Category: Patient Resources

Colonoscopy Prep Instructions

Our office regularly uses one of two similar solutions: Suprep or Clenpiq. They contain medications that, when taken orally, will hold water in the bowel so it does not get absorbed into the body. These solutions are not really drugs since they don’t get absorbed into the bloodstream but remain in the colon. The result is that the clear liquids you drink along with them will act as a kind of “colonic” from above – flushing through the colon and washing it clean. We have also found that the “split prep” technique works much better than taking the whole preparation the evening before the exam. You will receive instructions to take half the solution in the evening and half of it very early in the morning.

The morning of the day of the prep you can have a light breakfast. Don’t eat a lot of bulky fiber, especially seeds – we are always seeing chia, sesame, quinoa, flax seeds, etc., in an otherwise clean colon, and they clog up the scope and hide small polyps, so you should try to cut them out of your diet for 2-3 days before your colonoscopy.

After breakfast, you should have nothing except clear liquids until your exam the next day. Be creative with your clear liquid restriction: anything water-based that light shines through counts as a clear liquid, e.g. jello, chicken broth, popsicles, sorbet, juice without pulp, Gatorade, Miso (without the tofu!). Blended foods do not qualify. Also, no dairy and no protein.

The first prep solution bottle should be drunk sometime after work the evening before your exam. Don’t make any plans to leave your house after you start the process – the first bowel movement will arrive unexpectedly without warning any time from one to about four hours after you finish the liquid. Follow the prep solution with at least 40 oz of clear liquids and keep drinking as much as you can to avoid dehydration. It is easy to get faint and light-headed if you do not drink enough fluids. 

The second bottle is the one that really does the important final preparation. The idea behind the timing of the second bottle is this: For a safe anesthetic, your stomach should have NO clear liquids going into it for three hours (at a minimum) before your procedure. This way it will be empty while you are sedated and there will be no chance of you aspirating while you are asleep.

So, make sure you know the time of your procedure, and make sure you have finished the second bottle of prep AND any extra clear liquids, three hours before that. If you assume it will take about an hour to wake up, drink the second bottle and finish any extra clear liquids, then you should set your alarm for about four hours before the colonoscopy time and start the second half of your preparation right away.

Some patients still prefer to use old fashioned Miralax preparation, or Osmoprep, which is done with pills (a lot of them!). These instructions are given individually but the principle remains the same: half the night before, and half about four hours before the exam. Whatever system you use, this modern way of timing the intake will make for the best chance of an effective cleansing and a good, safe exam.

 

Miralax & Gatorade Prep

What to Buy To Prepare for a Colonoscopy

Purchase Miralax 238g (8.3 oz) and 4 Dulcolax Laxative Pills (Not stool softeners) at the pharmacy (over the counter). Also (2) 32 oz. Bottles Gatorade (NO RED).

“PREP DAY”

• * Prepare two doses of the Miralax/Gatorade Mixtures. Divide the entire bottle of Miralax into two 32 ounce bottles of Gatorade.
• * Have a low residue breakfast BEFORE 10am. (white toast, eggs, yogurt, cream of wheat, smoothies without seeds)
• * AT 10am begin a “Clear Liquid Diet.” Clear liquids include water, juice without pulp, soda, black coffee, tea, electrolyte drinks, Ensure CLEAR, Boost Breeze, Jello, Broth, Popsicles.
• * AT 6pm take 2 tablets of Dulcolax and drink the first 32 ounces of Miralax/Gatorade Mix.
• * Drink the entire 32 ounces within 90 minutes.
• * Continue drinking clear liquids until bedtime.

On The Day of Your Colonoscopy

• * Wake up 5 hours before your arrival time to start the second prep dose. 
• * Immediately take 2 tablets of Ducolax and drink the second dose of Miralax/Gatorade Mix.
• * Drink the entire 32 ounces within ninety minutes.
• * You must complete your prep and discontinue clear liquids 2 hours prior to your arrival time.
• * You should take your regular medications, as prescribed, with sips of water.

