How to take Fortrans correctly before a colonoscopy?

• General principles
• How to prepare the gastrointestinal tract
• Using diet and cleansing enemas
• Use of Pharmaceuticals
• Use of Pharmaceuticals: One-Step Scheme
• Use of Pharmaceuticals: Two-Step Scheme
• Use of Pharmaceuticals: Cleaning with Lavacol
• Is a colonoscopy possible without preparation?
• Additional recommendations

Colonoscopy allows you to visually examine the intestinal mucosa and differentiate many diseases that have similar clinical signs. To make the study as informative as possible, proper preparation for a colonoscopy is necessary. If you ignore the specialist’s recommendations, the diagnosis will have to be repeated or the study will be postponed until another day, which slows down the diagnosis and the start of treatment.

General principles

Tell your doctor what medications you are taking. Activated carbon, medications based on bismuth and iron should be discontinued before the study. For other drugs, dosage adjustment is necessary.

If you suffer from constipation, you should start taking laxatives at least a week in advance. For people with constipation for more than a week, a combination of laxatives and an increased dosage is recommended. This will allow you to cleanse your body well.

When preparing for a colonoscopy, Vaseline oil orally and in the form of enemas is contraindicated.

Plant-based sedatives will help you feel comfortable during a colonoscopy. They must be taken for several days before the procedure. Calmness during the examination will help the patient undergo it painlessly, and the doctor will be able to obtain diagnostically important data.

About virtual colonoscopy

Virtual colonoscopy (VC), also known as computed tomography of the colon (CT colonography), is done to take images of the colon and rectum (the end part of the large intestine) to look for signs of cancer. Adults 50 years of age and older should be checked for colon polyps. Polyps are growths on the inner wall of the colon. They are usually benign (not cancerous), although some may be cancerous or precancerous.

During a VC, a technologist will use a CT scan to obtain three-dimensional images of the inside of the colon and rectum. VC differs from a regular colonoscopy in that the doctor can examine the colon without using a colonoscope (a flexible tube instrument that is inserted into the rectum).

Doctors need 3D images for:

• looking for signs of colon and rectal cancer;
• searching for growths (polyps) in the colon and rectum.

If you have any questions, call 212-639-7280. If the office is closed, call 212-639-2000 and ask for the radiologist on duty.

to come back to the beginning

Using diet and cleansing enemas

Doctors recommend following a special diet 3-4 days before the procedure. The following foods should be excluded from the diet:

• sweets;
• fatty meat, fish;
• smoked meats;
• berries;
• carbonated drinks;
• alcohol;
• legumes;
• mushrooms;
• greenery;
• spicy;
• nuts;
• dried fruits;
• vegetables;
• pickles;
• pearl barley porridge and millet;
• seaweed;
• black bread;
• canned food;
• soups with cabbage.

Studies prove that these products pollute the body, which should not be done before the examination.

What can you eat before a colonoscopy? The diet should include:

• lean fish;
• limited amount of butter and vegetable oil;
• White bread;
• eggs;
• bananas;
• lean meat;
• broths;
• fermented milk products, excluding cottage cheese;
• vegetable decoctions;
• tea and coffee;
• juices without pulp;
• rice and semolina porridge;
• honey, sugar.

It is recommended to consume liquid food the last day before the procedure. Broths, light juices and mineral water are ideal. You should refrain from drinking liquid 120 minutes before the procedure. If the procedure is in the morning, get up earlier and drink sweet tea. The main thing is to observe the above time period.

Colonoscopy requires a thorough cleansing of the intestines; cleansing enemas are required two days before the procedure. If you are prone to constipation, you should take a magnesium-based laxative or castor oil 15 hours before the procedure.

The volume of one enema is from 1.5 to 2 liters, use water at room temperature. The first two enemas are given in the evening two days before the procedure. The next day - two in the morning and two in the evening. At least 2 hours before the procedure, you need to completely cleanse the colon. The number of enemas is determined individually. The main condition is to rinse the colon to clean water. If the patient has been following a low-residue diet, two enemas will help evacuate the entire contents of the colon. For comfortable administration, the enema tip is lubricated with cream or oils; their remains must be removed with a napkin or washed thoroughly.

