DETROIT – Let’s be honest: no one wants to have a colonoscopy, but it is not only recommended; it can also be life-saving.
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One of the biggest problems with a colonoscopy is that it is simply inconvenient. You have to schedule the procedure in advance, arrange for a ride to and from the procedure (which requires the help of a friend or family member), rearrange your eating schedule, and, for many, the biggest dealbreaker is that you have to “prep your bowels.”
The last part, doing the prep, doesn’t sound like a big deal, but I assure you there is nothing fun about it. Let me explain: the purpose of the prep is to rinse out your colon to remove any food debris or stool that would obscure the view of your insides when the doctor looks through the colonoscope. Rinsing out your colon basically means that lots of fluid has to run through it, which results in diarrhea. Many people find that alone to be a near dealbreaker. Unfortunately, for anyone who finds watery stool a problem, I have to break the bad news that it is just a part of the process.
Outside of that, many people find the prep itself unpleasant for a variety of reasons. There is the issue of taste, the volume of the solution you have to drink, and the unpleasant side effects some people experience. Fortunately, colonoscopy prep has come a long way over the years, and there are now alternatives to the traditional prep.
Let’s start with the traditional prep that most people have heard of. It involves drinking a large volume of something called GoLYTELY, with or without MiraLAX. We joke in medicine that GoLYTELY is anything but “going lightly,” since its purpose is to have you go quite a bit. GoLYTELY and MiraLAX are not exactly the same, but they both contain the same major active ingredient: polyethylene glycol 3350. Because the polyethylene glycol and a variety of mineral salts (electrolytes) in the formulation are not absorbed by your intestines, they retain water in your intestines through osmosis. By retaining water in your colon, they create a liquid stool that effectively rinses you out from the inside.
If you are using the traditional GoLYTELY preparation, there are a few good tips to make drinking it a little easier. First, make sure it is chilled. You can put the 4-liter jug in the refrigerator to cool it down. You can also flavor it with something like Crystal Light (just make sure it’s not colored red or purple) to make it more palatable. Some people find that drinking it through a straw helps because it allows most of the fluid to bypass your tongue if you find the taste or texture difficult to tolerate. Depending on your doctor’s instructions, you will either have to drink the four liters all at once or at least half of the solution (2 liters) in each of two sittings. It can be difficult to guzzle down 2 to 4 liters of this solution, and the recommendation is to go slow and steady; otherwise, it may result in overdistension of your stomach, causing nausea and potentially vomiting.
If you have had experience with GoLYTELY in the past or are interested in alternatives, here is a perspective from a patient who had to undergo two colonoscopies over a relatively short period of time:
“I had to have two colonoscopies, and originally I was told to use GoLYTELY. After the first colonoscopy, I indicated how awful GoLYTELY was and that I was dreading having to drink that gigantic jug again. The nurse mentioned that Suprep was an alternative that many patients preferred. GoLYTELY and Suprep have some similarities but also notable differences. GoLYTELY comes in a 4-liter jug, which is to be consumed in several doses. The first half of the jug had to be drunk the night before within an hour and a half. The second half had to be consumed at 2 a.m. Although GoLYTELY supposedly has no flavor, I found it to be salty and unpalatable. It has a slightly slimy consistency and is quite gross, especially considering the large quantity that is required to drink. The directions said not to use any sort of flavoring; however, the nurse on the phone told me I could use a drink mix, so I used Crystal Light. Maybe the Crystal Light helped with the flavor, but it was still slimy, salty, and disgusting. It might have been more tolerable in a smaller quantity, but the large jug was just too much.
My experience with Suprep was much different. Suprep also has to be drunk in two separate doses; however, it is only one glass per dose. After drinking the glass in the late afternoon, the other was to be consumed in the evening. Suprep’s smaller total volume, combined with a more tolerable taste, makes it far superior. The taste was slightly better than GoLYTELY, and I also used Crystal Light to add flavor. So, the combination of the significantly smaller quantity along with the improved flavor made it a far superior alternative.”
Dr. Harry Wasvary, Chief of Colon and Rectal Surgery at Corewell Health in Royal Oak, says Suprep is even available in a pill form known as Sutab. He notes that with Sutab, you still have to drink lots of water, but it is often preferred over drinking the large volume of GoLYTELY.
The way Suprep works is similar to GoLYTELY’s mechanism of action in that it also holds water in the bowel to cleanse the inside of your colon. However, Suprep is not based on polyethylene glycol; it uses a different set of mineral salts combined to make sulfate molecules. The chemistry is not especially important. What is important is the fact that it does not require you to drink 4 liters of what many people consider to be an unpalatable liquid. The Suprep kit contains two bottles and a cup. You would pour one of the bottles into the cup and add water up to the 16-ounce line, then drink that cup. If you are using what is commonly referred to as a split-dose prep, you would drink the second bottle, also diluted into a 16-ounce cup, later in the day or evening. Note that you are only drinking 16 ounces of the prep liquid at a time (which can also be flavored). Most people find that even if they don’t love the taste, they can get 16 ounces down much more easily than two liters of GoLYTELY. I should add that with Suprep, you still have to drink additional water, but it is just plain water and not something that has any flavor you might not like.
One question you might have is: if Suprep is so great, why doesn’t everybody just prescribe it? First, it is not appropriate for everyone; there are certain medical conditions where Suprep might be contraindicated, and you should discuss that with your physician. Second, Suprep was not initially available in a generic form and was fairly expensive if insurance did not cover it. Since its initial release, it has gained broader acceptance regarding insurance coverage, and there is now a generic version available. If your doctor says you can use Suprep and prescribes it, and if your insurance covers it, you are all set. If your insurance does not cover it, ask about the generic version, any manufacturer rebates that are sometimes available, and look for price reductions using programs like GoodRx. Using one of those strategies will generally bring the price down significantly. Depending on your financial circumstances, even if insurance does not cover it, it might be worth trying Suprep if you have had a previous poor experience with GoLYTELY.
A couple of other tips that Dr. Wasvary suggests are scheduling your colonoscopy in the morning if possible. That way, you do not have as long a period without eating. Dr. Wasvary also recommends that if your doctor allows it, a split prep is better than doing a prep where you drink everything all at once. Finally, he says there really is no magic to it; you just need to ensure that you have enough fluid running through your colon to cleanse it adequately, which means making sure that you hydrate according to your doctor’s instructions.
