NCH colonoscopy instructions

If you have any questions, concerns, or need to reschedule or cancel your appointment please call our office and speak with any member of our staff. You can reach us at 802-334-3500.

PRE-OP will call a 1-7 days before your procedure to confirm or adjust your check-in time.

  • Arrange for a ride to and from the hospital. You will be having an anesthetic or local with sedation. Driving after receiving an anesthetic or sedation is extremely dangerous.
  • Expect to be at the hospital for three (3) hours.
  • Please leave your valuables at home, including jewelry.
  • Please bring a list of your regular medications with you.
  • Please call 334-4170 if you are going to be unavoidably delayed for your check-in time.

*If you are a woman and of childbearing age, you may be required to complete a pregnancy test prior to your procedure.

 A pre-op nurse will call you 1-7 days before your procedure to speak with you. Whether you are going to receive an anesthetic administered by an anesthesiologist, or you are having a local with IV sedation, your vital signs will be monitored by means of an automatic blood pressure cuff, EKG pad, and a pulse oximeter on your finger, which measures the concentration of oxygen in your blood. It is normal to receive oxygen through a nasal cannula during the procedure and in the recovery room until you are fully awake.

You will be given instructions when you leave the recovery room regarding activity and diet.  An appointment with your physician will be made for you before you leave the recovery room, if needed.


To prepare:

Purchase from your local pharmacy the following (these items do not require a prescription):

  • MiraLax 238 gm (available in a bottle; you may also purchase the generic called PEG 3350).
  • Dulcolax 10mg total (Bisacodyl) Tablets may come in 5mg or 10mg.
  • 64 ounces of Gatorade or a clear non-carbonated liquid (water, Crystal Light, apple juice). Please avoid red beverages.

MiraLax is an osmotic laxative used commonly in the treatment of occasional constipation. It has no sugar or sweetener, no taste, grit, or residue. When used as a colon preparation, it allows complete pre-procedure cleansing while minimizing patient discomfort. Please follow the instructions carefully. 


  • If you are having an Upper Endoscopy (EGD) Discontinue any PPI (Pantoprazole, Omeprazole, Nexium, ect.)
  • You may start Pepcid (famotidine) 20 mg by mouth daily to replace the PPI.
  • Discontinue anticoagulants (blood thinners) that you are taking (Coumadin/Warfarin, Clopidogrel/Plavix, Eliquis/Apixaban, Aggrenox)

If you are on aspirin 325mg, drop the dose down to an 81mg for the week leading up to the procedure

  • Discontinue Fish oil (Omega 3)
  • Discontinue Vitamin E
  • Discontinue Turmeric (Curcumin)


  • Discontinue fiber supplements: Metamucil, Citrucel, FiberCon, etc.
  • Discontinue taking iron pills or medications that can cause bleeding (Aleve, Naprosyn, Motrin, ibuprofen, sulindac, or any other NSAID). Use Tylenol for pain if needed.
  • Discontinue all over-the-counter herbal products.



ALLOWED:  Soup, fish, chicken, eggs, white rice, bread, crackers, plain yogurt, pasta, potato with no skin, gelatin, broth, bouillon, all liquids.

AVOID:  Fresh and dried fruit, all vegetables, raisins, nuts, seeds, cloves, any other meat besides what is listed above.


This is the prep day. Only clear liquids are allowed until the colonoscopy is completed. Consumption of anything other than clear liquids will impair the quality of the prep and thus impair the quality and safety of the colonoscopy.

 CLEAR LIQUID DIET includes: Any liquid you can see through with no pulp

  • Water
  • Clear broth, beef or chicken
  • Juices (apple juice, grape juice, white cranberry juice, Tang, Kool-Aid, lemonade)
  • Sodas
  • Tea: No cream or milk, including non-dairy
  • Black coffee only
  • Clear gelatin (without fruit)
  • Popsicles (without fruit or cream)
  • Italian ices
  • Gatorade, Crystal Light, iced tea, other clear beverages

Mix the entire 238 gm bottle of MiraLax (or the generic form glycolax) in 64 ounces of Gatorade or any other clear, non-carbonated fluid. Shake well and keep refrigerated for better taste.

