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- All About Laxatives
- Constipation Overview
- Constipation Symptoms
- Diagnosing Constipation
- Constipation Management
- Constipation Outlook
- Want to learn more about constipation?
- Texas Children’s Blog
- Preparing for a Colonoscopy
- What is a colonoscopy?
- How to prepare for a colonoscopy: what to expect
- Food planning for colonoscopy prep: what to eat and what to avoid
- Cleansing the bowel
- Preparing for a colonoscopy: travel plans
- Colonoscopy preparation FAQs
All About Laxatives
The first rule of laxatives is that you usually don’t need them.
The best remedy for constipation is drinking more fluids, adding fiber to your diet, and getting more exercise.
It’s also important to know that going a day without a bowel movement does not mean you have constipation.
Sure, some people have three bowel movements a day, but others only have three a week. Normal is relative, especially in this case.
How Do You Know When You Are Constipated?
Constipation is one of the most frequent complaints doctors hear. It’s estimated that constipation results in at least 2.5 million doctor visits annually in the United States and Americans spend hundreds of millions of dollars on laxatives every year.
Constipation occurs when stool passes too slowly through your digestive tract. This allows too much water to be absorbed, making the stool harder, drier, and more difficult to pass.
Although everyone’s digestive system is a little different, if you have not had a bowel movement in four days, you may be constipated and a laxative could help.
If you have tried adding fiber, drinking more fluids, and increasing your activity, and you are still constipated, there are many constipation remedies that are available over-the-counter. These include laxatives, stool softeners, lubricants, and tap water enemas. Here is what you need to know about laxatives:
- Bulk-forming laxatives. These laxatives work by drawing water into your stools to make them larger, softer, and easier to pass. They work slowly and stimulate your colon naturally. They are considered the safest type of laxative and the only type that might be recommended for daily use. Examples are psyllium (Metamucil), polycarbophil (FiberCon), and methylcellulose (Citrucel). It is important to drink plenty of fluids with a bulk laxative.
- Saline laxatives. These laxatives are also called osmotic laxatives because they draw extra fluid into the large intestine to help soften stool and flush out your colon. Because the active ingredients in these laxatives are commonly magnesium or phosphate, they can be dangerous for people with kidney failure. A common example of this type of laxative is Milk of Magnesia, which is magnesium.
- Stimulant laxatives. These are the roughest type of laxatives because they cause your bowel to contract and squeeze out the stool. Stimulant laxatives can be taken by mouth or by suppository. When taken by mouth they work in about seven hours; by suppository they can work in about 30 minutes. These laxatives should never be used more than once every three days because they can cause your bowel to lose its ability to contract. A common example of a stimulant laxative is bisacodyl (Dulcolax and Correctol).
- Other constipation remedies. Stool softeners and lubricant laxatives are also helpful because they make dry, hard stools easier to pass. Mineral oil can be used as a lubricant laxative, as can a glycerin suppository. Even though mineral oil is available over the counter, because it can interfere with your ability to absorb the important vitamins A, D, E, and K, it’s essential to discuss its use with your doctor.
Benefits and Risks
The benefit of laxatives is that you can purchase them without a doctor’s prescription and they are generally safe and effective. Laxatives may help prevent constipation caused by some drugs or prevent straining to have a bowel movement, which might be dangerous for some people.
Here are some risks to be aware of:
- Laxatives may cause cramping, bloating, and nausea in some people.
- Long-term use of laxatives, except for bulk laxatives, can make you dependent on laxatives to go to the bathroom and may mask important constipation symptoms.
- Laxatives can interfere with how other medications are absorbed. In general you should avoid taking a laxative within two hours of taking other medications.
- Never use laxatives for weight loss. Laxative abuse does not help you lose weight and can result in dangerous dehydration, weakness, fainting, and kidney damage.
Laxatives can be useful constipation remedies, but they are not a substitute for eating enough fiber, getting regular exercise, and drinking plenty of fluid. Other ways to avoid constipation are to never ignore the urge to have a bowel movement, set aside regular times of the day for a bowel movement, and avoid foods that are high in fats and sugar.
If you are having trouble with constipation, talk to your doctor about what type of laxative might be best for you. Never ignore symptoms of blood in your stools or dark, tarry stools. If you have constipation for more than two weeks, abdominal pain, nausea, or vomiting, talk to your doctor before starting any constipation remedy.
Learn more in the Everyday Health Digestive Health Center.
Constipation can be quite unpleasant, and people experiencing the condition may be tempted to run to the drug store and buy laxatives. But, the FDA is warning such people to read the label carefully and not exceed the recommended dose, or they may risk their lives.
The problems stem from laxatives with the active ingredient sodium phosphate, which are recommended to be taken in a single dose once a day and for no more than three days. They can be taken orally or rectally, depending on the product.