The process requires organization. Any deviation from the specified scheme will not allow you to complete the preparation for colonoscopy successfully; actions must be comprehensive. If for any reason you did not follow the recommendations, tell your doctor. Having assessed the situation, he will decide on the need to shift the timing of the endoscopic examination. Remember, proper cleansing of the body is the key to a painless and informative study.

Before the procedure

Purchase a pre-procedure kit

Before the VC procedure, you need to cleanse (empty) your colon. To do this, you need to purchase everything you need at the MSK pharmacy .

• Two tablets (5 mg) bisacodyl (Dulcolax®). You will receive a pack of 10 tablets, but you only need to take 2.
• One bottle (50 ml) iohexol (Omnipaque®). This is a contrast agent that makes the VC procedure of the colon easier. Do not put iohexol in the refrigerator.
• Do not store the bottle in direct sunlight.

You will also need:

• 64 oz (1.9 L) of any clear liquid that is not red, purple, or orange. We recommend purchasing a sports drink such as Gatorade ® or Powerade ®
• If you have diabetes, make sure clear liquids do not contain sugar.

Ask questions about your medications

You may need to change the time you take your regular medications so that they do not coincide with the times you take the medications you need to prepare for the procedure. If you usually take your medications at the time you would take one of your bowel preparation medications, schedule the other medications to be taken 1 hour earlier or 1 hour later. If you have trouble scheduling time to take your medications, call your doctor or nurse.

If you are taking medications to thin your blood, such as to treat blood clots, do not stop taking them until your doctor tells you to do so . Blood thinners include warfarin (Coumadin®), dalteparin (Fragmin®), dabigatran (Pradaxa®), enoxaparin (Lovenox®), clopidogrel (Plavix®), prasugrel (Effient®), and cilostazol (Pletal®). There are other similar medications, so check with your doctor if you are unsure.

Contrast agent

A contrast agent is a special dye that helps the doctor see pathologies of internal organs. Oral contrast agent will be part of the bowel preparation for VC. Be sure to tell your doctor if you have previously had a reaction to any CT contrast agent. This includes barium and iodinated contrast agent.

If you are having a VC procedure without oral contrast, ask your nurse for the resource How to Prepare for a Virtual Colonoscopy Without Oral Contrast or use the search function on the web page.

For diabetics

• If you take insulin or other medications for diabetes, your dosage may need to be adjusted. Ask the doctor who prescribed your diabetes medication what you need to do one day before your procedure and the morning of your procedure. Tell your doctor that you will be on a zero-treatment diet the day before your procedure.
• If you monitor your blood sugar (glucose) levels, ask your doctor if you should keep the same testing schedule. Call your doctor if your blood sugar drops below 70.

Removing devices from the skin

If you wear any of the following devices on your skin, the manufacturer recommends removing them before undergoing a scan or procedure:

• Continuous Glucose Meter (CGM)
• Insulin pump

Contact your healthcare provider to schedule an appointment closer to your scheduled device replacement date. Make sure you bring a spare device with you that you can wear after your scan or procedure.

If you are unsure how to monitor your glucose levels when the device is turned off, talk to your diabetes care provider before your visit.

to come back to the beginning

Use of Pharmaceuticals

There are special tools that allow you to properly prepare for endoscopy. When using them, you can refuse cleansing enemas and a strict diet. The technique is suitable for patients suffering from constipation.

Colon cleansing with Fortrans is widely used. The mechanism of action is based on blocking the absorption of fluid from the gastrointestinal tract. Thanks to this, feces are quickly evacuated. The drug is suitable for patients suffering from diseases of the pancreas, liver and biliary tract. There are two schemes for using the product: one-stage and two-stage.

One-stage scheme

The day before the examination, you will have to give up foods prohibited as part of the slag-free diet. On the day of diagnosis, drink only liquids.