If you are diabetic: Use sugar-free drinks during the prep.

At 1:00pm Take Dulcolax (Bisacodyl) (s) 10mg. by mouth.

If your Check in time is before 10:00am

At 5:00pm the day prior drink an 8-ounce glass of the prep rapidly every 15 minutes until the solution is gone.

If your Check in time is at 10:00am or after (split prep)

At 5:00pm the day prior drink an 8-ounce glass of the prep rapidly every 15 minutes until half (32 ounces) of the preparation solution is gone (approximately 4 glasses).

At 7:00am on the day of the procedure, drink an 8-ounce glass of the prep rapidly every 15 minutes until the remaining preparation solution is gone (approximately 4 glasses).

A loose, watery stool should occur in approximately one hour. Continue drinking fluids from clear liquid diet until the watery stool is clear and free of solid material.

 AFTER 12:00 MIDNIGHT, you may ONLY have water, apple juice or ginger ale up to 2 hours prior to your check-in time.


DO take your usual morning medications at least 2 hours prior to check in with a small sip of water, with the exceptions noted below:

  • If you are a diabetic do NOT take: Regular insulin, diabetic pills, any insulin if you take a mixture such as 70/30, 60/40, etc., Humalog, or Byetta pen.
  • If you take NPH insulin, take one-half (1/2) of your normal dose only. If you take Lantus or Levemir, take your normal
  • Please take all heart and blood pressure medications and any inhalers.
    • However, if your colonoscopy is scheduled with anesthesia and you currently take medications for your heart and blood pressure, the preop department will review which ones to take prior to your procedure.
  • Other: __________________________________________________________________

 DO NOT take the following medications:

  • Liquid antacids (Maalox, Mylanta, etc.)
  • Carafate
  • Vitamins



PREPARATION:  You should receive instructions for preparing your colon from the office.

COLONOSCOPY:  A procedure on a clean, prepared colon using a flexible scope with fiber optics to visualize the entire colon (also known as the large intestine) for colon cancer screening and possibly visualize the last part of the small intestine. It also allows for treatment such as removal of polyps, biopsies of unusual areas, or control of bleeding.

LENGTH OF PROCEDURE:  The procedure usually lasts from 30-60 minutes, but can take longer if polyps are present, if the colon is excessively long or twisted, or if excessive scar tissue exists. The extent of time required from check-in to check-out is approximately 3 hours.

AWARENESS DURING THE PROCEDURE:  The procedure is usually done with moderate “conscious” sedation where you are comfortable during the exam. You may fall asleep but are easily aroused. Occasionally, deeper anesthesia with an anesthesiologist present is used. Which one depends on a variety of issues, including medical history and past experience with anesthesia. You may experience some cramping or “gassiness” during the procedure or after.

AFTER THE PROCEDURE:  You cannot drive home after the procedure due to the IV sedation and you should not drive that day. You must make arrangements to have someone to take you home from the hospital. Even if you want to take a cab/bus home, you must have someone with you that will be responsible for you. You should take the rest of the day off and not operate any machinery, go to work, or sign any legal documents for the rest of the day. You should be able to return to work the following morning.

COMPLICATIONS:  Complications uncommonly occur.  If one does occur, it will be treated appropriately.  This could require hospitalization, medication, additional procedure(s), blood transfusion, or surgery.  Please contact North Country Surgical Associates immediately if you experience any of the following:

  • Temperature of 101°F degrees or higher any time within 72 hours after the procedure.
  • Blood from the rectum of greater than one (1) teaspoon.
  • Severe abdominal pain.
  • Any symptoms that may concern you.

ALTERNATIVES:  Alternatives include sigmoidoscopy (only looks at the ending of the lower colon), barium enema (radiology study), 3-D virtual colonoscopy (not yet approved as a screening tool and usually not covered by insurance), and stool hemoccult testing. Please make an appointment in the office if you would like to discuss the alternatives further.