Sodium phosphate laxatives, also called saline laxatives, are sold under the brand name Fleet and also sold as store and generic brands. They work by drawing water into the bowel, which softens the stool to allow it to pass easier.
The FDA is now finding that adults older than 55 and children with certain health conditions may face added risks if they exceed the laxative dosage. The agency has received 54 reports of side effects, including 13 deaths, linked to over-the-counter sodium phosphate laxatives.
Serious side effects include dehydration and/or abnormal levels of electrolytes in the blood that can lead to serious complications, including kidney damage and sometimes death.
The most harmful side effects occurred when people overdosed by taking a single dose that was higher than recommended or took more than one dose in a day because the first laxative didn’t have the desired effect, said Dr. Mona Khurana, a medical officer in the FDA’s division of nonprescription regulation development.
Twelve adults and one child died after they overdosed on over-the-counter sodium phosphate products. Side effect case counts could be higher than the 54 reported cases, she added, since not everybody who develops problems reports them to the FDA.
“The bottom line is that these products are safe for otherwise healthy adults and older children for whom dosing instructions are provided on the Drug Facts label as long as they follow these dosing instructions and don’t take the product more often, or in greater amounts, than the label instructs,” she said in a statement.
The FDA’s new warning also urges people to check with their doctors if they are taking drugs that affect how the kidneys work, including diuretics; angiotensin-converting enzyme (ACE) inhibitors used to lower blood pressure; angiotensin receptor blockers (ARBs) used to treat high blood pressure, heart, or kidney failure; and nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin.
People with inflammation of the colon should also check with a doctor before taking laxatives, according to the FDA. These warnings are not currently on product labels.
The product labels do warn people to not to orally or rectally take another dose of the product if they have yet to have a bowel movement after taking the laxative. In addition, the labels tell adults and children to ask health care professionals before using these products if they have kidney disease, heart problems or dehydration.
Children under 2 years old should never take laxatives rectally, the label adds.
Constipation is marked by infrequent bowel movements or trouble passing stools. Causes include insufficient water intake, not enough fiber in diets, a disruption of regular routine (such as traveling), stress, eating large amounts of dairy products, hemorrhoids, medications, pregnancy, depression, eating disorders and other medical conditions, according to WebMD. People may take a laxative to help relieve their symptoms.
Laxatives are also often misused following eating binges by people with eating disorders who mistakenly believe the medications will rush food and calories through the guy before they can be absorbed, according to the National Eating Disorders Association.
Taking too many laxatives overtime may weaken the bowel muscles, further leading to constipation.
Contact a doctor after taking laxatives if you experience symptoms including dry mouth, thirst, reduced urine output and lightheadedness, especially with changes in position, after taking these laxatives. These may all be signs of dehydration. People experiencing kidney injury may report drowsiness, sluggishness, and swelling of the ankles, feet and legs.
If the rectal laxative doesn’t leave the body for more than 30 minutes, contact a doctor.
Download a pdf of this constipation information.
It is normal to have a bowel movement (defecate) anywhere from three times a day to three times a week, as long as the stool (fecal matter) is soft and comfortable to pass. A person experiencing constipation has hard or lumpy stool, which is difficult to pass. Chronic constipation affects 15-30% of Canadians, and is commonly found in young children and the elderly, occurring more frequently in females than in males.
Transit time is the duration between when food enters the mouth and when leftover waste finally passes out as stool. A meal could take anywhere from 12-72 hours to travel through the digestive tract. Each person is unique; a normal bowel movement pattern for one person may be very different from those of family members or friends. Some individuals have an irregular pattern, never knowing what to expect. Usually, before food enters the colon, most of the nutrients have been absorbed into the body and the colon’s role is to remove water. If someone has a long transit time, meaning food passes slowly through the colon, then too much water is absorbed, hardening the stool.
Factors that can contribute to constipation, often by altering transit time, include:
- medication side effects (e.g., some narcotics, antidepressants, codeine, calcium or iron supplements, and medications that affect the nervous system),
- diseases in which there is a physiological change to some tissue or organ of the body (e.g., radiation therapy, inflammatory bowel disease, colon cancer, diabetes, stroke, hypothyroidism, or Parkinson’s disease),
- functional disorders, such as irritable bowel syndrome, intestinal obstructions or strictures resulting from surgery, and
- diet and lifestyle choices, such as consuming a diet too low in fibre and fluid, insufficient physical activity, and chronic use of laxatives, suppositories, or enemas.
The increased length of time during which stool remains in the colon causes increased pressure on the bowels, leading to abdominal cramping and bloating. Bowel movements may occur infrequently, resulting in hard, lumpy, dry stool, looking like either many small pellets or one solid, hard, sausage-shaped piece. Rectal pressure or fullness, bloating, abdominal pain, and a sensation of incomplete evacuation are common symptoms of constipation. The slowdown in the digestive tract may also cause poor appetite, back pain, and general malaise.