The dose of the drug is calculated based on the patient’s body weight. 1 bag is designed for 20 kg. A person weighing 60 kg needs to take three sachets of Fortrans, 80-100 kg - four sachets.

The drug is dissolved in still water at the rate of 1 sachet per liter. Reducing the volume of liquid is not recommended. A patient weighing 60 kg should drink 3 liters of liquid with Fortrans diluted in it.

The prepared solution must be drunk in fractional portions over 4-5 hours. Calculate the time so that the last portion is taken no later than 4 hours before the endoscopy. Bowel movement begins an hour after taking the first dose of Fortrans and is completed within 3 hours after the end of the dose. This scheme makes it easy to prepare for diagnostic manipulation.

Two-stage scheme

Preparation for colonoscopy with Fortrans using this method will take two days. The day before the test, the patient can have a full breakfast. Recommended products: eggs, yoghurts, semolina. You need to eat no later than 12.00. Next, you need to exclude everything except broths, water and tea.

At approximately 17.00, start taking Fortrans in the standard dosage. You should drink the entire volume of the solution within 4-5 hours. During the intake process, as well as for 2-3 hours after its completion, active bowel movements will occur.

On the morning of the examination, you need to drink a sachet of Fortrans diluted in a liter of water. The volume must be drunk within 120 minutes, but no later than 4 hours before the procedure.

Fortrans allows you to cleanse the intestines of feces in the shortest possible time; the scheme is easy for the patient and safe. It is preferable to use a two-step method. This scheme allows for cleaning as efficiently as possible and is well tolerated.

Cleaning with Lavacol

The next remedy used before endoscopy is Lavacol. The product is effective, but has a number of contraindications:

• peptic ulcer of the stomach and duodenum;
• erosive gastritis;
• renal dysfunction;
• dehydration;
• intestinal obstruction;
• stenosis in the gastrointestinal tract.

Before using the product, you should consult your doctor. 1 sachet is diluted in 200 ml of still water. This amount must be drunk every 20 minutes until the total volume of the solution taken reaches three liters. Eating is prohibited.

During the process of cleansing the intestines, some people experience discomfort after starting to use Lavacol, and occasionally nausea and vomiting occur. These manifestations are not a reason to stop taking the solution and go away on their own. In general, the medicine is well tolerated and effectively cleanses the intestines.

Preparing for a colonoscopy. Recommendations of an endoscopist.

09.01.2020 Recommendations that are extremely important to follow to achieve high-quality preparation for a colon examination:

Diet.

2 days before the test, you must follow a low-fiber diet (for chronic constipation - 3 days before the test):

On the eve of the test day, eating solid food should be completely avoided after 13.00, then drink clear liquids in any quantity:

• in the morning - light breakfast (according to the list of permitted products),
• until 13:00 – lunch (also according to the list of permitted products),
• dinner - only permitted liquids (clear broths, tea and coffee (without milk), juice without pulp, water, non-alcoholic uncolored drinks).

On the morning of the examination , after completing the preparation (if intravenous anesthesia or simultaneous gastroduodenoscopy is not planned), you can drink sweet tea, transparent colorless or yellow liquids. You should stop taking all liquids no later than 2 hours before the examination, especially if the examination is to be performed under intravenous anesthesia (this does not apply to taking a drug to prepare for the examination, which must be taken on the morning of the examination day!).

Scheme of preparation for colonoscopy with the drug Movirep + Simethicone.

Two-stage preparation is required, regardless of the time of the scheduled study! The time for taking the solution is discussed with the doctor and depends on what time the study is scheduled for.

The evening before the study, you need to drink 1 liter of Moviprep from 18:00 to 19:00 (or from 19:00 to 20:00), after which drink another 500 ml of permitted liquid (water, clear broth, fruit juice without pulp, compote without berries, non-alcoholic non-colored drinks, tea and coffee without milk).

