Being a subject I’ve got rather more experience with than I’d like, I figured I’d do a bit of a writeup. And yeah, there’s TMI contained below.
- The prep.
They say the prep is the worst part, and truly they’re correct. Well, before my first, I dreaded the IV more than anything else, because I’m a tough person to stick: I’ve had it take 3 different people to get an IV started. This isn’t as much fun as you’d think it is, because of course you can’t get the happy juice until AFTER they stick the IV in. I think they need to figure out a way to fix this 
The prep comes in several basic varieties:
a) A gallon of nasty stuff.
b) A half gallon of nasty stuff
c) A small quantity of really nasty stuff
d) Pills that have a ‘black box’ warning about how you’re gonna trash your kidneys if you even THINK about taking them.
e) Adjuncts: Dulcolax (bisacodyl)
Doctors are used to just prescribing type ‘a’ without even thinking about it. I am reasonably certain that none of the doctors who do so have ever, in fact, had a colonoscopy themselves or they would not be prescribing this. These doctors are a) morons, b) willfully cruel, or c) think their patients are too stupid to follow instructions and drink adequate quantities of other fluids. In fairness, some patients are that stupid. You, however, are not one of them.
Some more progressive doctors prescribe category b. “See! You no longer have to drink 12 times as much liquid as anyone is capable of. Only 6 times as much! Isn’t that GREAT!!!”. These doctors are a) morons, b) willfully cruel, or c) can’t be bothered to think about alternatives and discuss them with the patients.
If your doctor prescribes either a or b, gently suggest[sup]1[/sup] that there might be alternatives. Some doctors will give instructions for using Gatorade and Miralax (the main active ingredient in the gallon-o-glurge products) instead of the prescription preps, which is (from what I’ve heard) a LOT more humane. My own doctor has a real blind spot about that, insisting that the prescription stuff is better for electrolytes and if I wanted to take the risk, he didn’t want to know about it. As it happens, the risk is minimal and a few minutes with a spreadsheet proves it - it’s trivially easy to make up the sodium and potassium with table salt and salt substitute.
Also, Gatorade: While they recommend it, they also say “any flavor you like as long as it’s one that tastes bad”. Meaning: no red/orange coloring. My doc is even stricter: no blue or purple. That leaves lemon, or lemon-lime. OK, they now make a clear fruit-punch version, but they didn’t before. There are alternatives that aren’t as good, electrolyte-wise (Propel Fitness Water for example), and Gatorade actually had a couple of versions that were clear and had their full load of electrolytes.
But the bottom line is, either drink the bad Gatorade, or make your own and don’t tell 'em. Even bad Gatorade is better than the prescription stuff, from what I’ve heard.
Option c: There’s a prep called SuPrep which is Sodium Sulfate (I think). One of the gallon-o-glurge versions advertises itself as “just like the other one but without the sodium sulfate that makes that one so nasty”. Yes, it’s like pure distilled evil, only less of it. I believe this is what a friend wound up with when the gallon-o-glurge proved intolerable. My doctor offered that as an alternative this last time around, he mentioned it makes some people throw up and I could have some Zofran (antinausea med) if needed. Then he mentioned that a picosulfate prep had just been approved in the US - they’ve had it in Canada for years. So I opted for that as I’d heard good things about it. That also falls in the option c category. I drank a 5-ounce cup of it for each session. As I told DH, “tastes like really bad lemonade”, but cut with sips of fancy no-artificial-color orange soda, it was pretty tolerable.
Option d: Osmo-Prep pills. This is sodium phosphate; used to be available as a liquid (Fleet’s phospho-soda) but it’s been discontinued. Can trash your kidneys especially if you get dehydrated or are otherwise at risk. I did that the first 4 times - flat out told the doctor I didn’t think I could tolerate the gallon-o-glurge stuff. I didn’t know about the SuPrep stuff, and picosulfate (Prepopik in the US) was not yet available here. Tolerable, though you have to down 4 gi-fucking-NORMOUS pills with 8 ounces of gatorade (or your own substitute) every 15 minutes for an hour.
Option e: Some of the preps have you take 2 Dulcolax tablets the night before the day-of-all-liquids.
(i) Translation: Offer a glare of utter incredulous contempt and ask “are you out of your FUCKING MIND???”.
- My experience with the preps:
First off, you’ll generally be given a “split dose” prep: half the evening before, and half the morning of the procedure. Consider this when scheduling the procedure because if you’re to go in for a 9 AM procedure, you’ve got to get up at 3-4 AM to do the second dose!! It’s proven to give much better results than doing everything the night before, so it’s worth doing the split-dose version.
I’ve never used the large-volume preps. Told the doc right out that I didn’t think I could tolerate them, and I’ve heard horror stories about them. The possible advantage is that depending on your instructions, you MAY be able to stop drinking before you’ve downed the whole amount.
