Colonoscopy Tips for First-Timers with IBD

The prep is often considered the worst part of the experience. But when you know what to expect, you can make it a bit less unpleasant.

If you feel intimidated or nervous about your upcoming colonoscopy, you’re not alone. Whether it’s your first scope or you’ve had many, it’s normal to dread the preparation and procedure.

It can feel especially daunting if the procedure is intended to diagnose uncomfortable new symptoms such as diarrhea, stomach pain, or blood in the stool — or if you already have inflammatory bowel disease (IBD) and are in a flare.

Jitters aside, a colonoscopy is considered low risk and safe for people with IBD.

Yes, there will be discomfort that comes along with the bowel-cleansing prep, but the procedure itself is relatively easy and pain-free. Read on for information and helpful tips to calm your nerves, ease the process of getting ready, and even make the bowel prep more comfortable!

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What is a colonoscopy?

A colonoscopy (sometimes called lower GI endoscopy) is a procedure that allows a gastroenterologist to evaluate the insides of the large intestine (colon, rectum, anus) and the end of the small intestine (terminal ileum).

During the procedure, the doctor inserts a colonoscope, a flexible tube-like device equipped with a light and high-definition camera, through the anus to visualize the lining or mucosa of the lower intestines.

The doctor uses the colonoscope to view any areas of concern, take pictures, and perform biopsies if necessary.

It’s a relatively short procedure, usually lasting anywhere from 30–60 minutes, and is performed with sedation. You won’t feel a thing!

Why is it important for people with IBD?

A colonoscopy is extremely valuable for evaluating both new and existing IBD. It allows the doctor to see how badly your intestines are inflamed. They can also note the exact locations of disease and take biopsies to confirm a suspected diagnosis or change in disease.

When performing a colonoscopy, your GI doctor will note any abnormalities like redness, ulcers, masses, strictures, or other changes to the appearance of the bowel lining.

However, even in the absence of obvious abnormalities, biopsies of the colon lining can help determine if there’s any inflammation or disease.

“In people with suspected IBD, colonoscopy allows biopsies, which are very important in establishing a firm diagnosis. Biopsies help differentiate between ulcerative colitis, Crohn’s disease, and indeterminate colitis,” says Dr. Scott Yagel, a board certified gastroenterologist in Chesapeake, Virginia.

In people with existing IBD, biopsies are also very important for evaluating disease progression and remission. If a medication doesn’t seem to be working, a colonoscopy can help the doctor clarify a diagnosis or see if the disease has progressed. This can help inform treatment decisions.

A colonoscopy can also confirm remission. When you feel well, you’re considered to be in clinical remission, but you can still have inflammation in your intestines.

“Research suggests that we should do a repeat colonoscopy to establish what’s called endoscopic or mucosal remission. This is different from clinical remission when symptoms such as pain, diarrhea, and bleeding improve,” explains Yagel.

Endoscopic remission means that there’s no visible inflammation in the lining of the intestines. It’s ultimately the goal of treatment and shows how well treatment is working.

How frequently should you have a colonoscopy?

After your initial, or diagnostic colonoscopy, the time frame for doing a repeat colonoscopy is at the discretion of your doctor. The frequency will depend on the information your doctor needs to make treatment decisions or establish remission. Your doctor will recommend a colonoscopy as needed.

Once someone has had IBD for 8–10 years, their risk of colon cancer increases. At this point, regular screening colonoscopies are recommended every 1–5 years, depending on individual risk factors like severity of disease and family history of colon cancer.

Most people who’ve had IBD for 8–10 years will need a screening colonoscopy every 1–3 years.

These recommendations for colon cancer screening in people with IBD are different from the general population.

“The standard population is screened for polyps that can develop into cancer over several years,” Yagel says. “In the IBD population, cancer can develop in the flat mucosa, or lining of the intestines, not necessarily polyps. The flat mucosa can go through a process called dysplasia, a medical term for abnormal or precancerous cells. Dysplasia can turn into cancer without there being a polyp or a mass.”

Since people who’ve had IBD for over 8 years are at risk for developing dysplasia, regular colonoscopies are especially important in preventing colon cancer.

What preparation is required for a colonoscopy?

The FDA has approved a variety of laxative preparations for colonoscopy. The newer liquid and pill preps are much easier to take than the older large-volume ones. You should expect to have a discussion with your GI doctor about what kind of prep you’ll tolerate most easily.

The most common and inexpensive preps are liquid polymer-based formulas. They contain polyethylene glycol (PEG), which cannot be absorbed by the bowels. The solution works by pulling fluid into the bowels as it passes through. Some versions contain lower volumes of fluid for people who have trouble downing the solution.

The pill or tablet formulas are saline-based laxatives with the main ingredient being sodium phosphate or sodium sulfate.

Saline-based preps are essentially concentrated electrolytes that also draw fluid into the bowels. They’re usually prescribed as a series of pills, so expect to take upward of 24 pills.

These newer pill preps may have some out-of-pocket costs, so if budget is an issue, be sure to discuss that with your doctor. Together, you can decide which laxative prep will work best for you.