On the morning of the test , drink another 1 liter of Moviprep, in the last glass of which you must add an antifoam agent - 1/2 bottle of Simethicone emulsion (syrup, i.e. liquid form! Not tablets or capsules!) Espumisan (or Bobotik, or Subsimplex) , then drink another 500 ml of permitted liquid (water, clear broth, fruit juice without pulp, compote without berries, non-alcoholic non-colored drinks, tea and coffee without milk).

⃰ Choose the time for taking the drug in the morning so that about 4 hours pass from the end of taking the drug to the test. For example:

The package contains 2 sachets “A” and two sachets “B” for preparing two liters of solution. To prepare one liter of the drug solution, you need to dissolve the contents of one sachet A and one sachet B in a small amount of water, then bring the volume of the solution with water to one liter (the preparation of the solution is also described in detail in the instructions for the drug).

Scheme of preparation for colonoscopy with Eziklen + Simethicone.

Two-stage preparation is required, regardless of the time of the scheduled study. The time for taking the solution is discussed with the doctor and depends on what time the study is scheduled for.

The evening before the study, you need to drink 500 ml of Esiclene solution from 18:00 to 19:00 (or from 19:00 to 20:00), after which drink another 1 liter of permitted liquid (water, clear broth, fruit juice without pulp, compote without berries, non-alcoholic non-colored drinks, tea and coffee without milk).

On the morning of the test , drink another 500 ml of Eziklen solution, to which you need to add an antifoam agent - 1/2 bottle of Simethicone emulsion (syrup, i.e. liquid form! Not tablets or capsules!) Espumisan (or Bobotik, or Subsimplex), after Why drink another 1 liter of permitted liquid (water, clear broth, fruit juice without pulp, compote without berries, non-alcoholic non-colored drinks, tea and coffee without milk).

⃰ Choose the time for taking the drug in the morning so that about 4 hours pass from the end of taking the drug to the test. For example:

Pour the contents of one bottle of Esiclene into a measuring cup (included with the drug) and add water to the mark (500 ml). The preparation of the solution is also described in detail in the instructions for the drug.

Scheme of preparation for colonoscopy with Fortrans + Simethicone.

Two-stage preparation is required, regardless of the time of the scheduled study. The time for taking the solution is discussed with the doctor and depends on what time the study is scheduled for.

The evening before the study, you need to drink 2 liters of Fortrans solution from 18:00 to 20:00 (or from 19:00 to 21:00).

On the morning of the study , drink another 2 liters of Fortrans solution, in the last glass of which you must add an antifoam agent - 1/2 bottle of Simethicone emulsion (syrup, i.e. liquid form! Not tablets or capsules!) Espumisan (or Bobotik, or Subsimplex ).

⃰ Choose the time for taking the drug in the morning so that about 4 hours pass from the end of taking the drug to the test. For example:

Dissolve the contents of 1 packet of Fortrans in a small amount of water, then increase the volume of the solution with water to one liter (the preparation of the solution is also described in detail in the instructions for the drug).

General recommendations for preparation with drugs.

Any of the solutions should be drunk fractionally, in small sips (do not drink in one gulp!) - 250 ml (1 glass) every 15 minutes. At the very beginning of taking the drug solution or if it is taken quickly in large quantities, nausea and vomiting may occur.

If it is difficult to take a solution of the drug due to its taste, you can drink the solution chilled, through a cocktail tube (straw), in between drink or wash down the solution with a small amount of water, sweet tea, and also dissolve candy caramel (barberry-type candies). , honey, lemon, etc. The taste is improved by adding simethicone to the drug solution.

While taking the drug, it is recommended to maintain physical activity (walk around the apartment, perform circular movements of the body, squats), and perform good self-massage of the abdomen, especially in cases of delayed action of the drug.

The active effect of the drug lasts 1.5-2 hours after taking the morning portion of the drug (the effect of the evening portion can last up to 3-4 hours) - during this time there will be intense loose stools. At the end of taking the morning dose of the drug, the stool should change to a clear, colorless and light yellow liquid, which indicates the patient’s readiness for the study.

