Preparing for your Colonoscopy: MIRALAX

Colonoscopy Bowel Preparation

Having a colonoscopy can be daunting, but with a little preparation and some knowledge the procedure is easier to handle. That’s what this brief guide is about. It’s broken into sections so you can refer to them as you need them. The sections are:

• Section 1. General checklist
• Section 2. Things you will need for your preparation              
• Section 3. One week before your colonoscopy
• Section 4. The day before your colonoscopy
• Section 5. The day of your colonoscopy

Please note: If you are having a colonoscopy AND an upper endoscopy (EGD), these instructions cover both procedures.

Preparation Information

Section 1: General checklist of things to do before your procedure:

• Be sure you are aware of your insurance benefits and coverage.

  • Not all insurance policies cover screening colonoscopies. If your insurance company requires a referral or prior authorization, please make sure our office has received it prior to your procedure.

  • If there has been a change in your insurance information since your procedure was scheduled, please call our office to be sure your information is updated.

• Be sure you are signed up for your Solution Health MyChart account. It will help us to communicate with you and provide you with direct access to all your medical information. You can find your MyChart here: https://mychart.solutionhealth.org
• If you have diabetes, be sure you have contacted your managing or prescribing provider for medication instructions.
• If you take a prescription for diabetes such as Ozempic (semiglutide), Trulicity, Mounjaro (tirzepatide), Wegovy, Tanzeum, Victoza (liraglutide), Saxenda, Adlyxin (lixisenatide), Byetta (exenatide), or Bydureon: these prescriptions delay gastric emptying. You must be off this prescription for TWO FULL WEEKS prior to your procedure.  Please contact your managing or prescribing provider for instructions on what to do or take during the two-week hold, and how to restart your medication(s) after your procedure.
• If you take a prescription for weight loss such as Ozempic (semiglutide), Trulicity, Mounjaro (tirzepatide), Wegovy, Tanzeum, Victoza (liraglutide), Saxenda, Adlyxin (lixisenatide), Byetta (exenatide), or Bydureon: these prescriptions delay gastric emptying. You must be off this prescription for THREE FULL WEEKS prior to your procedure.  Please contact your managing or prescribing provider for instructions on what to do or take during the three-week hold, and how to restart your medication(s) after your procedure.
• If you are on a prescription blood thinner (such as Coumadin, Plavix, Eliquis, Brillinta, Xarelto, Pradaxa, or an equivalent) our nurses will contact your prescribing provider for instructions on holding this medication. If you have not heard from one of our nurses one week prior to your procedure, please contact Elliot Gastroenterology at 603-314-6900.
• If you have children or are the primary caregiver for a family member, arrangements should be made for child or dependent care during your preparation and on the day of your procedure.
• You will need a responsible adult to drive you home from your appointment.

You will receive intravenous sedation (propofol) during your procedure. Although short acting, propofol may have subtle, prolonged effects on your reaction and judgment time, thought processes, and wakefulness. We fully expect you will be able to return to your normal activities the day after your procedure. This includes driving and going to work.

Please be aware that you may be contacted by the procedural department the day of your appointment to adjust your arrival time.

Section 2: Colonoscopy bowel preparation materials:

• One bottle of MiraLAX or generic polyethylene glycol powder 238 grams, or 8.3 ounces.
• One bottle of MiraLAX or generic polyethylene glycol powder 119 grams, or 4.1 ounces.
• Dulcolax or generic bisacodyl tablets, 5 milligrams (mg). You will need 4 tablets. This is a laxative tablet. DO NOT get the suppository or the stool softener.
• 64-ounces PLUS 32-ounces of Gatorade, Propel, Vitamin Water, Crystal Light, or other noncarbonated liquid drink (you will need a total of 96 ounces). Colors you can use include clear, yellow, orange, or green. You cannot drink anything that is colored red, blue or purple. These colors can “stain” the inside of your colon and make it harder for the doctors to see any abnormalities.

These items are available over the counter at any store that has a pharmacy section. No prescription is necessary. For your convenience, the Elliot Pharmacy at River’s Edge and the Elliot Pharmacy at Bedford offer a Colonoscopy Bowel Preparation Kit for purchase. The kit includes generic MiraLAX and generic Dulcolax tablets (clear liquids are not included in this kit).