Most complications result from the intense straining needed to pass stool. These include hemorrhoids, anal fissures, diverticular disease, bright red streaks on the stool (rectal bleeding), and a condition in which the rectal wall pushes out through the anus (rectal prolapse).
A panel of experts developed the main diagnostic criteria for functional constipation, and update them regularly. Below are the current Rome IV diagnostic criteria*.
- Must include two or more of the following:
- straining during more than one-fourth (25%) of defecations
- lumpy or hard stools (Bristol stool form scale 1 or 2) more than one-fourth (25%) of defecations
- sensation of incomplete evacuation more than one-fourth (25%) of defecations
- sensation of anorectal obstruction/blockage more than one-fourth (25%) of defecations
- manual maneuvers to facilitate more than one-fourth (25%) of defecations (such as digital evacuation, or support of the pelvic floor)
- Loose stools are rarely present without the use of laxatives
- Insufficient criteria for irritable bowel syndrome (IBS)
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
A physician may order a number of tests, including blood analysis, to check for abnormal levels of thyroid hormone, electrolytes, or glucose, and a stool sample to examine for hidden (occult) blood. Other tests include a sigmoidoscopy or colonoscopy, which are examinations involving an instrument that allows a physician to see the inside of the rectum and colon. Colorectal screening is recommended in persons older than 50 years of age.
It is important to differentiate between temporary (acute) constipation and chronic constipation, as the treatments and recommendations may differ.
Always check with your health care provider before making major changes, to be sure these actions won’t interfere with other conditions you might have.
Diet: Eating regular well-balanced meals and snacks with high-fibre content, as outlined in Canada’s Food Guide, available from Health Canada, and maintaining an adequate fluid intake, is the recommended approach to prevent and manage constipation.
Exercise: Exercise helps to move food through the colon more quickly. Aerobic exercise, such as brisk walking, accelerates your heart and breathing rates, and helps to stimulate the natural contractions of intestinal muscles.
Physiotherapy: Pelvic dysfunction physiotherapy may include bowel retraining, electrical stimulation, and posture correction.
If constipation does not improve with diet and lifestyle changes, then there are supplements and medications available.
Bulk Forming Agents: These are made of indigestible fibre, which absorbs and retains fluid and helps to form a soft, bulky stool (e.g., Metamucil®, Prodiem®). While not quick-acting, they are safe for long-term use. Add these to your diet gradually and increase your fluid intake at the same time.
Enemas: An enema involves insertion of a liquid, usually water, into the rectum via the anus. Typically, after holding the liquid in place for a few minutes, there is an intense urgency to move the bowels.
Stool Softeners: These products work by holding water in the stool (e.g., Colace®). They are safe for long-term use and for pregnant women and the elderly.
Lubricants: Lubricant laxatives coat the colon and stool in a waterproof film, allowing it to remain soft and slip easily through the intestine, usually within 6-8 hours. Don’t use these products for longer than a week, as some have been shown to cause vitamin deficiencies and medication interactions. An example of a lubricant laxative is mineral oil. Not recommended for pregnant women or for persons who have difficulty swallowing.
Stimulants: These laxatives increase muscle contractions to move food along the digestive tract more quickly (e.g., Ex-lax®, Dulcolax®, castor oil, senna tea, and Senokot®). Stimulants are typically recommended for short-term use. However, in some individuals, constipation does not resolve with dietary adjustments, exercise, or short-term laxative use. For those with persistent or difficult constipation, physicians might suggest long-term laxative use. These are not recommended for pregnant women.
Hyperosmotics: Osmotic laxatives encourage bowel movements by drawing water into the bowel from nearby tissue (intestinal lumen), thereby softening stool. Some of these laxatives can cause electrolyte imbalances if they draw out too many nutrients and other substances with the water. They can increase thirst and dehydration. There are four main types of hyperosmotics:
- Saline laxatives are salts dissolved in liquid; they rapidly empty all contents of the bowel, usually working within 30 minutes to 3 hours. Examples of saline laxatives are citrate salts (e.g., Royvac®), magnesium preparations (e.g., Phillips’® Milk of Magnesia), sulfate salts, and sodium phosphate. Not intended for long-term use or for pregnant women.
- Lactulose laxatives are sugar-like agents that work similarly to saline laxatives but at a much slower rate, and are sometimes used to treat chronic constipation. They take 6 hours to 2 days to produce results.
- Polymer laxatives consist of large molecules that cause the stool to hold and retain water. They are usually non-gritty, tasteless, and are well tolerated for occasional constipation. Results can be expected within 6 hours, but it can take longer depending on the dose. An example of a polymer laxative is polyethylene glycol (e.g., PegaLAX®).