TIPS:

To improve the taste try

1. Add ice/Refrigerate mixture

2. Use a straw to drink mixture

If you experience nausea or vomiting, rest for 15 minutes, then try to resume prep.

Use Vaseline or an ointment for diaper rash around the anus before and/or during prep to minimize irritation from passing bowel movements.

Colonoscopy Post-Op Instructions/Information 

1. You have just had an examination of your colon (large intestine) called a colonoscopy.

2. No driving or operating heavy power equipment today.

3. Do not drink alcohol today.

4. Do not sign any important or legally binding papers today.

5. No strenuous activity today.

6. You may start taking small sips of clear fluids after your colonoscopy. If tolerated, then you may start small amounts of food until tolerating your normal diet.

7. You may experience drowsiness or forgetfulness. You may also notice altered bowel habits, excessive gas and belching or bloated feeling.

8. If recommended by your physician, you should avoid Aspirin, Aspirin products and Arthritis medications for 7 – 10 days following the exam if biopsies or polypectomies have been performed.

9. You may develop soreness or redness where your IV medication was given. Apply warm wet cloths to the area for 15 minutes 3 – 4 times per day.

10. You may have a bloated, gaseous feeling in your abdomen after a colonoscopy. Passing gas and belching will help. Walking or lying down on your left side with your knees flexed may relieve the discomfort.

11. Call the office at (832)942-8350 right away if you notice any of the following:

    a. Vomiting of blood and/or “coffee ground” material.

    b. Rectal bleeding – >1Tbsp, blood clots, or continuous bleeding.

    c. Severe abdominal pain.

    d. Chills, fever over 101 degrees F.

    e. Persistent nausea or vomiting.

    f. Persistent disorientation.

    g. Persistent coughing or spitting up blood.

    h. Persistent redness, hardness, or tenderness at IV site.

Anorectal Surgery Post-Op Care Instructions

SOME ANORECTAL OPERATIONS ARE PAINFUL. In order to minimize your discomfort and maximize the rate at which you heal, the following instructions have been prepared. Please read it through as it will help answer many questions you might have. Any other instructions given to you at the facility should not override these instructions. If you have read these instructions pre-operatively and have questions, please call and get your answers before surgery.

MEDICATIONS:

• * Local anesthesia is usually injected for postoperative pain relief; usually lasting for 4-6 hours.
• * Resume all prescribed medications you were taking regularly before surgery unless otherwise instructed. Take prescribed postoperative medications as instructed.

PAIN CONTROL:  The goal is to relieve acute pain to a tolerable level. During healing, some pain is normal. Do not take pain medicines on an empty stomach.

• * Begin taking oral pain medication when you get home after surgery, use the schedule below:
  • 1) Toradol (Ketorolac) or Advil (Ibuprofen): Take 10mg Ketorolac or two 200mg Ibuprofen tablets (400mg) every six hours, this reduces pain and swelling. If you suffer ulcers or stomach irritation, do not take. If bleeding is excessive, discontinue. If you are allergic to aspirin, do not take.
  • 2) Tylenol (acetaminophen): Two 500mg tablets (1,000mg) every six hours.
  • 3) Alternate Advil and Tylenol to take one or the other every three hours. You may substitute Vicodin for Tylenol. Tylenol dose should not exceed four grams (4,000mg) per day.
  • 4) Hydrocodone (Vicodin):  One every four hours or two every six hours. These contain acetaminophen (Tylenol). You may substitute for Tylenol. Do not add any more Tylenol.
  • 5) Muscle relaxers every 6 hrs.
• * Fiber Supplements such as Konsyl, Metamucil, or Benefiber should be taken two times a day while the wound(s) are healing.
• * Take Milk of Magnesia 1 tablespoon daily for the first seven days post-operatively.
• * If you have not had a bowel movement within 48 hours after discharge, take 2 Ducolax tabs.
• * If you have not moved your bowels by the morning of the 4th day following surgery call the office.

