day of Your Colonoscopy

If you’re scheduled to arrive after noon, take dose 2 the morning of your colonoscopy. Skip this if you’re scheduled to arrive at or before noon and already finished dose 2 the night before.

Dose 2 (if You’re Scheduled To Arrive After 12 p.m.)

The following table will help you figure out when to start drinking part 2 of your Sutab. To read the table, first find your arrival time. The time you need to start drinking Sutab 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 12:15 p.m., start part 2 at 5:15 a.m.
• If your arrival time is 12:30 p.m., start part 2 at 5:30 a.m.
• If your arrival time is 12:45 p.m., start part 2 at 5:45 a.m.

Follow “Steps for Taking Sutab Bowel Prep.” You must finish all 48 ounces of water at least 4 hours before your colonoscopy.

Things To Remember

• Finish dose 2 of your Sutab prep and all 48 ounces of water at least 4 hours before your colonoscopy.
• Take only the medications you were told to take the morning of your colonoscopy. Take them with a few sips of water no later than 2 hours before you arrive. You can continue to drink clear liquids until 4 hours before your scheduled arrival time. Do not eat anything until after your procedure.
• 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 To Your Appointment

• 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 colonoscopy will take place at one of these locations:

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

MSK Monmouth
480 Red Hill Rd.
Middletown, NJ 07748

Where to park

MSK’s parking garage is on East 66^th Street between York and 1^st avenues. If you have questions about prices, call 212-639-2338.

To get to the garage, turn onto East 66^th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital.

There are other parking garages on:

• East 69th Street between 1st and 2nd avenues.
• East 67th Street between York and 1st avenues.
• East 65th Street between 1st and 2nd avenues.

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

If your colonoscopy is scheduled at Monmouth, enter the parking lot and follow the signs for the Lower Concourse. There is free parking by the Lower Concourse entrance. There is additional parking to the right of the entrance. Free valet parking is also available.

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 colonoscopy, 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 (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 colonoscopy. 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.

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 usually takes 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 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 a fever of 101 °F (38.3 °C) or higher.
• You have very bad stomach pain.
• You have vomiting (throwing up).
• Your abdomen feels hard.
• You feel weak, faint, or nauseous after your colonoscopy.
• You’re bleeding from your rectum for more than 24 hours.
• You’re bleeding from your rectum between bowel movements.
• You have 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.