- Glycerine is available as a suppository and mainly has a hyperosmotic effect, but it may also have a stimulant effect from the sodium stearate used in the preparation. Glycerine is available through several manufacturers.
Enterokinetic: Prucalopride succinate (Resotran®) works by targeting the serotonin (5-HT4) receptors in the digestive tract to stimulate motility (muscle movement) and has Health Canada approval for the treatment of chronic idiopathic constipation in women for whom laxative treatment has failed to provide relief. Resotran® usually produces a bowel movement within 2-3 hours and then spontaneous complete bowel movements typically begin occurring within 4-5 days of starting treatment. Side effects may include nausea, diarrhea, abdominal pain, and headache, mostly following the initial dose and then subsiding with ongoing treatment.
Guanylate cyclase-C agonist: Linaclotide (Constella®) works by increasing intestinal fluid secretion, which helps ease the passage of stool through the digestive tract, relieving associated symptoms and has Health Canada approval for the treatment of chronic idiopathic constipation in men and women. In clinical trials, Constella® showed a statistically significant improvement compared with placebo for complete spontaneous bowel movements. The results occurred within the first week, often on the first day, of dosing and were sustained over the 12-week treatment period. Diarrhea is the most commonly noted side effect.
Constipation can occur for many reasons, so treatment often requires trial and error. An individual may experience a short bout of constipation and return to a normal routine, or it may be an ongoing health issue. With diet and lifestyle changes, and the proper use of supplements and medications, most forms of constipation are manageable. If your bowel habits change drastically for no apparent reason, be sure to consult your physician.
Want to learn more about constipation?
We have several related articles that may be helpful:
- Biofeedback Shows Promise for Chronic Constipation
- Call for Patient Perspectives – Constella® for Chronic Constipation
- Carbonated Water May Help Dyspepsia & Constipation
- Chronic Constipation Disrupts Daily Life
- Constipation and Diet
- Dietary Fibre Q&A
- Diverticular Disease
- Increase Dietary Fibre – Reduce Health Care Costs
- Irritable Bowel Syndrome (IBS)
- More Information on Constipation
- Pelvic Floor Dysfunction
- Physical Activity and GI Health
- Polyethelyne Glycol vs. Lactulose
- Prunes vs. Psyllium for Reducing Constipation
- Serious Toll of Chronic Constipation Overlooked
- Talking to Your Physician about IBS and Constipation
- The Scoop on Poop
- Treating Constipation with Laxatives
Image Credits: © bigstockphoto.com/monkeybusinessimages, © _ella_/Dreamstime.com
Texas Children’s Blog
OVER-THE-COUNTER CONSTIPATION MEDICATIONS:
|Docusate||Colace®, Pedia-Lax® Liquid Stool Softener, Dulcolax® Stool Softener||
|Magnesium hydroxide||Pedia-Lax® Chewable Tablets, Phillips® Milk of Magnesia||
|Glycerin suppositories||Pedia-Lax Glycerin suppositories||
|Senna||Fletcher’s® Laxative for Kids, Little Remedies® for Tummys||
|Bisacodyl||Dulcolax® Laxative Tablets, Dulcolax® Laxative suppositories||
Typically, stool softeners and osmotic laxatives are the first-line medications used for treating short and long-term constipation in healthy children. Although docusate and magnesium hydroxide can be taken with few side effects, polyethylene glycol tends to be the preferred choice due to its imperceptible taste, texture, and odor. The medications’ dose is dependent on the child’s age, weight, and constipation severity, and can be adjusted as symptoms improve or worsen. Glycerin suppositories can be safely used in infants and children, but should be used infrequently due to rectal and skin irritation and medication tolerance. Stimulant laxatives, such as senna and bisacodyl, are usually reserved for children with more severe constipation who do not respond to high-fiber diets and osmotic laxatives. Under the guidance of a pediatrician or pediatric gastroenterologist, these medications are commonly used in combination with stool softeners or lubricant laxatives. Because stimulant laxatives may cause cramping, dehydration, and fluid and electrolyte imbalances, these medications should not be used for long periods of time.
Gas and Indigestion Medications: Gas and indigestion (“heartburn”) can present in many ways, including excessive crying, back arching, abdominal bloating and/or discomfort, and decreased appetite. Causes, such as swallowing too much air, overeating, drinking soda or other carbonated beverages, lactose (or other food) intolerance, acid reflux, constipation, and viral illnesses, are commonly seen in children. Unfortunately, symptomatic treatment with over-the-counter medications may provide little beneficial effect.