DISCHARGE/INFECTION: 

• * Some bloody discharge, especially after bowel movements, is normal for at least two to four weeks after rectal surgery. If you have profuse, continuous bleeding with passage of clots, call your doctor immediately. There may be gelfoam packing which will slough and dissolve on its own. 
• * Fever and chills in the first 24 hrs. after general anesthesia is normal.  Post-operative infection around the rectal opening is surprisingly uncommon despite the obvious contamination by stool. This is probably because of the excellent blood supply to the area.

WOUND CARE:

• * After surgery, having an ice pack close to the area will help decrease the swelling. Use intermittently 30 minutes on and then 30 minutes off in an effort to reduce pain and swelling.
• * Sit in a tub of water or Sitz bath with the water as warm as you can tolerate for approximately 30 minutes, at least 3 times a day, especially after a bowel movement. Start baths the evening of surgery and apply the prescribed cream after baths.  You may use a handheld shower at home if you have one. Its name comes from the German verb “sitzen,” meaning “to sit.”
• * Apply a small amount of the moisture barrier ointment (Calmoseptine, Desitin, etc.) around the outside with a finger after each sitz bath or shower and after each bowel movement. Start the evening of surgery. These ointments will help protect the operative site skin and help with itching and burning from temporary seepage, which is a normal part of healing. You may also be given a prescription cream to apply the evening of surgery as well. Please take as directed. Kleenex Cottonelle wipes may be used after toilet paper as needed for anal comfort and hygiene. Do not try to wash or scrub off barrier protection ointment during showers or bathing. You may also use a 4×4 gauze dressing or cotton ball on open wounds to further prevent itching and irritation of perianal skin from any drainage. Use loose cotton underwear; not tape to hold cotton ball or gauze dressing in place. Large dressings or pads can be used to protect clothing or underwear but should not replace 4×4 gauze or cotton ball placed within an open perianal wound.
• * Avoid any sitting “doughnuts” or any persistent pressure to the area. Use a soft fluffy pillow to sit and change positions frequently.
• * It is not uncommon (20-30%) to have minor bowel leakage (soiling) after anorectal surgery. The leakage resolves after all the healing has finished in 6-8 weeks
• * You make have a packing in the anal opening. This will fall out with your first bowel movement. If it falls out earlier, that is OK.

STITCHES/SWELLING:

• * You may have some stitches after surgery. These will dissolve on their own. Do not be alarmed by the swelling of the skin tags you may have around the anus. These are not hemorrhoids, but simply a response of the skin to the stitches and/or surgery you have had. The swelling will decrease daily. Sitz baths will help speed this process. Stitches may break apart, do not become alarmed. Healing will still proceed normally. Swollen skin tags will get smaller in time. Skin tags are the price one pays to avoid an anal stricture from removing too much perianal skin during a conventional hemorrhoidectomy. This is rarely a problem with the THD. Any remaining bothersome skin tags can be easily removed at a later date once all healing is complete (approximately 6-12 months).

URINATION: 

• * It is not uncommon to have difficulty completely emptying your bladder after surgery. If this happens after you get home, try to encourage urination by sitting in a warm tub or standing in a warm shower.
• * If you are still unable to empty your bladder and become painfully distended, you will need a Foley catheter. In this case you will need to go to the closest Emergency Room to have them insert the catheter into your bladder. This Foley catheter will stay in 4 to 7 days. The ER will instruct you on how to remove the catheter at home. Have the ER call my office if they need orders for the foley catheter.

DIET:

• * Feeling tired, sometimes with nausea, is common. Plan a light meal immediate after the surgery and continue to drink liquids, since many patients may be dehydrated.
• * Once nausea resolves, A regular diet, including plenty of fresh fruit and vegetables, is recommended. Try to drink 6 to 8 glasses of water per day.

ACTIVITIES:   

• * You may be out of bed as desired.  You may use the stairs.
• * No heavy lifting or strenuous exercise for 2 weeks.
• * You may drive when you are no longer taking narcotics for pain. 
• * Return to work or full activity when able to do so without significant pain. Depending on the type of operation you had it may be 3 to 7 days (i.e. fissure surgery) or 3 to 6 weeks (i.e. standard hemorrhoidectomy, complex fistulotomy or sphincteroplasty).

