Her eyebrows said, “Oh, boy!” Then, exit stage left.

Upon her return, my eyebrows popped up, “Oh, my!”  Exit stage right.

This scenario – sometimes in turns and sometimes in parallel – played out again and again over the following four to five hours. What’s going on here? Team colonoscopy prep of course! My idea for the world’s worst date.

And it is true what they say, “It’s not the colonoscopy that is bad; it’s the prep!” To quote my brother-in-law after his inaugural event, “a completely miserable experience.” But there are ways to make the process of preparation more bearable. First, some basics.

Colon cancer is largely preventable with proper screening and detection. Authorities, including the American Cancer Society, recommend adults with no family history of colorectal cancer should initiate regular screening at age 45 and repeat testing every ten years. Individuals with a family history should begin screening 10 years prior to the earliest age of detection by any immediate family member. The discovery during a screening of any colon polyps should prompt more frequent follow-ups, likely every two to three years.

There are three primary methods of colon cancer screening for early detection. One is stool sampling using a brand name product and process like, Cologuard. Two, an external imaging process that can help assess colon health and identify polyps with reasonable accuracy, which is called colonography. But, arguably the most effective approach to screening and detection is the almighty colonoscopy – quite simply, a camera up the bum. It allows for complete visual inspection and immediate removal of discovered polyps. Note: It produces the world’s worst home movie.  

A colonoscopy is the most thorough approach to colorectal cancer screening … and of course the most unpleasant, especially the preparation. What is the preparation you ask?  It is 1) fasting (i.e., no food) for over sixteen hours, 2) drinking way too much of a mixture designed to clean out your colon, and 3) having everything in your colon vacate, often explosively.

 What makes it horrible? Four things …

1.  The “goes in”:  Most of the prescribed preparations taste horrible and seemingly get worse with each glass. Some are equivalent to drinking four liters of soapy water.

2.  The “goes out”:  Frankly, a process hard to execute gracefully.

3.  If you get the timing wrong, the process duration can interfere with a much-needed night’s sleep

4.  If you “half-ass” the prep, let us say the doctor’s view is impaired and you may earn another try at obtaining a quality inspection.

What can make it better?  My top ten colonoscopy best practices! 

Having survived colon cancer at age 35 and navigated three decades of regular colonoscopy screenings, I share the following …

Tip #1:  Listen to the doctor or nurse’s pre-job brief carefully. Follow their instructions to the letter. Do ask what preparation alternatives are available. Some formulas are significantly more ingestible than others while maintaining the same cleansing effectiveness. Find one of our more preferred preparations here:  PicoPrep Powder for oral solution – NPS MedicineWise

Tip #2:  Schedule your procedure in the morning. Plan to complete your preparation the afternoon prior.

Tip #3:  Start early, say six to eight hours before bedtime. You want the process complete before trying to go to bed.

Tip #4:  Make formula ingestion more palatable with the following:

o Chill your solution.  

o Consider adding a flavored extract (e.g., raspberry) to the solution

o Take a deep breath, hold your nose, and drink each glass in one go.

o Consume doctor-approved chasers, which may include any clear juice.

o Set a timer to flag the time for the next prescribed glass.

Tip #5: Consume all of the preparation as directed. Drink ample amounts of allowed liquids, including water, green tea, white wine, and the very clearest of soup broths – sorry, no coffee.  

Tip #6:  Once begun, plan to stay put! No, you cannot pick up the dry-cleaning, drop off the kids, or walk the dog. Stay put! You have been warned.

Tip #7:  Set the stage, in your bathroom …

o  Cleaning supplies … plan to stay ahead with periodic efforts to stay neat and tidy

o  Some entertainment … lay out a favorite book, or maybe set up a podcast?

Caution: After long sitting sessions, your legs can fall asleep. Be cautious when standing.

Tip #8:  Think your process is over? Not so fast, consider going to bed with a towel or adult diaper in the event you are not quite right. Even if you are right, it is easier to sleep soundly without worrying about accidents. 

Tip #9:  Plan for a post colonoscopy pick-up or taxi. No driving post-sedation.

Tip #10: Plan for a relaxed afternoon and evening the following day. Spoil yourself.

 And if you are trying the couple’s therapy teased above …

 ·     Have two bathrooms, one designated for each participant.

·     Enjoy team member motivation, support, and empathy throughout the process.

·     Post-procedure, plan a gradual return to consumption. Preferably a plan that includes a gut microbiome-friendly menu and perhaps a probiotic.

Finally, there is a reward! If you do this right, you can find yourself post-procedure feeling thin, feeling well-rested, and feeling relaxed. Consider a nice dinner out at your favorite restaurant. Here’s hoping you can toast to a clean bill of health!