The pill-based prep is not fun because you have to drink a lot of liquid in a short time. And for me, it takes an hour or more after the last dose before “things start to happen”, and I’ve found that with every procedure, it’s taken a lot longer for my body to give up and say it’s done for the evening.
The picosulfate prep: I drank it at 6:30 - and it was 3+ hours before it did anything, which was annoying. On the plus side, it was less of a RUN NOW!!! when I did need to make a bathroom run. That extra half-second of warning is very useful. On the really annoying side: the first dose never DID give up - I was up every hour or so during the night, which hadn’t been an issue with the pill prep. Anyway, as a result, I decided to get up and take the morning dose at 6 AM vs. 8 AM. To be contrary: that one kicked in within an hour, and I was done by 10:30.
I think I’m an outlier on all of these, however; I get the impression that things work faster for most people, and don’t linger afterward for most people. But next time around, I’ll take the “evening before” dose at noon, not 6 PM!
- Survival tips
There are the standard ones: lots of stuff to read in the bathroom, wet wipes vs. toilet paper, TV in the bathroom if feasible. To this I add:
- A padded toilet seat is nice.
- Make sure that bathroom is YOURS for the duration. If your spouse asks if he can use it long enough for a quick shower, gently suggest[sup]1[/sup] that he may wish to use a different bathroom.
- Elastic-waist pants are your friend. My husband was dressed in his normal clothing - button-waist pants and belt - when I spotted this and suggested he change. He was grateful, later.
- Do not - repeat, DO NOT - put the toilet lid down. That split second can be… disastrous.
- Broth: Go to the nearest Vietnamese noodle shop or other place that might have good broth, and purchase several quarts of broth to take home. It’s a LOT better than Campbell’s or Swanson’s, and it’s a good alternative to sweet drinks. Also, you may get chilled doing the prep and the warmth is good. In addition, the warm liquid in your stomach can help stimulate the gut and get things moving along.
- Make sure you’re never more than a few steps away from the bathroom. I’ve found that my body won’t do a damn thing until I leave the bathroom, then it says “haha, time to go back in there NOW”.
- Jell-o: As with Gatorade: any flavor you like as long as it tastes bad. This because of the restriction on the colors. Most docs don’t care about blue/purple, mine does. So it’s lemon (meh), or lime (gag), or if you’re feeling extra frisky, lemon-lime!! (see previous) Sometimes you can find melon flavor, pineapple can be had from online vendors, and this last time around I found some Jolly Rancher green apple which wasn’t bad. And you can make Knox Blox with unflavored gelatine and juice. In all cases I did the “jello jigglers” version - gives you something to chew.
- You are generally asked to follow a low-fiber diet for 2 or so days before the “clear-liquids” day. If you find that this makes things unpleasant, gut-wise, you can add some Miralax to the mix. If you recall that the low-fiber instructions say “no fiber supplements”, this doesn’t count since it’s just a bit of what is in the prep anyway!
- Consider bringing spare underwear when you go for the procedure. Depending on whether your body is done, you may need to make a sudden dash, and you may not quite make it :(. And if there’s no toilet paper in the bathroom you can get to from the waiting room, don’t be polite about it like I was. Stand in the middle of the waiting room and yell about it if you have to (I wish I’d done that). Seriously, that bathroom is always low to empty, which is just brainless on their part. Egad. I was eyeing the box of copy-machine paper they had outside the bathroom, wondering if I could make that work in an emergency.
- Afterwards: Sometimes the gut’s first reaction to its first warm meal is to go ‘YAY! WAKE-UP TIME!!’. This has, annoyingly, been the case for me the past few times (including for hours afterward, this last time). Sigh. Avoid eating at a restaurant on the way home from the procedure. Just trust me on that.
- If you use a CPAP, consider taking the night off before the prep. If your gut is misbehavin’, you don’t want to risk any delays.
- If you use the Prepopik prep, fill the scrip a week or so in advance. Maybe things are different elsewhere, but NOBODY around here carries the stuff in stock and it had to be pre-ordered. Bizarro. I guess most doctors around here haven’t figured out that they’re stupid and cruel. Thankfully, my doc had actually warned me that there was a lead time involved.
- Scheduling.
a) If you’ve been putting it off,
QUIT BEING A WUSS AND GET THE DAMN THING DONE ALREADY, YA PANSY-ASS CHICKEN!!!
b) Seriously. Just do it. We have a friend who postponed his a couple of years - which gave him time to develop cancer and lose 12 inches of his colon in a reasonably unpleasant hospital experience. I’m thankful that I had the stomach issue that led me to going in when I did, otherwise I might not have bothered (and my internist wasn’t too fussy about pushing for them at age 50).