Colonoscopy Preparation: What to Expect

You will receive sedation during the procedure and cannot drive for 24 hours afterward. Arrange a responsible adult to drive you home and stay with you for 2-4 hours post-procedure. Plan to take the full day off work (both the prep day and the procedure day). Confirm the facility address, arrival time (typically 1-2 hours before the procedure), and any pre-registration requirements.

Stop blood thinners (aspirin, warfarin, clopidogrel) 5-7 days before as directed by your prescribing doctor. Stop iron supplements 5-7 days before (they make the colon harder to examine). Stop fiber supplements 3 days before. Continue blood pressure and heart medications unless specifically told to stop. Diabetes medications may need adjustment on prep day due to fasting. Your gastroenterologist provides a specific medication list.

Your doctor prescribes a bowel prep solution (MiraLAX with Gatorade, SUPREP, GoLYTELY, or similar). Fill the prescription early as some pharmacies need to order it. Buy clear liquids for prep day: chicken or beef broth (no noodles), apple juice, white grape juice, Jello (no red or purple), popsicles (no red or purple), sports drinks, black coffee, and tea. Avoid anything red, blue, or purple as it can be mistaken for blood during the procedure.

No solid food from midnight the night before prep day (or from the morning of prep day, per your instructions). Drink only clear liquids you can see through: broth, apple juice, clear sports drinks, Jello, popsicles, water, and black coffee or tea. No milk, cream, or orange juice. Drink plenty of fluids throughout the day to stay hydrated before the prep begins. You will feel hungry but it is only for one day.

Most preps use a split-dose approach: drink half the solution in the evening (typically starting at 5-6 PM) and the other half early the morning of the procedure (4-6 hours before your appointment). Drink each glass steadily over 10-15 minutes. Chilling the solution and drinking through a straw (followed by a sip of ginger ale) reduces the unpleasant taste. Stay near a bathroom as bowel movements begin within 30-60 minutes.

The prep causes watery diarrhea that clears your colon for examination. This is normal and expected. You will have 10-20 bowel movements over 3-6 hours. By the end, your stool should be clear or light yellow liquid (like urine). Apply petroleum jelly or diaper cream around the anus to prevent irritation from frequent wiping. Use moist wipes instead of dry toilet paper. Stay hydrated with clear liquids between bathroom trips.

You must stop drinking all liquids 2-4 hours before your procedure (check your specific instructions). A small sip of water with approved morning medications is usually permitted. An empty stomach is essential for safe sedation. If you do not complete the prep or if your stool is not running clear, call your doctor's office before the procedure. An incomplete prep may result in cancellation and rescheduling.

Arrive 1-2 hours before the scheduled procedure time. Bring your ID, insurance card, and a list of current medications. You will change into a hospital gown and have an IV placed for sedation and fluids. A nurse reviews your medical history, allergies, and prep experience. Your gastroenterologist visits to explain the procedure, discuss what they are looking for, and answer questions. The wait can be 30-60 minutes.

Most colonoscopies use moderate sedation (propofol or midazolam with fentanyl). You fall asleep quickly and wake up with no memory of the procedure. The doctor inserts a flexible tube with a camera (colonoscope) through the rectum and examines the entire colon. The procedure takes 20-45 minutes. If polyps are found, they are removed during the procedure (painless, you will not feel it). Air is pumped in to expand the colon for better visualization.

You wake up in a recovery area within 15-30 minutes. Some grogginess, bloating, and gas are normal. Your doctor provides preliminary results before you leave: whether they found polyps (number and appearance), any abnormal areas, and whether biopsies were taken. Biopsy results take 5-10 business days. If polyps were removed, your doctor discusses the follow-up colonoscopy schedule based on the findings.

Go home and rest. You may feel bloated and gassy for several hours (this is from the air pumped during the procedure, and walking helps pass the gas). Start with light, easily digestible foods: toast, soup, crackers, rice. Resume your normal diet by the next day. Avoid alcohol for 24 hours after sedation. You can return to work and normal activities the day after the procedure.

If polyps were removed, results typically come back in 5-10 business days. Your doctor's office calls or sends a message with the pathology report. Polyps are classified as hyperplastic (benign, no cancer risk), adenomatous (precancerous, most common), or sessile serrated (precancerous). The type, number, and size of polyps determine when your next colonoscopy is recommended (typically 3, 5, or 10 years).

If no polyps found: repeat in 10 years (for average-risk patients). If 1-2 small adenomas: repeat in 5-7 years. If 3+ adenomas or any advanced adenoma (over 10mm, villous features, or high-grade dysplasia): repeat in 3 years. If a large polyp was removed in pieces: repeat in 6-12 months to ensure complete removal. Family history of colon cancer may warrant more frequent screening regardless of findings. This guide is informational only, not medical advice.