Colorectal Screening

Colorectal cancer is a leading cause of cancer deaths in the U.S. for both men and women. With early detection through screening, colorectal cancers are preventable and treatable. Talk to your primary care provider about colorectal screening. To schedule an appointment with a primary care provider at UofL Health – UofL Physicians, call 502-588-4343.

If a colonoscopy is recommended, a number of UofL Physicians practices offer this. To schedule a screening colonoscopy, talk to your primary care provider or call the UofL Health Cancer Screening Program at 502-210-4497.

Screening Guidelines

The United States Preventive Services Taskforce (USPSTF) recommends screening for colorectal cancer in all adults aged 45-75 years.

For patients ages 76-85, talk to your provider about whether or not screening is recommended. Your provider will consider your overall health, prior screening history and preferences.

Screening should be done by ONE of the following:

Annually, have a Fecal Occult Blood Test (FOBT). If the physician finds blood in your stool, you may need a colonoscopy.
Every five years, have a virtual colonoscopy, also called Computed Tomographic (CT) Colonography. A colonoscopy will be performed if polyps are found.

Every 10 years, have a colonoscopy performed if not at high risk.

Who Should Be Screened?

Anyone age 45 or older should be screened. In 2018, the American Cancer Society lowered the screening age recommendation from 50 to 45 because of a higher incidence rate in those aged 45-49 that wasn’t being caught early enough.

For those with a personal history of inflammatory bowel disease or a family history of colorectal cancer or certain type of polyps, screening should be completed earlier.

Are You Born After 1990? You May Be at a Higher Risk.

The nation is currently facing an epidemic of young people with colon and rectal cancer that is presenting in people that have essentially no other medical problems. Based on actuarial data, if you were born after the year 1990, your risk for developing colorectal cancer is roughly six times what it would be for your parents over the course of your lifetime.

Health experts aren’t sure why exactly this is happening, but they do know it is not because of a genetic predisposition or environmental exposure.

In this group of younger people, the disease is often more deadly because most clinicians do not have the raised awareness of young people being diagnosed with colorectal cancer. The symptoms younger patients present with could be discounted because of their age.

Due to the prevalence of the disease in younger people and how the disease manifests itself, patients should be encouraged to talk to their health care provider about preventative screenings and physical exams to identify colorectal cancer.

What are the Symptoms?

Having a hard time initiating a bowel movement
Changing the foods that you eat because some foods are not tolerated like they used to be
Pain in the abdomen
Abdominal distension and bloating
Severe nausea
Blood when a person passes a bowel movement

What Types of Screenings are Recommended?

Colorectal cancer screening is covered by most insurances, though some still may not cover it until age 50.

Colonoscopy – A screening colonoscopy is the best way to detect pre-cancerous polyps and cancer. The procedure may be done by a colorectal surgeon, general surgeon or gastroenterologist. This should be completed every 10 years.
Stool test – A take-at-home stool test including FIT or Stool DNA such as Cologuard ® which looks for blood in the stool or both blood and DNA changes suggestive of colorectal cancer. A positive take-at-home test must have a colonoscopy to complete the screening process. This can be completed with a primary care provider.

Preparing for Your Colonoscopy

Some health care providers may require a different type of prep for colonoscopy. The following is the Dulcolax and MiraLAX over-the-counter preparation instructions. This currently applies to colonoscopies scheduled through the Brown Cancer Center Colon Cancer Screening Program and taking place at:

One Week Before Your Colonoscopy

Ask About Taking Your Medications

Not all medications are safe to take prior to your colonoscopy. Discuss all of your medications, both prescription and over-the-counter, with your health care provider.

Commonly, anticoagulants (blood thinners) and diabetes medications should be carefully discussed with your provider to determine a care plan. Do not stop taking either medication without first consulting your prescribing provider.

If medications are not taken properly prior to the procedure, your colonoscopy may be canceled.

Arrange for a Ride Home

A responsible caretaker (age 18 or older) who is available to take you home after your colonoscopy must be arranged in advance. Your caretaker should be prepared to contact your care team if there are any questions or concerns.

Get a Letter from Your Doctor, if Needed

Some conditions may require you to have a clearance letter from your doctor prior to your procedure, including a recent history of chest pain, trouble breathing, fainting or if you have an automatic implantable cardioverter-defibrillator (AICD). The letter must be received by the office at least one day before your colonoscopy.

