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How to Improve Your Patients Bowel Prep Scores

About 20-40% of all colonoscopies have inadequate bowel prep. How do we prevent this from happening again to the same patient? There is very little research to guide us. Take these steps to prevent a 2nd poor prep.

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Solutions to Inadequate Bowel Prep

Research has identified predictors of inadequate bowel preparation. Some of these predictors or risk factors are modifiable. The table below describes risk factors for inadequate bowel preparation and potential strategies to mitigate them.

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Predictors of Inadequate Bowel Prep

Multiple studies have examined the predictors of inadequate bowel preparation. These predictors or risk factors can be classified as medical factors and non-medical factors; patient-related and non-patient related; modifiable and non-modifiable. The table shows the predictors classified as medical factors and non-medical factors.

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Effect of Inadequate Bowel Prep on Quality

Inadequate bowel preparation can lead to reduced adenoma detection rate (ability to detect and remove polyps), and reduced cecal intubation rate (colonoscopy completion rates). It can increase withdrawal time because more time is spent cleaning the colon. It exposes the patient to more risk of complications. This table shows the effect of inadequate bowel preparation on other quality measures in colonoscopy.

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Types of Bowel Prep Agents

There are a number of bowel preparation agents available on the market. This table provides a list of agents that are FDA approved, those are not approved, and those that contain adjuncts (supplements).

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Split Dosages for Bowel Preparation Agents

The split-dose regimen has been shown in multiple studies to be better than night before dosing for morning colonoscopies. This strategy is associated with increased patient’s acceptance, tolerability and compliance. It leads to better bowel preparation scales. Almost all bowel preparation agent or purgative can be split-dosed. This table shows the different bowel prep agents, main ingredients, the evening before the colonoscopy dose, the morning of the colonoscopy dose, and the total volume.

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Bowel Preparation Scales

Bowel preparation scales are designed to rate the quality of bowel preparation during colonoscopy. The adequacy of bowel preparation during colonoscopy should be assessed and documented routinely.

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Bowel Prep for Small Bowel Capsule Endoscopy

The most important aspect of a good small bowel exam with capsule endoscopy is a clean small bowel.  If there is dark fluid or debris left behind after bowel prep for a colonoscopy we can usually wash and suction it clean during your procedure.

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Bowel Preparation Poem

Tis the week before colonoscopy

It’s time to pick up my meds and wipes

Avoid iron pills, fiber, imodium, lomotil, plavix and warfarin.

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Multi-Society Guidelines on Bowel Cleansing for Colonoscopy

A link is provided here for these guidelines.

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The Cost of Inadequate Bowel Preparation

Informative video on the cost of inadequate bowel preparation.

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1st Annual SCOPY award

We Won! 1st Annual SCOPY Awards

BowelPrepGuide.com wins the 1st SCOPY award for Best Patient Education Brochure, Flyer or Website
Bowel Prep shopping list
Example of a poor bowel prep

Poor Bowel Preparation

This is an example of a poor bowel preparation.
Example of a Fair Bowel Prep

Fair Bowel Preparation

This is an example of a fair bowel preparation.

Good Bowel Preparation

Example of a good bowel preparation.
Excellent Bowel Prep example

Excellent Bowel Preparation

Example of an excellent bowel prep.
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Colon Polyp

Colon Polyp

Colon Cancer

Colon Cancer

10 Tips for Making Colonoscopy Preparation More Tolerable

No one is excited about getting a colonoscopy. The most unpleasant aspect of colonoscopy is bowel preparation. The actual procedure is often quick and painless. Here are 10 tips for making your next colonoscopy more tolerable.

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30 Myths about Bowel Preparation, Colonoscopy, and Colorectal Cancer

There are several myths about bowel preparation, colonoscopy, and colorectal cancer. Here are 30 myths and facts about bowel preparation, colonoscopy, and colorectal cancer.

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10 Reasons to Get Screened for Colorectal Cancer

Screening rates for colorectal cancer remain relatively low. According to 2010 data from the Centers for Disease Control (CDC), colorectal cancer screening rate was 58.6% compared to 72.4% for breast cancer, and 83.0% for cervical cancer.

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 My Colonoscopy is Tomorrow. What Should I Expect?

Colonoscopy is a procedure that utilizes a flexible tube with light and camera at the end (endoscope or colonoscope) to look at the inner lining of a person’s large intestine (colon) through a video monitor. Colonoscopy may be recommended for the following reasons:

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 How to Increase the Tolerability of  Bowel Prep Agents

Bowel preparation agents often taste bad. To improve taste, the following have been suggested:

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Adverse Effects of Bowel Preparation Agents and How to Handle Them

The most unpleasant thing about bowel preparation is the taste of the bowel prep agents. Adverse events are generally rare except for the intended effect-diarrhea. The table in this article lists possible adverse events, frequency of occurrence and what to do if they occur.

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Diet and Bowel Prep

Most providers recommend a clear liquid diet a day before your colonoscopy. A low fiber diet is often allowable for breakfast and lunch a day before your colonoscopy in some patients and as long as you follow the split-dose instructions. You still have to be on a clear liquid diet for dinner.

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Medications to Discuss with your provider

Listed here are some medications that you need to discuss with your provider one week before your scheduled colonoscopy. Some of these medications may need to be stopped or their dosages adjusted prior to your colonoscopy and during your bowel preparation.

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How to tell if your bowel is clean prior to your colonoscopy

Your last rectal effluent (stool after finishing your bowel prep agent) can act as a guide. Your stool should be clear, yellow, light and liquid. The presence of dark particles or thick brown or black stool means you are not ready for colonoscopy.

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Bowel Preparation Poem

Tis the week before colonoscopy

It’s time to pick up my meds and wipes

Avoid iron pills, fiber, imodium, lomotil, plavix and warfarin.

Read more…

10 Signs and Symptoms of Colorectal Cancer

Colorectal cancer is the 2nd leading cause of cancer deaths in the United States. Colorectal cancer is preventable. Listed here are the 10 signs and symptoms of colorectal cancer. The list is not exhaustive.

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