As a result, before the study you need to drink, depending on the choice of drug:

Moviprep - 2 liters of solution (1 liter in the evening before the study, 1 liter in the morning on the day of the study) and one liter of permitted liquid (500 ml after each liter of the drug);

Esiclene - 1 liter of solution (500 ml in the evening before the test, 500 ml in the morning on the day of the test) and one 2 liters of permitted liquid (1 liter after each portion of the drug);

Fortrans - 4 liters of solution (2 liters in the evening before the study, 2 liters in the morning on the day of the study).

If the above dosage is not observed, the intestines will not be completely cleansed and the study will not be informative; you will have to prepare and undergo a colonoscopy again!

Be sure to bring the results of previous studies with you!

IMPORTANT!

• If you are taking medications that normalize blood pressure, heart rate, etc., they must be taken as usual.

It is recommended to take these drugs no earlier than 1 hour after finishing taking the drug to prepare for a colonoscopy.

If you are taking blood thinning medications, inform your endoscopist about this before the examination.

• For chronic constipation, it is necessary to take additional laxatives 3 days before preparing for the study. It is advisable to obtain recommendations on the choice of drug from a gastroenterologist.
• Diarrhea (loose stools) is an expected effect of bowel preparation. The active effect of the morning portion of the drug is 1.5-2 hours after administration, during which time there will be intense loose stools, this must be taken into account when calculating travel time.

For example, the test is at 14.00, travel time is 1 hour, you should stop taking the drug no later than 11.00.

• It is strictly forbidden to reduce the volume of solution and liquid.
• You cannot additionally (or instead) carry out the procedure of cleansing the colon with enemas!
• You can't take Vaseline oil!
• If a study is to be carried out under intravenous anesthesia, it is not recommended to drive a car, operate any machinery, or make important decisions on this day. It is advisable to be met and escorted home.

Successful colonoscopy with a detailed examination of the mucous membrane of the colon throughout its entire length depends on the quality of preparation for the study.

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Is a colonoscopy possible without preparation?

Without preliminary measures, endoscopic diagnostics are carried out only in an urgent manner. If a person experiences acute bleeding or intestinal obstruction, immediate medical attention is required. In such cases, there is no time to evacuate waste. For emergency endoscopy, special colonoscopes are used that have a wide channel and are equipped with an intensive irrigation system. It will not be possible to conduct a detailed examination of the mucous membrane, but therapeutic manipulations are possible.

Important! Routine endoscopic diagnosis is always carried out after preparation. During the manipulation process, the doctor must collect as much information as possible and get answers to diagnostic questions. You need to take your preparation seriously; this will allow you to undergo the examination without any discomfort.

Technique for endoscopic examination

In order to understand the nuances of the water regime before the procedure, it is necessary to understand exactly how it is carried out. Colon endoscopy is a minimally invasive diagnostic examination, the essence of which is to insert an endoscope into the anus. This device is equipped with a special camera that transmits the image to the doctor’s monitor in real time.

For normal tube patency, it is extremely important to ensure the absence of unwanted intestinal contents. Therefore, maintaining a diet is an essential component of obtaining reliable diagnostic data. In this regard, patients need to know what to drink before a colonoscopy to cleanse the intestines.

Water mode

Restrictions on the daily diet of patients undergoing endoscopic manipulation apply not only to food, but also to liquids. The most important component of dietary nutrition is regular consumption of sufficient amounts of water. Any day of a person who is prescribed the procedure should begin with its intake. In the morning, many people prefer to cheer themselves up with strong drinks, which raises the question of whether it is possible to drink coffee before a colonoscopy. There are no medical contraindications for its use, but for better results it is necessary to avoid strong varieties and the addition of milk or cream. It is not recommended to take coffee closer to the day of the examination.

Immediately after sleep, you will need to drink a glass of clean water (preferably not carbonated). During the day, the minimum volume of liquid drunk should be at least 1-2 liters

per adult. If there are contraindications, this amount may vary. On the day of the colonoscopy itself, you can drink water as usual.