OVER-THE-COUNTER GAS AND INDIGESTION MEDICATIONS:
|Simethicone||Infants’ Mylicon® Drops, Little Remedies® for Tummys Gas Relief Drops||
|Sodium bicarbonate, Zingiber officinale (ginger), Foeniculum vulgare (fennel)||Little Remedies® for Tummys Gripe Water, Mommy’s Bliss® Gripe Water||
|Aluminum Hydroxide, Magnesium Hydroxide, Simethicone||Maalox® Advanced Regular Strength, Mylanta® Classic Regular and Max Strength||
|Calcium Carbonate||Children’s Pepto®||
Simethicone, an active ingredient found in Infants’ Mylicon®, Little Remedies® for Tummys Gas Relief, and numerous antacid medications, dissolves gas bubbles and prevents gas pockets in the stomach and intestine. Although generally safe, there is little evidence to support its use in the treatment of gas, bloating, and colic. Similarly, gripe water, an herbal remedy that is not regulated by the Food and Drug Administration (FDA), has no proven, beneficial effect in the treatment of hiccups, gas, and colic. Antacid preparations are appropriate for short-term relief of indigestion in older children and adolescents with infrequent symptoms. Maalox®, Mylicon®, and Children’s Pepto® are some of the most well-known, over-the-counter antacid medications available today. Active ingredients, such as aluminum hydroxide, magnesium hydroxide, simethicone, and calcium carbonate, either alone or in combination, are found in all of these brand-named medications. The difference between each brand (and their multiple products) lies in the “recipe” of active ingredients found in each medication. For example, Mylicon® offers 4 antacid products, Regular Strength, Maximum Strength, Ultimate Strength, and Supreme, and each of these products has different active ingredients in varying amounts. Of importance, bismuth subsalicylate, an active ingredient similar to aspirin, is used in Pepto-Bismol® (versus Children’s Pepto®) and Maalox® Total Relief (versus Maalox® Regular and Advanced Regular/Max Strength) medications. Aspirin and aspirin-containing medications should not be used in children under 16 years of age with fever or viral symptoms, for it may cause Reye Syndrome, a serious and potentially life-threatening illness.
Probiotics: Probiotics, or microorganisms which may help re-establish the normal physiologic environment of the intestinal tract, are mainly derived from food sources such as cultured milk products. Numerous microorganisms, both alone and in combination, are available in many probiotics and dairy products (i.e., yogurt), but none of these preparations are regulated by the FDA.
|Lactobacillus reuteri||Pedia-Lax® Probiotic Yums||
|Saccharomyces boulardii lyo||Florastor® Kids||
Although more research is needed to clarify the role of different probiotics in treating certain illnesses, Lactobacillus GG and Saccharomyces boulardii have been shown to reduce the duration and frequency of infectious diarrhea in healthy children with normal immune systems. These microorganisms can be found in over-the-counter children’s probiotics, such as Culturelle® and Florastor® Kids, and may be given once or twice a day for a week. If chosen and used appropriately, common, childhood symptoms and illnesses can be safely treated with over-the-counter medications. However, if your child has a chronic, medical illness or severe and persistent symptoms, you should always speak with your pediatrician or pediatric gastrointestinal doctor prior to starting any new medications. If your child accidentally takes too much medication or the wrong medication, call the Poison Control Hotline at 1-800-222-1222, but if he/she becomes unresponsive, stops breathing and turns blue, develops seizure-like activity, or appears very ill, call 911 and seek medical care immediately.
Preparing for a Colonoscopy
- What is a colonoscopy?
- How to prepare for a colonoscopy: what to expect
- Food planning for colonoscopy prep: what to eat and what to avoid
- Cleansing the bowel
- Preparing for a colonoscopy: travel plans
What is a colonoscopy?
A colonoscopy involves inserting a thin, flexible tube called a colonoscope into the body through the anus to examine the colon (large intestine) and rectum. The main purpose of a colonoscopy is to investigate symptoms which may be coming from the colon and colorectal area, such as:
- Abdominal pain
- Passing blood with bowel movements.
- Persistent diarrhoea
During a colonoscopy it is possible to identify growths and other intestinal problems; including:
- Non-cancerous polyps
- Colon cancers
- Areas of inflammation
It is necessary for the whole colon to be visible to the video camera on the end of the colonoscope, otherwise it is impossible to carry out this screening process effectively. If you are concerned about the health of yourself or a loved one, download the Ada app for a free assessment.
People are recommended to follow particular instructions in preparation for a colonoscopy, including following a specialized colonoscopy prep diet and activity plan. The purpose of this is to induce a kind of diarrhea, emptying the area to be screened of stool and other waste to ensure full visibility. This process is known as colonoscopy prep.