Your prep will come with detailed instructions. These instructions will include dietary changes that you may need to begin up to a week before your appointment, as well as directions on how and when to take the prep.

Most preps have doses spaced apart, sometimes within the same day and sometimes split between evening and early the next morning. Follow the directions carefully, and remember that the goal of the prep is for your stool to become liquid.

The prep typically starts working within 1–3 hours. You can expect frequent bathroom trips. Toward the end of the prep, your stool should look watery and slightly yellow.

Tips to make your colonoscopy preparation easier

Since the prep is the most uncomfortable part of getting a colonoscopy, here are some tips to make it easier — and maybe even not that bad at all.

• Eat lightly in the days leading up to your prep: Avoid heavy or greasy foods and large meals for at least a day or 2 before your prep. Having less food in your gut means less has to come out during the bowel prep.
• Eat a low residue diet: At least 1 day before you’re required to begin a clear liquid diet, eat a low residue diet. This means no fibrous foods such as seeds, skins, beans, whole grains, uncooked vegetables, or raw nuts. These foods can stick to your bowels and make it harder for your doctor to view your intestines.
  • Low residue foods include: soft meats, creamy nut butters, eggs, tofu, peeled and cooked vegetables such as carrots and potatoes, canned or cooked fruit without skin or seeds, broth or cream-based soup, dairy products, white rice, white bread, and plain crackers.
• Add a supplemental drink: If your doctor approves, you can drink something like Boost or Ensure, to help you feel fuller on the day you’re allowed clear liquids only. Clear liquids include beverages such as tea or coffee without milk, soda, apple or white grape juice, electrolyte drinks, popsicles or Italian ice (without pulp or pieces of fruit), and Jello. Be sure that none of these are red or purple because red coloring can resemble blood in the colon.
• Pop it in the fridge: If taking a liquid prep, chill the liquid part of the prep in the fridge before drinking. This will make it more palatable. You can also use a straw to drink your prep. It will go down a little easier if you don’t like the taste.
• Pace yourself: Don’t drink the liquid solution or take the pills all at once. For example, drink a cup of solution every 15 minutes or take a smaller number of pills every 30 minutes (or as directed by your doctor) to help prevent nausea. If you’re prone to nausea, ask your doctor in advance about instructions for spacing out your prep and ask about having nausea medication on hand. You can also try peppermint or ginger tea, ginger ale, seltzer, or an allowed popsicle or Italian ice to calm any nausea.
• Stay hydrated before and during your prep: The prep works by pulling water into the bowels, which can cause dehydration. The more hydrated you are, the better you’ll feel through the process. Choose allowed beverages from your prep instructions.
• Get comfy: Wear comfortable clothing with an elastic waist to make it easier to get in and out of the bathroom. If you’re concerned about accidents, you can wear a pad or disposable underwear. You can even keep some entertainment you enjoy — like a book, tablet, video game, or TV show — close to or in the bathroom. You’ll be spending some time there so you might as well enjoy it!
• Prep your bottom: Once you start taking the prep, pre-treat your bottom with a barrier cream to prevent soreness. You can use petroleum jelly, diaper cream, or hemorrhoid ointment.
• Blot, don’t wipe: Once your bathroom trips begin, gently blot your bottom using soft toilet paper or baby wipes so it doesn’t get irritated. Better yet, use a squeeze bottle or portable bidet-type product (it’s a thing, just Google it).

Note: If you have unbearable nausea or if you vomit, stop the prep and call your doctor or on-call provider. The doctor can advise a change that will work for your body.

General tips for a stress-free colonoscopy

• Schedule smart: When scheduling your appointment, consider what time of day you prefer. Early morning appointments may have quicker wait times and you won’t have to go hungry for as long. Afternoon appointments may help you get a better night’s sleep before your procedure, as morning appointments may require you to take your prep late in the evening or in the early morning hours. An afternoon appointment may only require you to take the prep that morning.
• Make time: Clear your schedule for the time when you’ll be taking the prep and for the whole day of your colonoscopy. Since you’ll be sedated during the procedure, you should not work, drive, or be responsible for child care or home life afterward. Plan support so you can truly take the day off.
• Ask for help: Ask a friend or family member to provide transportation (remember, no driving) and stay with you during the procedure. Most providers will require you to do this in advance.
• Check in about meds: Check with your provider about whether you should take your usual medications before the procedure.
• Stock up! Have on hand everything you may need for the day of your prep. This includes things like liquid foods, straws, wipes, cream, and disposable underwear. You don’t want to even think about leaving the house once that prep starts working!
• Take it easy with food afterward: Treat yourself to a nice meal after the procedure; just don’t eat anything especially heavy because your gut may be gassy and crampy from the procedure.
• Rest, relax, and enjoy your day after the procedure! You’ll have done all the prep work and breezed through a nice nap during your procedure — you deserve a day to recover.

The takeaway

For people with IBD, getting a colonoscopy is extremely valuable to your diagnosis, treatment, and cancer prevention. Know that you have choices on what prep will work best for you and that you can minimize discomfort during the preparation and be prepared for a smooth procedure.