Should the colonoscopy prep use this many pills?

The answers here still apply.

I believe you’ve asked this before. The answer is the same no matter how fat or thin you are the bowel is pretty much the same length.

I never take everything they prescribe. I take about ¾. A jelly doctor tore me apart in a Q for saying that, but I’ll say it again. I feel petite people are over prescribed all types of medications. Even average women are smaller than the average man, and most prescriptions are to treat the average man.

I’ve had 3 colonoscopies, I’ve never taken the full dosage, and I’ve always been prepped just fine.

My mom did the pills last time and said she thought she was going to die. I told her not to take all the pills and she didn’t listen to me. She should have gone to the ER probably, but she knew if she went she probably wouldn’t get the colonoscopy and have to do it again. She’s in her 70’s now and after her last experience she said she probably won’t do another colonoscopy. That was her third (age 59, 60, 70) and the first one was fine. The second one the idiot gave her the liquid even though it is specifically contraindicated for her blood pressure medicine and her blood pressure was incredibly high for 48 hours, and the third time they still initially prescribed the liquid, and then they finally told her how many pills instead after she annoyed them. The problem with the pills is you can’t gauge as well how it’s working, because it takes a few hours for them to work. The liquid is more immediate and you can slow down or stop drinking.

Weight is not the only factors though. Narcotics and other medications constipated people, and those people, even skinny petite patients, need more colonoscopy prep than the average person.

I always tell the truth when they ask if I took the whole prep hoping they will give a damn and actually collect the data and analyze. A friend if mine said her husband once didn’t take the whole prep and answered honestly and the doctor wouldn’t even try and made him do it all over again two weeks later. He might have been ok for the procedure. I’m not sure exactly what part he didn’t complete though. I just take less, but still do the full routine. You can’t just skip a whole dose.

@JLeslie: Your premise is flawed. The prep is based on the length of the colon, not the weight of the patient.
From my response the last time:
“The average length of the small and large human intestinal tract is around 25 feet. That doesn’t change if the person is 100 or 400 pounds. The cleanser is not designed to be systemic, merely direct. If a plumber has to snake 25 feet of pipe, it is still 25 feet whether it’s in a mansion or a studio apartment.”

Well, the amount of food in the colon is different. Just ask nurses who clean out bed pans. None of the nurses want the fat patients.

It doesn’t change that I never take the whole prep and am always clean. It doesn’t change that my mom was shitting pure liquid for hours and hours and hours because she was over medicated.

I truly believe we don’t have accurate information about colonoscopy prep. The patients can’t be trusted to report honestly and the studies that have been conducted likely are conducted like most pharmaceutical studies, they take an educated guess on dose, they see if it works and see what the side effects are. If it works and no one dies or has extreme life threatening side effects they go with that recommendation. They rarely go back and cut the dose to see if it is still effective.

Look at what happened with Ambien. They actually had information women were over medicated and they ignored it and only used the averages of men and women. Now, years later, after women have had some scary side effects, for the first time in history, dosage recommendations are officially different for women than men.

I’m not saying my antidoctal experience and observations are scientific, I’m only saying I question if any scientific evaluations were done for the colonoscopy prep recommendations to adjust for gender or weight.

You know what one of the female scientists said about the original results of Ambien testing that showed a problem? She said, “we ignored the results because women have cyclical hormonal changes that we feel mess up results.” That report I saw harped on the hormones, I still say weight is a very big factor. My petite friends feel over medicated all the time, even on drugs like Advil. For children we adjust ibuprofen dosage by weight, what really changes?

Didn’t read the post, did you.

Drugs that are designed to be systemic are all about weight and size. The colonoscopy prep drugs are not designed for that. Maybe they should have the directions cover, in detail, exactly how much of which kind of food one has eaten during the preceding few days, that might be more accurate, but again, not a weight based measurement.

Should a 250 pound person use twice as much eyewash? If I weigh 20 pounds more than you should I use a 20% longer piece of dental floss?

@canidmajor Have you had a colonoscopy?

My generalization about weight was including drugs like ibuprofen and Ambien.

Regarding colon prep it was about the quantity of food in the intestines. The larger the person, more food, unless the restrict for two days before the prep or if a tiny person binges beforehand they might have more than usual food. Fat people might be more likely to eat constipating food, but not necessarily. Also, there is obviously a difference between overweight people and simply very talk people, both eat more calories, and likely more food bulk, than a short thin person though.

@JLeslie If a person is fat, I would think most of the fat is not in the bowels, it’s elsewhere. So, the size and length of the bowels are probably comparable to everybody else’s.

I am not questioning the length of the bowels. I’m talking about the likelihood of the quantity of food in the bowels. I would guess there is a range of normal length of intestines. I don’t know if there is any significant correlation to the person’s height.

