Colonoscopy

What is a Colonoscopy?

A colonoscopy is an examination of the lining of the rectum and colon (the large intestine) through a flexible tube called a colonoscope. This allows a specially trained doctor to directly view this area and identify, biopsy, or remove any abnormalities such as polyps. Removal of polyps helps to prevent colon cancer.

How to Prepare for a Colonoscopy

Day of the test

• Pack lightly and wear loose, comfortable clothing. Leave your money and all other valuables, including jewelry, at home.
• You can brush your teeth.
• The test takes about 30 to 60 minutes, but plan to spend two to three hours at the unit to allow time for your preparation, your test, and your recovery. We give each patient the attention needed for their test; however, unexpected delays may occur.
• Before the test, a nurse will greet you and help you change into a hospital gown.
• The nurse will place a catheter in your arm. You will receive relaxing medicines through the catheter during the test.

After the test

• After the colonoscopy, you will go to a recovery area where a nurse will watch you until most of the effects of the relaxing medicine have worn off.
• You may have some cramping or bloating because air is placed into your intestine during the test. This should go away after several hours.
• The nurse will provide information about how to take care of yourself at home.
• A copy of your exam results will be sent to your referring doctor.
• We will contact you with the test results. If you do not hear from us within one week, please call the number listed for your test location.
• You should NOT do any of the following until the day after your exam.
  • Drive a car
  • Operate machinery or power tools
  • Drink alcoholic beverages
  • Make any important decisions

Colonoscopy Preparation Guide

It is important that you follow the instructions below. If you do not follow the guide, your colonoscopy may need to be cancelled, rescheduled, or repeated.

One to two weeks before your colonoscopy

Purchase these preparation materials

• MiraLAX^®: 1 bottle, 238 grams (if your doctor has advised you to use a different prep than MiraLAX^®, you will need a prescription).
• Dulcolax^® (Bisacodyl): 4 pills, 5 mgs each
• Gatorade or Crystal Light Lemonade: 64 ounces (two 32 ounce bottles), yellow, green, or clear only

Diet

• Try to eat a low-fiber diet for one week before your exam. Avoid seeds, nuts, popcorn or other high-fiber foods.

Transportation

• Arrange for a responsible person to pick you up after your colonoscopy. Inform them that your estimated exam completion time will be two to three hours after your arrival time. You are not allowed to drive or leave the endoscopy center alone.

Medications

Blood thinners: If you take aspirin, do not stop taking your aspirin. If you take NSAIDs, such as Advil^®, Motrin^®, Celebrex^®, or ibuprofen, you may continue to take them as usual.

If you take medication to thin your blood, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it. Some examples of blood thinners are: Coumadin^® (warfarin), Plavix^® (clopidogrel), Ticlid^® (ticlopidine hydrochloride), Agrylin^® (anagrelide), Xarelto^® (Rivaroxaban), Pradaxa^® (Dabigatran), Eliquis^® (Apixaban), and Effient^® (Prasugrel). Do not stop these medications without the consent of your physician. Some endoscopic procedures may be performed while on these medications, others may not.

GLP-1 agonists or SGLT-2 inhibitors: You will need to stop taking them before your procedure or there is a small risk you could experience a serious reaction. These medications should be held per the duration of the dosing schedule. For example, if the patient takes the medication weekly, the dose should be stopped for a week. There are medication examples listed below. If you do not stop these medications far enough in advance, your colonoscopy may need to be cancelled or rescheduled.

To reduce the risk for reactive airway complications, we recommend that you avoid smoking (tobacco, cigars, cannabis, vaping products) for at least 24-hours before your scheduled procedure.

Iron supplements (Ferrous sulfate, gluconate): Please stop taking these medications seven days prior to your procedure.