CAUSE FOR CONCERN:  If any of the following occur, please call our office and speak with a nurse who will help you with your problem or ask the doctor to call you:

• * Persistent fever over 101° F
•  * Heavy or persistent bleeding from the rectum
• * Pain that is not relieved by your medications
• * Constipation
• * Chills

BE SURE TO KEEP YOUR FOLLOW-UP APPOINTMENT IN OUR OFFICE. IF AN APPOINTMENT WAS NOT MADE FOR YOU, PLEASE CALL THE OFFICE THE NEXT BUSINESS DAY AND MAKE AN APPOINTMENT TO BE SEEN IN 2 TO 4 WEEKS OR SOONER IF INSTRUCTED IN POST-OP ORDER.

Some common potential complications following anorectal surgery are in order of most frequent to least:

1. Urinary retention (10-30%)
2. Swollen skin tags after conventional hemorrhoidectomy (6%), not with THD
3. Fecal Impaction (avoidable- 1%)
4. Anal stricture/stenosis (avoidable and may eventually need dilatation under anesthesia- 1%))
5. Significant bleeding (less than 1%)
6. Infection (rare and less than 1%)
7. Pruritis Ani “Monkey Butt” (avoidable if barrier ointment is used 24/7 as instructed).
8. Thrombosed external hemorrhoids after THD or LIS (less than 1%)

Finally, if you have any questions or concerns regarding your surgery or recuperation please DO NOT HESITATE to call our office –we are here to help in any way we can.

 

Anorectal Surgery Pre-Op Instructions

MEDICAL CLEARANCE:

• * You may need to be seen by your primary care doctor and have lab work done prior to your procedure.

MEDICATIONS:

• * STOP 2 weeks prior to your procedure o Phenteramine and All Herbal Supplements/Teas (Black Cohash, Echineasa, Ephedra, Fererfew, Garlic, Ginkgo Biloba, Ginseng, GBL/BD/GHB, Goldenseal, Hoodia, Kava, Licorice, Saw Palmetto, St John’s Wort, Valerian)
• * Take your important prescription medications with only a sip of water the morning of the procedure.
• * If you take Blood thinners: Plavix, Pradaxa, Eliquis, Xarelto, Effient, Coumadin, etc., you will need to consult with both our surgeon and the prescribing physician on when and if you can stop it before your surgery. You may continue your Aspirin.
•  * If you take Diabetes medication: you should consult your managing physician.

ARRIVAL TIME:

• * You will receive a call from a surgery center nurse 1 to 3 business days prior to your procedure with your ARRIVAL time to the facility.

TRANSPORTATION:

• * You MUST HAVE AN ADULT DRIVER bring you and stay in the facility the entire time you are here. Generally, the total time you will be here is between 2 and 2 ½ hours. Please remember our doctors are surgeons and emergencies do occur that require their attention which may delay your procedure.

PREPARATION:

• * Constipation can make your recovery more difficult. Prevent constipation by taking a daily fiber supplement (BenefiberTM, MetamucilTM, HydrocilTM, etc). One tablespoon in a glass of water in the morning is the recommended dose. We recommend powders over pills. Drink plenty of liquids and follow our instruction carefully. The best time to correct constipation is prior to surgery.
• * Prep: 2 Hours before leaving your home give yourself one Fleets enema. Repeat 1 hour later with a second Fleets enema. This is not necessary if you completed a full bowel prep the day before.

EATING & DRINKING:

• * DO NOT eat anything after midnight prior to your procedure.
• * You may drink CLEAR liquids ONLY until 2 hours before your ARRIVAL time. You may not put ANYTHING in your mouth for those last 2 hours. Food or liquid in the stomach may cause problems with the anesthesia, and your procedure will be delayed or canceled if you ate or drank.
• * If you have any questions about your surgical procedure, please contact us. It is very important to be well informed about the procedure, risks and benefits, alternatives and expectations. We take surgery very seriously. Your surgeon will see you before surgery and answer any last-minute questions. Post-operative instructions will be given at the hospital or surgery center. Please go to our website www.bayoucitysurgical.com for more information. Look for patient instructions.