Bowel Prep: What You Need To Know

What Is Bowel Prep?

Bowel preparation, commonly known as "bowel prep", is the process of removing all feces from the colon in order to have a medical or surgical procedure such as a colonoscopy.

It is important to clean the colon of all stool, food particles and anything else that may be present for several reasons. If you are having surgery on or near the colon, having stool present is a risk for infection and can get in the way of some procedures. Imagine putting a camera in a mud puddle and trying to take a picture.  You wouldn't see a thing.  The same is true when you are trying to see the inside of the colon during a colonoscopy--only a clean colon can be truly examined for the presence of polyps.

In the case of a colonoscopy, stool in the colon can prevent the surgeon from seeing the tissue that is being inspected and would make it very difficult to introduce the lighted scope into the rectum and colon. Imagine a plumber trying to clean a clogged pipe in your home and compare that to a pipe that is completely clean and clear, and you will understand why your doctor wants your colon as clean as possible.

A full colon can make it difficult to operate upon adjacent tissues, such as the uterus. Think of the colon as a balloon taking up room in an already tight space. An empty colon, like a deflated balloon, takes up far less room and gives a surgeon far more room to work.

There are times when a bowel prep is done purely to prevent potential complications from surgery. For example, if your bowel was nicked during surgery, the infection risk would be dramatically decreased if the bowel was empty.

For your own safety, and to have the best possible outcome from your procedure, it is imperative that you follow your bowel prep instructions to the letter.

How to Do Bowel Prep

Bowel prep procedures vary between doctors and between procedures. The bowel prep for someone who is having a colon surgery might be very different from someone who is having a colonoscopy.

Follow your doctor's instructions carefully, and err on the side of caution when you are in doubt. The goal is to have your digestive tract clear of all fecal material, food and anything else that may be present. If you are unable to do this, or if you do not follow the instructions, your procedure may be delayed or canceled.

Your bowel prep may consist of one step or several, depending on your physician's wishes. Most patients are required to drink a large amount of medicated fluid such as Go-Lytely, which will stimulate their digestive tract and cause copious diarrhea-like bowel movements. Some patients may have a large number of pills to take, rather than the solution. Other patients rely upon enemas to complete the bowel prep.

In rare cases, pills, fluid, ​and enemas will all be used, but one or two of these is typical.  Your doctor may also prescribe an anti-nausea medication such as Reglan, which also increases the speed at which your prep works.

If you normally take medications in the morning, do not take them without first consulting your physician. You may be asked to skip your medications for the day, or to take them after your procedure is complete.

You may also be given special instructions if you are taking a blood thinner, as these can increase bleeding during surgery and other procedures.  If you are taking a blood thinner be sure to let the provider who ordered the bowel preparation know.

What Not to Do Before and During Bowel Prep

You may be given detailed instructions for your bowel prep prior to your procedure. These typically include the time when you must stop eating, and when you should begin your bowel prep.

Resist the temptation to have a heavy meal as your last meal. Many people eat a large last meal as though they will never have the opportunity to eat again.  Remember, you will basically be cleansing your digestive tract of everything you have eaten in the last few days, so adding a large amount of food immediately before your bowel cleanse will just make it take longer.

Do not eat solid foods. Your doctor may allow you to have clear liquids during your bowel prep and after, but that only includes foods that are liquid and clear at room temperature. You may not have Jello or other soft foods unless specifically instructed by your doctor.

Do not stop your bowel prep without informing your doctor. An incomplete or inadequate bowel prep, typically caused by not following the instructions carefully and completely, can increase the length of your procedure.  Your doctor will know if you don't complete your bowel prep, whether you tell them or not, because they will be able to see the stool that remains in your colon.

In some cases, if you fail to complete your bowel prep properly and your procedure is canceled, you may be liable for the cost.