Stop 7 days before your procedure

• Dulaglutide (Trulicity^®)
• Exenatide (Byetta, Bydureon^®)
• Liraglutide (Saxenda^®, Victoza^®)
• Lixisenatide(Adlyxin^®)
• Semaglutide (Ozempic^®, Wegovy^®)
• Tirzepatide (Mounjaro^®, Zepbound^®)

Stop 4 days before your procedure

• Ertugliflozin (Steglatro™)
• Ertugliflozin/metformin (Segluromet™)
• Ertugliflozin/sitagliptin (Steglujan™)

Stop 3 days before your procedure

• Bexagliflozin (Brenzavvy^®)
• Canagliflozin (Invokana^®)
• Canagliflozin/metformin (Invokamet^®)
• Canagliflozin/metformin XR (Invokamet^® XR)
• Dapagliflozin (Farxiga^®)
• Dapagliflozin/metformin XR (Xigduo^®)
• Dapagliflozin/metformin XR (Xigduo^® XR)
• Dapagliflozin/saxaglipitin (Qtern^®)
• Dapagliflozin/saxaglipitin/metformin (Qternmet^® XR)
• Empagliflozin (Jardiance^®)
• Empagliflozin/metformin (Synjardy^®)
• Empagliflozin/metformin XR (Synjardy^® XR)
• Empagliflozin/linagliptin (Glyxambi^®)
• Empagliflozin/linagliptin/metformin XR (Trijardy^® XR)

One day before your colonoscopy

Food

• Do not eat any solid food for breakfast, lunch, or dinner.
• You may have clear broth or bouillon, Jell-O^® and ice pops (yellow, green or clear).

Drink

• Drink plenty of clear fluids such as: water (still, sparkling, seltzer), broth, apple juice, white grape juice, and diet/regular ginger ale or Sprite^®.
• Do not have any red, blue or purple foods and drinks.
• Do not drink alcohol.
• Coffee and tea are OK, no milk or cream.

4 pm on the day before your colonoscopy

• Take 4 Dulcolax^® pills.
• Mix the entire MiraLAX^® bottle with 64 ounces of Gatorade or Crystal Light lemonade in a large pitcher. Stir and place in the refrigerator.

5 to 6 pm on the day before your colonoscopy

• Drink the first half (32 ounces) of MiraLAX^® solution during this hour. You may not enjoy the taste; try drinking it cold, use a straw, or take small sips. Use a measuring cup or large drinking glass to measure eight ounces.
  • 5 pm: Drink 8 ounces of the MiraLAX^® solution
  • 5:15 pm: Drink 8 ounces of the MiraLAX^® solution
  • 5:30 pm: Drink 8 ounces of the MiraLAX^® solution
  • 5:45 pm: Drink 8 ounces of the MiraLAX^® solution

Six hours before your arrival time

You may need to set an alarm to meet this time requirement.

• Drink the remaining half (32 ounces) of MiraLAX^® solution starting six hours before your arrival time. It is important to finish drinking all the solution.
  • Six hours before arrival: Drink 8 ounces of the MiraLAX^® solution
  • Five hours and 45 minutes before arrival: Drink 8 ounces of the MiraLAX^® solution
  • Five hours and 30 minutes before arrival: Drink 8 ounces of the MiraLAX^® solution
  • Five hours and 15 minutes before arrival: Drink 8 ounces of the MiraLAX^® solution

The exact times can be found using the Solution Schedule table, based on your arrival time:

On the day of your colonoscopy

• Do not eat or drink anything the morning of the procedure
• Take medications with small sips of water
• Do NOT drink any liquids later than 3 hours before your arrival time

Contact Us

If you have specific questions about preparing for your procedure at Penn Medicine, please call your testing location.

• Perelman Center for Advanced Medicine: 215-349-8222
• Penn Presbyterian Medical Center: 215-662-9131
• Penn Medicine Radnor: 610-902-1500
• Endoscopy Center at Pennsylvania Hospital: 215-829-3561
• Penn Gastroenterology Limerick: 484-938-4030