PSC and IBD
Most people with PSC have a colonoscopy every year because they also have inflammatory bowel disease (IBD). Regular colonoscopies are important to check the health of the bowel. Many people report that the worst part isn’t the colonoscopy procedure itself but the bowel preparation (bowel prep).
The colon or bowel is part of your intestines, along which digested food and faeces (poop) travel. Bowel prep is a powerful laxative designed to completely empty your colon prior to a colonoscopy. It is important that the colon is empty so that the lining of the colon can be examined.
So what’s wrong with the bowel prep?
It can be difficult for some people (not all) to drink and it can cause nausea and bloating. Not everyone manages to drink the prep in full or keep it down, meaning the bowel prep isn’t as effective as it could be. This is a problem because the endoscopist needs a clear view of the lining of your colon during the colonoscopy. If they don’t get a clear view, the colonoscopy takes longer and may not be as thorough as examining a clean colon, meaning potential problems in your bowel might be missed.
How do you take yours?
Bowel prep instructions usually advise patients to mix the powder with plain water. Individuals who have a colonoscopy every year develop their own methods for drinking the prep, for example by adding flavour enhancers to make the prep easier to drink. Members of our PSC community gave us their tips and tricks. We’ve compiled the top 12 here.
But how good are these strategies?
Dr Keith Siau (University of Birmingham) and colleagues looked at the evidence.
Of 467 studies identified in published scientific research, six had sufficient and comparable detail to determine if taking bowel prep with something other than water alone, improves the patient experience of preparing for a colonoscopy.
Six different methods were compared versus water alone:
- citrus reticulata peel (citrus zest)
- orange juice
- menthol sweets
- simethicone (a treatment for wind/excess gas)
- Coke Zero
- sugar-free chewing gum
Criteria assessed:
- how it was to drink: palatability, taste and willingness to repeat
- side effects: nausea, vomiting and bloating, abdominal pain
- how well the bowel prep worked: quality of bowel cleanliness
What did the results show?
Overall, the results showed that taking bowel prep with something other than water, or alongside something to mask the flavour, was an effective way to improve the palatability and taste, and reduce some of the side effects (vomiting and bloating) associated with taking bowel preps.
There was no difference to the feeling of nausea or abdominal pain. Importantly, those people who drank bowel prep with something more flavoursome than plain water, the overall cleanliness of the bowel was superior and individuals reported they were more willing to repeat the bowel preparation in future.
Is it worth it?
If you are struggling to take your bowel prep in full, or cannot tolerate the side effects of a bowel prep, you may like to consider taking it with flavoured water, or with a mint or boiled sweet. It’s a personal preference and may involve a few different tries to find something which works for you.
By Dr Sarah Waterson and Martine Walmsley. Reviewed by Dr Keith Siau (@DrKeithSiau on Twitter) 27 January 2021
Reference
Kamran U, Abbasi A, Tahir I, Hodson J, Siau K. Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta-analysis. United European Gastroenterology Journal. 2020 Aug 24:2050640620953224.
Looking for more information about colonoscopies?
Take a look at our colonoscopy information for everything you need to know about having a colonoscopy.