• If you are on a low-sodium diet, or must avoid sodium, be sure to mention this to your physician. Some bowel prep solutions contain significant amounts of salt.
• If you are diabetic, be sure that your physician is aware of this. Going for extended periods of time without food may cause issues, so be sure to have a plan in place for low blood sugar.  If you are on a clear liquid diet you may want to have a fluid with calories available, such as Sprite, in case your blood sugar level gets too low.
• Even though you may be drinking a large volume of bowel prep solution, you still need to take in fluids as you normally would. Water is ideal, but clear liquids (preferably not carbonated) are acceptable.  If you begin to feel lightheaded or dizzy, you may be dehydrated.  Add water to your fluid intake right away.
• Avoid high-residue foods and fiber supplements in the days before your procedure. Corn and nuts are examples of a high-residue food, which often is visibly unchanged when it is expelled from the body.  A low residue diet is beneficial in the day or two prior to a bowel cleanse. 
• Keep your bowel prep solution cold, if possible; this can reduce how much you taste it. You may also want to drink it through a straw.
• You may experience urgency, and need to get to the bathroom very quickly. If you are not able to move quickly or need assistance to get to the restroom, plan to stay close to the bathroom. If you decide to sleep during bowel prep, be aware that you may have difficulty waking and moving to the bathroom quickly enough to avoid accidents.
• Consider purchasing high-quality (very soft) toilet paper for your bowel prep. You will be going to the bathroom frequently, and soreness may develop if you use a harsh paper.
• Consider purchasing wet wipes for your bowel prep to use instead of toilet paper. They are gentler and may prevent irritation when wiping frequently is necessary. 
• Get comfortable and wear clothes that can easily be removed, such as pajama pants or a nightgown. You will be spending a lot of time going to the bathroom, and you may just get to the point where you just stay on the toilet instead of getting up and going every few minutes.
• Consider applying a barrier ointment, such as those used for diaper rash, to the anal area before starting the prep and reapplying as needed.  This will protect the delicate tissues in the area from irritation when you start having multiple bowel movements in a short period of time.
• Dress warmly. You will be spending a great deal of time in the bathroom on a cold toilet seat, partially undressed. Do your best to make sure you aren't cold along with everything else that is going on. Some people wrap themselves in a blanket.
• If you are given a solution that you must drink, consider flavoring it to make it more palatable. Crystal Light and Kool Aid are common choices. You may not want to use something that you enjoy on a regular basis, such as your favorite lemonade mix, as it may no longer be appealing after bowel prep.
• If you are feeling lightheaded during your bowel prep, slow your intake of the bowel prep solution. Also, try to push/bear down less, as this can cause a feeling of lightheadedness.  Increase your water intake in case the feeling is being caused by dehydration.
• It is possible for the bowel prep process to remove some of the normal flora of your intestines. This can make it more difficult to digest food, or just make your system feel "off" in the days following your procedure. Adding yogurt with active cultures to your diet as soon as soft foods are permitted can help with this issue.
• If you have followed instructions and completed your prep but the solution is coming out cloudy or you still have stool coming out, call the provider's office for further instruction.  Cloudy solution indicates that the prep has not been completely effective and you may need additional solution or medications.

Risks of Bowel Prep

In general, bowel prep is very safe, and most patients have no true medical problems with the procedure. The vast majority of bowel prep patients do, however, have a great deal of discomfort during the process as they typically use the bathroom well over multiple times per hour during the course of the prep.

Many patients say that the bowel prep is worse than the actual procedure the prep is done for, as you are asleep or sedated for a colonoscopy or surgery.

Common Side Effects of Bowel Prep

(May be present in up to half of all patients doing bowel prep)

• Cramping
• Nausea
• Feeling of Fullness
• Fecal Incontinence
• Changes in Taste
• Vomiting
• Sweating
• Diarrhea (expected result of bowel prep)

Rare Side Effects of Bowel Prep

• Seizure
• Shortness of Breath
• Facial Redness
• Chest Pain
• Heart Palpitations
• Muscle Weakness
• Acute Renal Failure (Kidney Failure)

Any of these signs/symptoms should be reported to your doctor immediately.

Dehydration During Bowel Prep

Dehydration is common when doing a bowel prep if you are not taking in adequate fluids during the process. While you may be required to drink up to 8 ounces of bowel prep solution every ten minutes, if you aren't taking in water in addition to the solution, you could become dehydrated.

The best way to monitor your hydration status is to look at the color of your urine.  Dark urine indicates a need for more fluid while clear and nearly colorless urine indicates adequate hydration. If your urine is darkening during the preparation process, add a few glasses of water before you continue to drink the prep solution.

Adding water to your prep will not only improve your hydration, but will help prevent any harm to your kidneys during the process.  While this complication is rare, it is always better to prevent harm than to treat it.

Signs of dehydration include:

• Dizziness
• Decreased Urination
• Headache
• Stomach Cramps
• Rapid Heart Beat

A Few Words From Verywell

A bowel prep is not particularly pleasant, but it is done for a good reason: to improve the outcome of your procedure.  It may be tempting to fake it, or to not complete the process, but if you choose to do that you are 1) dramatically decreasing your safety during surgery or 2) decreasing the effectiveness of your colonoscopy--which is done to prevent or diagnose cancer.   So as hard as it may be, do your colon preparation to the best of your ability, and complete it as directed.  You can stop when the drink starts coming out looking exactly like it went in--not cloudy--and your colon prep is officially complete.