Monitoring Bad Bellies

Last month I had another colonoscopy and gastroscopy, which now works out to be my about my fourth colonoscopy and second gastroscopy since my UC diagnosis. This week, I would like to share my experiences with this process, and best tips for how to get through it!

Disclaimer: I will be discussing the colonoscopy process as per my experiences in Australia, however they may differ slightly from your experiences, particularly in other countries. It is common for doctors to give out a “bowel preparation kit,” which will contain strict instructions for dietary restrictions and preparation materials, so please follow these instructions first.

DIETARY RESTRICTIONS

The first phase when preparing for a colonoscopy is to restrict your diet, which will help with cleaning out the colon. Cleaning out the colon is necessary to give the doctor a clear view during the procedure. This phase commonly begins from 48 hours before the procedure, and is a two-step process.

Firstly, on the second day before the procedure, you need to follow a low-fibre diet. I was given the following restrictions:

• No red meat
• No brown bread, cereals, or other foods containing whole grains or seeds
• No foods or drinks with a strong colour (especially red or purple)
• No fruit or vegetables, except for potato or pumpkin
• No full fat dairy products

Next, on the day before the procedure, you are restricted to a clear liquid diet until midnight. I was told that the following were approved clear liquids:

• Water
• Clear fruit juices
• Black tea or coffee (i.e. no milk, although sugar is allowed)
• Cordial
• Clear broth
• Clear jelly (as long as it is not red or purple) - my favourite is Aeroplane Jelly (see image below)
• Icypoles (or popsicles)
• Clear soft drinks
• Clear sports drinks

My main tip for this part of the preparation process is to stay at home on the day before the procedure if possible. Because there are no carbohydrates allowed on the liquid diet, it can be difficult to maintain high energy levels, and therefore you may feel quite tired.

My second tip is to always have a drink or other liquid in your hand or by your side at all times, as this will encourage you to keep hydrated. Additionally, constant sipping will help to fill your stomach, and therefore keep hunger at bay, albeit temporarily.

Also, please note that you may need to stop taking medications or supplements during the liquid diet day, as this can complicate the bowel preparation process, so make sure you check on this with your doctor.

BOWEL PREPARATION

Next, the “fun” part – the laxatives. In fact, this is the part that I dread the most when it comes to having a colonoscopy, and I have to confess that because of this, I often put off having the colonoscopy done for as long as I can!

Every time I have had a colonoscopy, I have been given PicoPrep to take, which primarily contains sodium picosulfate, magnesium and citric acid. There are many different types of laxatives that are used in bowel preparation, and some of them are listed here.

I was given three sachets of PicoPrep, and instructed to take them as per the below schedule. Each time, I had to dissolve the powder into a glass of warm water, and then drink it slowly.

• First sachet at 5pm.
• Second sachet at 6pm.
• Third sachet at 7pm.

Here are my tips for this part of the process:

• Add a clear liquid like cordial to the water with the PicoPrep, which will help cover the flavour. The PicoPrep itself is very sour, I believe due to the fact that it contains citric acid, and it also has a bad smell, so having something else with it can help to get it down. My cordial of choice is lime cordial (see photo below) - although this now means that I can’t drink lime cordial at any other time, or any other lime-flavoured drink, because it always reminds me of having a colonoscopy! 

• Stay close to the bathroom, as it will only take an hour or two for the laxative to take effect, and after that you will need to make very frequent trips to the toilet. Also, make sure you have plenty of toilet paper in the house, as you will need it!
• Keep drinking in between doses, as this will keep you hydrated and help with clearing out the bowel. 
• Watch TV or read a book during the night, as this will help to pass the time and distract you from what is happening in your belly. However, make sure that you also set alarms, so that you don’t lose track of time and forget to take the next dose. 
• This time I found that the PicoPrep made me feel nauseous, and perhaps my anxiety about what was to come was making the nausea worse, so it was difficult to drink the last dose. To help with this, I took sips every 5-10 minutes until I got it all down, and also lay down in between sips to help settle my stomach. 
• If possible, ask someone to stay with you during the night, just in case something goes wrong or you need help – and to keep you company during the ordeal! 
• I found that having chicken noodle soup, with the noodles and other solid parts strained out, helps to make you feel like you are eating real food. Also, having jelly helps you feel like you are eating something more substantial.
• Go to bed early if you can, as you will need as much sleep as possible. However, getting a good sleep will not be easy as you will still need to make trips to the toilet during the night. For me, the best sleeping position when you do go to bed is to lie on your back, as this will help settle things in your belly for a little while. 
• I often experienced pain and chafing due to the frequent toilet trips, and sometimes using regular toilet paper made things worse. Therefore, I suggest alternating toilet paper with wet toilet wipes like these Kleenex ones if they are available to you, as they can sometimes be a bit softer on the skin. 
• Remember that you must stop drinking any liquids at midnight, and cannot have anything in the morning either.