How to prepare for a colonoscopy: what to expect
The aim of colonoscopy prep is to ensure that the colon is empty and clean before the screening. This normally involves:
- Following a colonoscopy prep diet. This is made up of low fiber food; this stage lasts for three to four days, with a liquid-only food intake on the final day before the colonoscopy.
- Drinking bowel-cleaning liquids. These are medications called laxatives, which may take the form of pills or drinks, and which are taken to induce diarrhea. They will most commonly be taken the night before the screening, often with another dose on the morning of the screening. This is called a split-dose-regimen.
- An enema before the colonoscopy. This may be given in cases where the large intestine is difficult to empty, for example due to constipation.
Good to know: People preparing for a colonoscopy experience frequent bowel movements as the preparatory medications take effect, and will need ready access to a bathroom at all times. It is for this reason that clearing one’s schedule of appointments for at least one day before the screening and staying at home are both highly recommended.
Colonoscopy prep tips: creating the optimum setup
Before starting colonoscopy prep, most people find it helpful to shop for all the supplies that they will need. In addition to the foods and liquids that will be eaten as part of the food intake plan, people preparing for a colonoscopy may wish to purchase products to soothe the skin around the anus, specifically diaper cream (to soothe the skin) and alcohol-free cleansing wipes containing aloe-vera or vitamin E.
Food planning for colonoscopy prep: what to eat and what to avoid
During colonoscopy prep, one should aim to eat a diet which is nutritious, but which does not cause large amounts of feces to form in the intestine. Three days in advance, it is important to stop taking fiber supplement products, as these help the body to produce fecal matter and would work against the colonoscopy preparations.
At this point, it is important to stop taking all other supplements and vitamins, as well as any medicines that contain iron. Physicians or hospital staff will advise on whether and when to stop taking any prescription medicines that are normally used regularly, and on the use of over-the-counter anti-inflammatory medications, such as ibuprofen.
Low fiber food
Eating low-fiber food for three or four days before the procedure will help to empty the colon, because low-fiber foods are easy to digest and leave one’s system quickly.
Foods to avoid during colonoscopy prep include:
- Fatty foods
- Fruit with seeds or peel such as apples, berries or figs
- High-fibre cereals such as bran flakes or granola
- High-fibre vegetables such as corn, broccoli, cabbage, beans or peas
- Legumes such as dried peas, lentils or split peas
- Seeds, nuts or popcorn
- Tough meat with gristle
- Raw vegetables
- Whole grains
Low-fibre food options which are suitable for colonoscopy prep include:
- Cooked vegetables without skin or peel
- Fruit without skin or seeds
- Lean meat such as chicken, turkey or veal
- Well-cooked vegetables without skin
- Breads and cakes made with refined white flour such as bagels, muffins or rolls
- Pasta and rice
- Potatoes without skin
- Smooth peanut butter or almond butter
The day before before the colonoscopy, it is recommended to avoid solid food completely. Consuming liquids only for this time period helps prevent new fecal matter from forming, entering the colon and being present during the screening, and will ensure that the colon remains empty and clean.
It is important to avoid red and purple food dyes as they can discolor the lining of the colon and make it harder to see the area being examined during the colonoscopy.
Drinks and liquid foods which are suitable to eat the day before the screening include:
- Clear broth, including chicken, beef, or vegetable
- Clear, light-colored juices such as apple, white grape, lemonade without pulp, and white cranberry
- Flavored water
- Jell-O or other gelatin without fruit (taking care to avoid red and purple food colouring)
- Popsicles without fruit or cream
- Sports drinks such as Gatorade and Propel (light colors only)
- Tea and black coffee without any cream, milk or sweetener
Cleansing the bowel
The aim of colonoscopy prep is to pass all the fecal matter from the area to be examined during the screening, so that there is nothing left to obstruct the view of the colonoscope. To aid the process of emptying the bowel, one will be prescribed a laxative product to take as part of the colonoscopy prep. In some cases, enemas may also be prescribed.
Good to know: Many people pass clear, yellow liquid once they have finished passing waste. This yellow liquid which a person may pass is made up of digestive juices and does not indicate that the prep has been ineffective. However, if the person preparing for the colonoscopy is still passing liquid containing fecal matter, or brown, cloudy liquid, they should seek medical advice as they will need to take additional steps to clean their colorectal region before the screening can be performed.
Colonoscopy prep medications
Laxative medications help the stool to pass smoothly through the colon.
Before a colonoscopy, osmotic laxatives are most commonly prescribed. These work to empty the bowel by drawing the water from the large intestine into the stool in order to soften it, making it easier to pass. These are usually drunk dissolved in large amounts of water. Specific instructions for preparing the solution vary from brand to brand, and will found be on the packet of the product that has been prescribed.
