Options for Colonoscopy Preparation: Are You Being Adequately Informed?

So no one wants to have to go through Colonoscopy Preparation or how to get ready for a colonoscopy or other type of colon exam. The procedure generally begins a few days before and is intended to clean your bowels thoroughly so that the physician performing the examination is able to clearly see the inside of your colon.  Gastroenterologists cannot see through lenses that are clouded so it is very important to prepare for your examination properly.

Here’s what you need to know about preparing for a colonoscopy, sigmoidoscopy, or other types of procedures that may require bowel cleansing.

sigmoidoscopy-photo 1. Different doctors will sometimes order different types of preparations.  Preparations are medications or products that you will take prior to your examine which will cause your bowel to empty.

2. Unfortunately, your doctor may not discuss colonoscopy preparation options with you in advance and may simply hand you a prescription to be filled at your local pharmacy and  you may have no idea what is in the preparations or understand that there are different options for preparing for a colonoscopy exam.

3. Some medications for colon cleansing and bowel preparation procedures have been found to have side effects and your doctor may not tell you about these, even if you ask directly about problems with safety. Note: to be fair all substances can have side effects but it is important to know what the side effects of a particular medication are or what the track record has been so that you are making an informed decision about what medicines to put in your body.

A patient wrote in and reported that he was to be scheduled for a sigmoidoscopy which is a procedure which is very similar to a colonoscopy except that in the sigmoidoscopy procedure the examination would just be done to the lower third of the colon, while in the colonsocopy, the physician would look at the entire 5 feet of colon.

 

In this patient’s case he had previously had a colonoscopy examination and had done very well with the preparation process using a Miralax/Dulcolax prep. But in this visit, to discuss a possible bowel issue, the physician decided to have the patient undergo a sigmoidoscopy and informed the patient that he was to use a bowel preparation method using “tablets” instead of drinking the liquid type bowel prep which the patient had previously used before. The patient questioned the physician and asked if there weren’t some negative side effects and/or problems/issues with the tablet prep. The physician did not acknowledge or explain any issues with the tablet bowel preparation medications to the patient. The patient remembered reading about some issues with the tablets as he had researched this the last time he had a colonoscopy, and specifically asked the physician about “problems” or drawbacks to using  the tablet preparation.  The physician explained that the pill bowel preparation was “easier” for the patient, although the patient wasn’t asking the doctor which bowel prep was easier, he was asking which one could be safer. And considering that the patient had encountered no difficulties or problems with the former bowel prep which was MiraLax and Dulcolax, the patient was asking why he could not simply use what he had used in the past, since his bowel was totally “clean” according to the physician during the last procedure.

The physician did not offer any explanation or additional information and handed the patient a prescription. The patient went to the pharmacy to have the prescription filled and paid $92.79 for the prescription. Thinking this was a mistake surely, the patient questioned the pharmacy staff and asked if the price was correct since he remembered how little he had spent for the last Miralax/Dulcolax prep a few months earlier. The pharmacy staff acknowledged the pricing was correct, then the patient finally used the last “safety net” in the medical chain and asked to speak to the pharmacist about the tablet preparation.  Hadn’t there been some “problems” with side effects with this medication asked the patient of the pharmacist. Especially in elderly persons or anyone with heart conditions perhaps? The pharmacist replied that he didn’t know of any such problems, and that all bowel preps basically accomplished the same thing. Cleaning of the bowel.

So the patient paid the $92.79 and went home. Later that evening the patient, being very conscious of his own health, did a search online about Visicol and OsmoPrep, the same medication that the patient was prescribed, and in a class of medications that is used in bowel cleansing prior to colonoscopies.  You can see the information below that the patient easily found regarding these types of bowel cleansing preparations.

“On December 11, 2008 the U.S. Food & Drug Administration (FDA) added the strongest safety warning available to oral phosphate drugs that are used before colonoscopies, following reports of kidney damage in several patients.

According to the FDA, it has received more than 20 reports of a serious form of kidney failure among patients taking the bowel-cleansing drugs. Some of the products affected by this action include the following: Visicol and OsmoPrep – both prescription tablets made by Salix Pharmaceuticals and Fleet Phospho-soda, made by C.B. Fleet Company Inc.”

The patient reported that he was disappointed in this experience with his physician and the pharmacist, and had asked questions of both about the safety of a particular class of bowel preparation medications in order so that he could make an informed decision about which to use. Unfortunately, neither health care professional offered any indication that there had been severe problems in the past leading to death of patients who had used these types of medications. Even if the numbers reported were “low” considering the number of patients taking these drugs the fact remains that the patient should have been given this information especially after probing and questioning both the physician and the pharmacist.

Furthermore, and as a final note, the cost of the OsmoPrep medication was $92.49, while the Miralax would have cost $12.26 for the bottle along with the Dulcolax or generic laxatives costing anywhere from $3.49  or $4.69 a box, and the patient would have used only 4 tablets for the preparation. So roughly, the Miraxlax Dulcolax prep would have cost around $14.26 for the preparation vs $92.49 for the OsmoPrep which was potentially more hazardous to the patient.

Because colon cancer is a huge issue for so many patients and colon cancer screening is vitally important this article was not written to discourage anyone from having testing performed. Certainly, it is important for everyone who fits certain criteria to have appropriate screening and diagnostic testing.   Colon cancer screening saves lives, and it is one of tests that can detect issues that could lead to a cancer before they affect you and when your doctor can intervene. So this article perhaps is not geared not only towards colonoscopy preparations, but rather, whether patients are adequately informed by their physicians about options with medications that are prescribed. There are some in the medical profession who believe that giving patients too much information or details will cause them to defer from having testing and or that patients are not in a position to make informed choices regarding medications. Others think that it is only through providing more transparency in the medical decision making process and by involving patients in decision making in their own health that will provide the best outcomes for both patient and physician. Because many types of healthcare decisions are not “black and white” but rather “shades of grey” then you will undoubtedly hear more about these kinds of issues in the future. How much you want to know, how much your medications and procedures cost, and what your options are with regards to medicines that are prescribed are all issues that may warrant additional debate.

Bottom line is that although you should always consult with your doctor when making medical decisions. However, if you are going to be undergoing any type of procedure that is non-emergent, or not an emergency, it may be in your best interest to ask many questions in advance from your health care provider about the medications they are planning to use during your procedure. And if you have the time to research your options safely, it may be in your best interests to also do research on your own about details regarding medications and then getting a second or even third opinion if necessary. Although most of us would like to think that our Doctor’s always know best,  with patient appointments in this day and age lasting only minutes, sometimes your medical provider may be more interested in getting you in and out of the office quickly instead of providing you with information about options that would allow you to make a choice regarding your care so that you and your physicians are partners in your health care rather than you being a passive recipient of care.

For more information about what you need to know about sedation medications that your doctor may use during procedures such as colonoscopies or other procedures requiring conscious sedation, please review our article about having a colonoscopy And Types of Sedation Options You Should Know.

We’d like to hear from you. What are your thoughts about medications that may be used by your doctor for procedures you may need or choose to have performed. Do you want to know details about the medications you are being prescribed? Or would you prefer not to know and to let your doctor just “handle it”.   What do you think?