@osoraro Have there been any reliable studies testing lesser amounts of prep than what is commonly prescribed today in controlled conditions with results separated out by gender and obesity?

I’m smallish, I guess you would consider me petite. I’ve had two colonscopies and the meds they gave me didn’t work as they should’ve. Size didn’t seem to matter in my case. I don’t see how anyone can make a judgement based on size of patient. Yes, they went ahead and did my colonoscopy. I was fine.

@chyna What do you mean they didn’t work as they should have? You weren’t cleaned out and they still did your colonoscopy and didn’t make you take more prep? I’m not sure I understand.

@canidmajor According to this obesity and being a man are risk factors in the prep not being sufficient.

@JLeslie Yes, I wasn’t cleaned out as I supposedly should have been. But they did it anyway.

@chyna Got it. I wonder why they didn’t make you continue the prep or come back? I don’t expect you to know the answer. Do you take medication that might inhibit the effectiveness of the prep? That happened to my aunt. She was just 105 pounds at the time. Although, I’m not sure she was fully compliant. They had her continue and come back the next day.

Not getting in the middle of this but this is the prep many places are recommending nowadays. It’s much better tolerated.

http://www.salix.com/healthcare-professionals-resources/gi-digest-newsletter/gi-digest-archive/importance-of-split-dosing-bowel-preparation-for-colonoscopy/

Nurse here. I don’t mind fat people opening their bowels as they tend not to eat high fibre food so actually there’s very little to come out.

Back to the colonoscopy thing. The most common complication of colonoscopy is a missed lesion. In a perfectly clean bowel a quarter of colonoscopies will have missed at least 1 polyp. The more liquid stool in the bowel the more likely you are to miss something. The smallest polyp I have personally found that was cancerous (as opposed to pre cancerous which is more common for polyps) was 2mm. As we all know bowel cancer is incredibly easy to treat if caught early (in this patients case it was rejected completely with good margins at the same colonoscopy). If that had been left by the time the patient had had a repeat colonoscopy the cancer would have been considerably larger so easier to spot but also more difficult to treat.
It doesn’t take much liquid stool in your bowel to obscure things like that so if you aren’t taking the prep properly and there is some stuff left over you aren’t doing your self any favours. The colonoscopist isn’t going to care. They’ll still perform the procedure but they’ll make a little note on the report about the quality of bowel prep to protect themselves if it turns out you do have bowel cancer.

OMFSG. I’ll put this argument to rest once and for all. It’s a question about a frikking colonoscopy prep—I don’t know why all the name calling. I can 100% absolutely guarantee that I know more about this than anybody here, with the possible exception of @Lightlyseared. I’ve done over a thousand colonoscopies, and I have about 15 more scheduled this week.

1) Prep dose has absolutely nothing to do with the weight of the person. A heavy person can be well prepped and a light person can be badly prepped with the same dose.

2) Prep quality has more to do with the strict compliance with the protocol of the prep and the timing of the last prep dose than anything else. If you took your last prep dose 4 hours before the procedure you’re going to be better prepped than if you took your last dose 12 hours before the procedure.

3) There used to be a prep that did cause hyperphosphatemia in those with renal insufficiency. Nobody uses that any more

4) If you have any question in your prep, take more. The prep is a pain, but coming back for a repeat colonoscopy because you were insufficiently prepped is even worse.

5) You want the colonosopist to spend time looking at your colon, not washing your colon.

6) And for the love of everything that is holy, do not eat any corn. Corn kernels are exactly the right size to get stuck in the suction chamber of the colonoscope.

That is all. Continue to bicker if you want, but that is the answer to the question.

@osoraro Thanks. I like number 2, I found that very useful. Thank you for verifying number 3. I didn’t know about number 6, doctors have never mentioned that.

So, you disagree with the doctor in the medscape article about obesity. Interesting.

NIH website if you’re interested regarding obesity and colon prep. It’s a 4 month study.

@JLeslie I know that study. Odds ratio of the study for obesity barely reached significance. Not enough to recommend different preps for different sized people. If you read it, you’ll see that a far greater predictor is narcotic use. For those patients we recommend a double prep.

@osoraro Thanks for your comment. I read another study that said they couldn’t repeat the findings in my link using a split prep and some drug they named, which I assume is the currently used drug, (the liquid) there was no significant difference regarding BMI. Although, that particular study seemed screwy, because the way I interpreted it they used one drug all day, and the other drug in the split. So, it wasn’t really a good double blind random study from what I could tell. But, it did record data for the effectiveness of the split day by gender and BMI. I don’t know how many participants.

I know about the narcotics. I assume that’s why my aunts prep wasn’t effective. At least partly that reason.