Seek medical advice if there is any confusion about how to prepare the solution and when to take it. Because these medications work by keeping water in the bowel, it is important to drink enough liquid to stay hydrated. Drink water, or one of the recommended liquids, regularly throughout the colonoscopy prep plan.
Good to know: It is important, and not harmful, for a person preparing for a colonoscopy to drink the prep solution as planned, even if they already have diarrhea before starting to to take it. The prep solution is designed to ensure that any solid stool which may have formed higher up in the colon is passed before the scan.
How long should colonoscopy prep take to start working?
Most colonoscopy prep products start working two to three hours after they are taken, although the exact time-frame varies between medications. In some cases, if bowel movements do not begin to occur when expected, an extra dose may be needed. However, it is always advisable to follow the specific instructions that come with the product in relation to taking an extra dose and to consult with one’s medical provider in case of any doubts.
How to drink colonoscopy prep medications without throwing up
It is possible for drinking the solution to make one feel nauseous. Tips which may help a person to avoid nausea include:
- Sipping the solution slowly
- Taking breaks between sips
- Using a straw
- Cooling the liquid instead of drinking it at room temperature
If nausea is known to be a problem for the affected person in general, or has been experienced in a previous screening, anti-nausea medications may be recommended.
To avoid vomiting, it can also be helpful to leave longer intervals between drinks. If someone does vomit after consuming a dose of the solution during their colonoscopy prep, it is important to repeat the dose.
How to tell if colonoscopy prep has been effective: what to expect
Prep is complete when bowel movements become watery and clear. This means that the colon is empty of fecal matter and is ready to be viewed by the colonoscopy camera without obstructions. The length of time that it takes to reach this point will vary between people and will depend on factors, such as their overall gastrointestinal health, and how well the prep diet plan was followed.
Good to know: When bowel movements become clear enough to see the bottom of the toilet bowl, colonoscopy prep can be considered complete.
Seek medical attention if significant amounts of blood, or blood clots, are passed during colonoscopy prep. Colonoscopy prep may cause any hemorrhoids that are present to bleed slightly, as they might normally during a bowel movement. In all cases where bleeding appears to come from a source other than existing hemorrhoids, or is excessive, a medical opinion should be sought as soon as possible, and the bleeding should be mentioned before the procedure.
What to do if colonoscopy prep is not working
The purpose of colonoscopy prep is to remove all fecal matter from the bowel. If a person usually suffers from constipation or chronic constipation, they may need an extended prep period before their colonoscopy. It is helpful to discuss constipation issues with the doctor when planning a colonoscopy, so that the preparation time can be adjusted if needed.
An extended preparation period typically involves the use of enemas and doubling the colonoscopy prep time-frame. Prep will then involve a period of over three or four days of eating low-fiber food, followed by two days of consuming nutritious liquids and colonoscopy prep solution.
In some cases, following the specialized food intake plan and using laxatives are sufficient to empty the bowel. However, other people, particularly those who are suffering from constipation, may need additional assistance to empty the bowel before their colonoscopy. If the bowel is not fully empty following colonoscopy prep, an enema will be prescribed.
The type of enema which is incorporated into colonoscopy prep is called a cleansing enema. It involves injecting liquid into the bowel via the rectum. This helps the body to push out any remaining waste. The liquid which will be used is usually a water-based solution with a small concentration of stool softener. The volume of water stimulates the movement of the large intestine, which in turn stimulates the bowels to expel both the solution and any remaining fecal matter.
If the bowel is not completely cleansed following an enema, the process can be repeated one or two more times. It is possible to undergo an enema in hospital, or to purchase an enema kit to carry out this process at home. The doctor will identify the most suitable option for the individual undergoing the colonoscopy.
Preparing for a colonoscopy: travel plans
A person can undergo a colonoscopy as an outpatient in most cases, arriving at the clinic and returning home the same day.
However, people undergoing a colonoscopy are usually given sedatives to help them relax and to ensure that they are comfortable during the colonoscopy. In all cases where sedatives are used, it is advisable to arrange for a friend or family member to accompany the person having the colonoscopy to and from the hospital. This is because, in general, avoiding activities such as driving is recommended for a time after the use of sedatives. The timeframe of this period depends on the specific sedative used.
Colonoscopy preparation FAQs
Q: Can I take routine medications whilst I am following my colonoscopy prep plan?
A: In the run up to a colonoscopy, a person should take their routine medication as normal. On the day of the procedure, if it is scheduled for the morning, avoid taking any medication unless specified by medical personnel, with the exception of blood pressure, heart and seizure medication. If a colonoscopy is scheduled for the afternoon, a person may take their routine medication, other than medications that they were instructed to avoid.
Good to know: Pain medication that is part of the NSAID group, like ibuprofen or aspirin, has historically not been recommended for use for several days or even more than a week before screenings where an additional procedure that causes bleeding is scheduled, such as a biopsy or polypectomy. This is due to the perceived increased risk of postoperative bleeding.