Purchase Supplies

In order to prepare your bowels for your colonoscopy, the following supplies will be needed:

Four (5 milligram) tablets of bisacodyl (Dulcolax® or generic brand). These are usually sold as a box of 8 tablets.
One 8.3 ounce (238 gram) bottle of polyethylene glycol (MiraLAX® or generic brand)
64 ounces of any clear liquid that isn’t red or purple. You will need to mix this with the MiraLAX®. Keep it at room temperature.
- A sports drink, such as Gatorade® or Powerade®, can help you to replace the electrolytes that you will lose during the bowel preparation.
- If you have diabetes, be sure to purchase sugar-free clear liquids.

Purchase Extra Supplies

If you have challenges with constipation, it would be helpful to add a 10-ounce bottle of magnesium citrate to your prep regimen.

At bedtime, the night before you begin your colon prep, drink the entire 10-ounce bottle of magnesium citrate.
Follow this with 20 ounces of water and go to sleep.
The next morning, before beginning the Dulcolax® and MiraLAX® prep, your bowels should begin to move.
Continue to drink at least 8 ounces of clear liquid every 30 minutes throughout the day you are taking the Dulcolax® and MiraLAX® prep.

Five Days Before Your Colonoscopy

Stop Taking Any Iron Supplements

Any iron supplements must not be used for the five days leading up to your procedure, as iron supplements can make it difficult for your provider to see your colon.

Three Days Before Your Colonoscopy

Adjust Your Diet

A low-fiber diet should be started three days before your colonoscopy. The following foods should not be eaten:

Raw (uncooked) fruits and vegetables.
Whole kernel corn, including canned corn.
Whole grains (such as oatmeal, brown rice, quinoa or wheat bread)
Seeds (such as poppy or sesame)
Nuts

Talk with Your Care Team

A few days before your procedure, you will get a call from someone on your care team to discuss the instructions and your medical history. At this point, your medications will be reviewed and you will be told which medications are safe to take on the morning of your colonoscopy.

Two Days Before Your Colonoscopy

Your low-fiber diet should be continued unless you:

Are often constipated
Take narcotic medicines
Have had a colonoscopy with a poor prep in the past

If any of those apply to you, stop following the low-fiber diet and instead follow these instructions:

Take one (17 gram) dose of MiraLAX® three times a day. Mix one dose with eight ounces of liquid each time. You can take one dose at breakfast, lunch and dinner.
Follow a full liquid diet. On a full liquid diet, you can eat and drink the following:
- Yogurt without any pieces of fruit
- Fruit juices without pulp
- Soda
- Broth or cream soups that have been strained to remove vegetable pieces
- Nutritional supplements
- Ice cream and fruit ices without any pieces of fruit, nuts, fudge or peanut butter mixed in

One Day Before your Colonoscopy

Prepare Your MiraLAX® Bowel Prep

On the morning of the day before your procedure, mix all 8.3 ounces (238 grams) of the MiraLAX® powder (or generic brand) with 64 ounces of a room temperature clear liquid until the MiraLAX® powder dissolves. Once the MiraLAX® is dissolved, you can put the mixture in the refrigerator if you would like; however, drinking it at room temperature will help it move faster through your digestive tract.

Follow a Clear Liquid Diet

You will need to follow a clear liquid diet the day before your procedure. A clear liquid diet includes only liquids you can see through.

While on a clear liquid diet:

Do not eat any solid foods.
Do not drink anything red or purple.
Try to drink at least one eight-ounce cup of liquid every 30 minutes while you’re awake.
Drink different types of clear liquids to ensure you receive enough calories. Do not just drink water, coffee and tea.

If you have diabetes, drink only sugar-free clear liquids and check your blood sugar level often. If you have any questions, talk with your health care provider.

Clear Liquid Diet

Soups

Okay to Have

Clear broth, bouillon or consommé

Do Not Have

Anything with pieces of dried food or seasoning

Sweets

Okay to Have

Gelatin, such as Jell-O®
Flavored ices
Hard candies, such as Life Savers® and lemon drops

Do Not Have

Anything red or purple
All other sweets

Drinks

Okay to Have

Clear fruit juices, such as lemonade, apple, white cranberry and white grape juices
Soda, such as ginger ale, 7UP®, Sprite® and seltzer
Sports drinks, such as Gatorade® and Powerade®
Coffee without milk or creamer (sugar may be added)
Tea without milk or creamer (sugar may be added)
Water, including carbonated (fizzy) and flavored water

Do Not Have

Anything red or purple. This includes red or purple juices, sodas and sports drinks.
Juices with pulp
Nectars
Smoothies or shakes
Milk, cream and other dairy products
Nut milks, plant milks, non-dairy creamers and other dairy alternatives
Drinks with alcohol

Gearing Up for Your Procedure

Begin Prepping Your Bowels

Step One

At 1 p.m. on the day before your procedure, swallow four bisacodyl (5 milligram) tablets with a glass of water.