THE PROCEDURE

Firstly, I will explain what happens during the procedure, for both a colonoscopy and a gastroscopy.

During a colonoscopy, the doctor uses a colonoscope, which is a long, thin plastic tube with a camera and light at the end. This is inserted through the anus, and used to inspect the inner lining of the large intestine. Biopsy samples are also taken for testing. A colonoscopy is commonly used to monitor IBD symptoms, but it is also used to check for signs of bowel cancer. Particularly for those with IBD, it is recommended that you have a colonoscopy done every three years on average, however this depends on the severity of your symptoms. In my case, my doctor has asked me to have one every two or three years. Again, it is best to discuss this with your doctor.

A gastroscopy is similar, but instead an endoscope (also a long, thin plastic tube with a camera and light at the end) is inserted into the throat, and used to inspect the inner lining of the oesophagus and stomach. A gastroscopy can be used to look for ulcers or polyps, however in my case it was used to check for possible damage caused by acid reflux.

Now I will describe the details of the procedure, which again is based on my personal experience. On the day, I was asked to come to the day clinic around 30 minutes before the appointment time to fill out paperwork and settle payment, and was then asked to change into a hospital gown. As part of this, I also had to remove all jewelry. Next, I was taken into one of the operation rooms, and asked to lie down on my side with my knees bent. I was then sedated while the procedure was performed, which took around 30 minutes.

Remember that you cannot drive after being sedated, so make sure you have someone with you who can drive you home afterwards. My doctor also recommended that I have someone stay with me for the rest of the day, in case there are any complications.

RECOVERY

In my experience, recovering from a colonoscopy is also a two-step process – on the day, and during the following 2-3 days.

On the day, after being brought out of the sedation, the immediate recovery process in my experience has always been as follows:

1. Continue lying down until you have woken up properly and feel more lucid, during which time the nurse will check your blood pressure.
2. The nurse will then lead you into the recovery room, where you are asked to sit down, and are given some water and food, such as sandwiches. This was the first time I have had a colonoscopy since my FM diagnosis, and I found this part problematic, as the sandwich selection was limited and not fructose friendly. In the end, I just had a plain cheese sandwich as it was better than nothing, but only had a few mouthfuls, as I did not want to get a stomach ache as well.
3. While you are in the recovery room, the doctor will come and tell you his initial observations and give you a written report.
4. After about 15 minutes, you will be given permission to change back into your clothes, and then led into the waiting room so you can go home.

After going home, I usually find it best to take it easy for the rest of the day, and sleep early that night. I am usually very tired, and don’t feel up to doing much anyway. Also, I try to only eat simple and “safe” foods, so as not to agitate my belly further.

In my experience though, it usually takes 2-3 days before I feel like I have fully recovered, both in terms of the fatigue and stabilising my belly. I still went to work that week, but tried to take it easy as much as possible and stick to “safe” foods.

THE FOLLOW UP

Finally, you will often need to make a follow up appointment with your doctor, particularly to hear the results of the biopsies.

I am happy to say that my results for the colonoscopy were good, and my UC is still in remission! However, unfortunately the doctor discovered that there was some persistent but minor damage in my oesophagus due to acid reflux, so I have been given a prescription for Nexium to help with this. On a positive note though, the damage has reduced since the last time I had a gastroscopy.

Do you have any other tips for surviving a colonoscopy? Please comment below.