However, some recent research suggests that there may not be a need to avoid all NSAIDs. The increased risk of bleeding needs to be examined by differentiating between the different types of NSAID medicine, as not all of them will increase the risk in all cases. NSAIDs should only be used on a doctor’s recommendation. They will recommend NSAIDs based on criteria including:
- Whether continuing or stopping medications that may already be in use will be better for the affected person
- The overall risk of bleeding complications during the procedure
- Whether the risk of bleeding complications will be increased by the particular painkiller used
- The risk of encountering a problem due to stopping the use of the painkiller, if used continuously.
Always follow a doctor’s recommendations closely before taking any medications, including NSAIDs, before a colonoscopy.
Q: What can I do to reduce feelings of hunger during my colonoscopy prep? A: It is normal to feel hungry whilst preparing for a colonoscopy, particularly in the liquid-only stage. It is important to follow the food intake plan in order to ensure that the prep is effective. Drinking sodas with a high sugar content can help to keep feelings of hunger at a minimum during this stage. Feelings of hunger are expected during this stage of prep and should not be a cause for concern; if hunger is excessively bothersome or results in feelings of pain, please consult the doctor.
Q: What do I do if colonoscopy prep medication makes me vomit?
A: If the laxative solution makes you feel nauseous, the best thing to do is to take a break from your intended dose schedule and leave a longer interval before taking the next dose. Missing a dose should be avoided, and it is therefore important to drink a replacement dose if vomiting occurs after drinking the solution. Other tips that may help reduce the likelihood of nausea and the risk of vomiting, and which are alternatives to drinking the solution straight, include:
- Drinking the prep solution in small sips
- Sucking hard candy or a chilled lemon slice in between sips
- Using a straw
- Chilling the prep solution and/or drinking cold water alongside it
- Discussing the use of a suitable anti-nausea medication with your healthcare provider, if nausea is expected
Q: Can a colonoscopy detect colon cancer?
A: Yes. A colonoscopy may be used as part of the screening process to detect colon cancer; a screening will be ordered for anybody at high risk of colon cancer or if it is suspected. When somebody is undergoing treatment for colon cancer, a colonoscopy may be scheduled periodically in order to monitor whether the treatment is effective. Feeling unwell? If you are concerned about the health of you or a loved one, get a free symptom assessment with the Ada app.
Q: Are polyps removed during a colonoscopy?
A: During the colonoscopy procedure, it is possible to remove most polyps that are detected, in their entirety. This process is called polypectomy and can be performed using a range of different techniques, including removing the polyps with the help of an electrical current or cutting them off with a wire. In most cases, a person can undergo polypectomy during their colonoscopy as an outpatient.
Q: How long do you poop after colonoscopy prep solution is taken?
A: Most colonoscopy prep solutions begin working two to three hours after they are consumed, although this varies between products. Another dose may be needed if bowel movements do not occur when expected. If bowel movements do not occur after an additional dose, consult your medical care team. An extended prep time may be needed, and the scan may need to be rescheduled if it is not possible to cleanse the colon in time.
Q: What are the colonoscopy prep guidelines for people with diabetes?
A: A person who is affected by diabetes and is due to undergo a colonoscopy will need to agree to a personalized colonoscopy prep plan with their doctor. In some cases, a person’s food intake plan and their normal dosing plan for taking insulin and other medications may need to be altered to accommodate colonoscopy prep. Their medical care team will work closely with them to ensure that their treatment regimen for diabetes is not disrupted in a way which could be harmful. People with diabetes who also have reduced kidney function will be prescribed a specialized laxative, rather than using generic colonoscopy prep products.
Q: How long does diarrhea last after colonoscopy prep?
A: For some people, diarrhea continues for a short amount of time after the procedure. A small amount of leakage may occur in the hours after the scan, and people may therefore be recommended to wear protective clothing and/or use fluid absorbing pads in their underwear during this time. A person’s food choices in the immediate period after their colonoscopy are believed to influence the likelihood of experiencing diarrhea; it is recommended to avoid fried food, and to opt for a healthy, solid meal.
Q: Is there such a thing as a colonoscopy bag?
A: Colonoscopy and colostomy sound similar, but they are different procedures, and there is no such thing as a colonoscopy bag.
A colonoscopy is a scan of the colorectal area, and does not involve a bag. In contrast, a colostomy, or bowel diversion, is a surgical procedure used to divert one end or a loop of the large intestine out through the wall of the abdomen or belly. An incision is made in the skin and through the abdominal wall to create an opening called a stoma, sometimes also known as an ostomy. Over this, a small pouch – known as a colostomy bag – is placed in order to collect excreted stool and other human waste.
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