Step Two

At 4 p.m., start drinking the MiraLAX® mixture.

At 4 p.m., drink one (8-ounce) cup of the mixture.
At 4:15 p.m., drink one (8-ounce) cup of the mixture.
At 4:30 p.m., drink one (8-ounce) cup of the mixture.
At 4:45 p.m., drink one (8-ounce) cup of the mixture.

You will drink four cups of the mixture in total.

When finished, half of the MiraLAX® mixture will be left.
Bowel movements usually start within one hour of drinking the first dose, but it may take longer for some people.
- Do not worry if you do not start having bowel movements after drinking the first half of the MiraLAX®. Keep drinking clear liquids and start the second half of the MiraLAX® as instructed.
Put petroleum jelly (Vaseline®) or A+D® ointment on the skin around your anus after every bowel movement to help prevent irritation.
Keep drinking clear liquids (8 ounces every 30 minutes) to stay hydrated and flush out your colon.

Step Three

At 9 p.m., start drinking the second half (four 8-ounce cups) of the MiraLAX® mixture.

At 9 p.m., drink one (8-ounce) cup of the mixture.
At 9:15 p.m., drink one (8-ounce) cup of the mixture.
At 9:30 p.m., drink one (8-ounce) cup of the mixture.
At 9:45 p.m., drink one (8-ounce) cup of the mixture.

Be sure to finish all of the MiraLAX® mixture before 10 p.m.

Step Four

Do not drink anything after midnight the night before your colonoscopy. In the morning, you may brush your teeth but spit out any liquids and do not swallow anything.

The Day of Your Colonoscopy

Things to Remember

Take only the medicines you were instructed to take the morning of your procedure. Take them with a few sips of water.
Do not wear any lotions, creams or powder on your chest or arms.
Take off any jewelry, including body piercings.
Leave all valuables, such as credit cards and jewelry, at home.
If you wear contacts, wear your glasses instead.

What to Bring

Your wallet card if you have an AICD.
Your rescue inhaler (such as albuterol for asthma) if you have one.
A case for your glasses or dentures if you wear them.
Your Health Care Proxy form, if you filled one out.

What to Expect

Upon arrival, you will change into a hospital gown and nonskid socks. You will meet with your doctor who will explain the procedure to you and answer any remaining questions. Your anesthesiologist will then review your medical history with you and talk about what kind of anesthesia you will receive.

When it is time for your procedure, you will need to lie on your left side with your knees bent. An intravenous (IV) line will be placed into a vein to administer anesthesia. Your procedure will begin once you are asleep. The procedure takes less than 45 minutes.

After Your Colonoscopy

You may experience bloating and stomach cramps after your colonoscopy, but this can be relieved by passing gas. You will continue to be monitored until you are fully awake and your IV has been removed. You and your caretaker will then be given further instructions leading up to your discharge.

At Home

Once you are discharged, you are free to start eating light foods, but spicy, greasy and fried foods should be avoided until you have worked your way back up to a normal diet. Alcoholic beverages should be avoided for 24 hours after your procedure, at which point you can resume all normal activities.

Your bowel movements may be irregular or different than usual for up to a week after your procedure. Bleeding in small amounts from your rectum is normal for the first 24 hours after your procedure.

When to Call your Health Care Provider

Call your health care provider if you experience any of the following:

A fever of 101° F (38.3° C) or higher
Strong stomach pain or bloating
Bleeding from your rectum that lasts more than 24 hours
Bleeding between bowel movements
Weakness, faintness or nausea
Heavy bleeding from your rectum

If you have questions or concerns, contact your health care provider.

After Your Colonoscopy

At Home

Your bowel movements may be irregular or different than usual for up to a week after your procedure. Bleeding in small amounts from your rectum is normal for the first 24 hours after your procedure.

When to Call your Health Care Provider

Call your health care provider if you experience any of the following:

A fever of 101° F (38.3° C) or higher
Strong stomach pain or bloating
Bleeding from your rectum that lasts more than 24 hours
Bleeding between bowel movements
Weakness, faintness or nausea
Heavy bleeding from your rectum

If you have questions or concerns, contact your health care provider.

If you’re diagnosed with colorectal cancer and further treatment is needed, the multidisciplinary colorectal cancer team at UofL Health – Brown Cancer Center has a team of oncology experts ready to help. Call 502-562-HOPE (4673) or visit this page.