Section 3: One week (7 days) before your colonoscopy:

• Stop ALL vitamins and supplements, including fish oil, iron, and areds.
• Stop any fiber supplements such as Metamucil, Benefiber or Citrucel. Check with your managing provider for alternatives.
• If you are on medications for constipation such as Amitiza or Linzess, continue those up to and including the morning of your procedure (other than fiber).
• Occasional over-the-counter items for pain and allergy relief may be taken up to the day prior to your procedure.
• If you are diabetic, call your managing or prescribing doctor to determine how your diabetes medicine should be taken the day of the procedure.
• If you are on a prescription blood thinner and have not received your instructions, please call Elliot Gastroenterology at 603-314-6900.
• Begin low-residue and low-fiber diet. Low-residue foods process quickly through the colon, providing an easier and more comfortable preparation.​​​​​​

Section 4: The day before your colonoscopy:

No breakfast today or tomorrow.

DRINK CLEAR LIQUIDS ONLY.

Clear liquid is any liquid that you can see through, and includes:

• Water, clear broth or bouillon, black coffee, or black tea (you may use sweeteners). DO NOT use or drink milk products.
• Gatorade, Powerade, Vitamin Water, or Pedialyte that is clear, yellow, orange, or green. Electrolyte drinks are recommended to help you stay hydrated.
• Lemonade, limeade, ginger ale, and clear sodas. DO NOT drink cola or root beer.
• Apple juice, white grape juice, white cranberry juice.
• Jell-O and popsicles are allowed if they are yellow, green, or orange colored.

Drink at least eight glasses of water or clear liquids. It is important to drink fluids the day before the procedure to keep you hydrated. The more you drink, the better you will feel.

Preparation timeline:

• Prepare your solution in the morning. You will be drinking this later in the day. Mix 8.3-ounce bottle of MiraLAX with 64 ounces of clear liquid in a large pitcher. Stir/shake until the entire contents of MiraLAX are completely dissolved. Chill the mixture if desired.
• At 1 PM Take 2 Dulcolax tablets with 8 ounces of water.
• At 3 PM Take the remaining 2 Dulcolax tablets with 8 ounces of water.
• At 5 PM Begin drinking the MiraLAX solution. Drink one glass every 20 to 30 minutes to finish the 64 ounces within 3 to 4 hours. Using a straw will help make drinking easier.

If you get nausea, stop for 1 hour then resume. Please note that everyone reacts to laxatives differently. You may feel bloated, nauseated, or have stomach cramping while drinking the solution. This is temporary and will improve once you start having bowel movements. Walking around between drinking each glass can help with bloating. Bowel movements usually start within 2 hours of starting to drink the liquids but may take longer.

Section 5: The day of your colonoscopy:

• 4 hours prior to your procedure time, mix 4.1 oz. bottle of MiraLAX into a pitcher and add a 32-ounce container of clear liquid. Shake or stir well. Drink and finish the 32-ounces within 1 hour.
• You may have clear liquids (NO broth) up until 3 hours before your procedure time
• 3 hours prior to your procedure time, you may take the following medications with a small sip of water:
  • Daily narcotic
  • Anti-anxiety
  • Blood pressure/cardiac medication
  • Seizure medication
  • Asthma inhalers
  • Thyroid medication

After taking your medications, nothing by mouth, even water, 3 hours before your procedure time or your procedure could have to be rescheduled.

Please call 603-314-6900 if you continue to pass thick, brown liquid or solid bowel movements after completing the preparation. The best results include passing only yellow liquid.

Please bring to your appointment:

• Insurance card
• Photo identification
• A list of all medications and dosages as well as allergies to medications.
• A list of conditions that may make you sensitive to sedation.

As a reminder:

• Please wear glasses; DO NOT wear contacts.
• Leave all jewelry at home, including body piercings.
• You may brush your teeth and wear dentures.
• Please allow for two to three hours at the facility. Please be aware unexpected delays may occur.
• As with any procedure, the anesthesiologist will perform an assessment the day of procedure to choose the safest method of airway protection based on the patient’s presence of symptoms on that day.
• Do NOT make any important decisions on the day of your procedure