RESULTS AND FOLLOWUP:  Results will be given both verbally and in written form right after the procedure.  They will be discussed with you and anyone waiting for you, if you so direct.  We will contact you by phone if anything needs immediate follow-up.  If you have not heard anything by two weeks, contact the office for results.

Office follow-up is usually not necessary after a routine colonoscopy.  If you would like a follow-up appointment or other issues are involved, schedule a follow-up office appointment.  Your next recommended colonoscopy is usually based on family history, findings at the time of colonoscopy, pathology results, or other risk factors.

INSURANCE:  Colonoscopies are frequently covered by insurance companies.  You may still be responsible for a deductible or a co-payment.  While our office will generally pre-certify your procedure, IT IS YOUR RESPONSIBILITY TO CALL YOUR INSURANCE COMPANY TO VERIFY YOUR BENEFITS FOR THIS PROCEDURE.  Medicare does not require precertification.


PLEASE NOTE:  It is extremely important to follow the preparation listed above so that the doctor will be able to see your entire colon.  Your colon must be clear of any stool.  Inadequate preparation limits the value of this procedure and could necessitate rescheduling the examination.


  • The prep tastes better and is better tolerated if chilled in the refrigerator before drinking, is taken through a straw, or you suck on lemon slices.
  • Keep reconstituted solution refrigerated and use within 48 hours after mixing.
  • Some people may develop nausea with vomiting during the prep. The best remedy for this is to take a break from drinking the solution for about 30 minutes and then resume drinking at a slower rate. It is important to drink the entire contents of the solution.
  • Walking between each glass can help with bloating.
  • Use baby wipes instead of toilet paper to prevent irritation of the anal area.
  • Apply some Vaseline or Desitin to the anal area/between the buttocks prior to beginning the prep and reapply as needed.
  • Remain close to the toilet facilities, as multiple bowel movements may occur. This prep often works within 30 minutes, but may take as long as three (3) hours.


Insurance Coverage for Colorectal Cancer Screening

The American Cancer Society believes that all people should have access to cancer screenings, without regard to health insurance coverage. Limitations on coverage should not keep someone from the benefits of early detection of cancer. The Society supports policies that give all people access to and coverage of early detection tests for cancer. Such policies should be age- and risk-appropriate and based on current scientific evidence as outlined in the American Cancer Society’s Early Detection Guidelines.

Private health insurance coverage for colorectal cancer screening

Many people choose to be screened with colonoscopy. While it might not be right for everyone, it can have some advantages, such as only needing to be done once every 10 years. And if the doctor sees something abnormal during the colonoscopy, it can be biopsied or removed at that time, most likely without needing any other test.

Although many private insurance plans cover the costs for colonoscopy as a screening test, you still might be charged for some services. Review your health insurance plan for specific details, including if your doctor is on your insurance company’s list of “in-network” providers. If the doctor is not in the plan’s network, you may have to pay more out-of-pocket. Call your insurer if there’s anything you’re not sure about.

Before you get a screening colonoscopy, ask your insurance company how much (if anything) you should expect to pay for it. Find out if this amount could change based on what’s found during the test and if it includes both professional and facility charges. This can help you avoid surprise costs.

Medicare coverage for colorectal cancer screening

Medicare covers an initial preventive physical exam for all new Medicare beneficiaries. It must be done within one year of enrolling in Medicare. The “Welcome to Medicare” physical includes referrals for preventive services already covered under Medicare, including colon cancer screening tests.

If you’ve had Medicare Part B for longer than 12 months, a yearly “wellness” visit is covered without any cost. This visit is used to develop or update a personalized prevention plan to prevent disease and disability. Your provider should discuss a screening schedule (like a checklist) with you for preventive services you should have, including colon cancer screening.

What colorectal cancer screening tests does Medicare cover?

Medicare covers colonoscopies, generally starting at age 50:


  • Once every 2 years for those at high risk (regardless of age)
  • Once every 10 years for those who are at average risk
  • 4 years after a flexible sigmoidoscopy for those who are at average risk

Flexible sigmoidoscopy every 4 years, but not within 10 years of a previous colonoscopy.

At this time, Medicare does not cover the cost of virtual colonoscopy (CT colonography).

If you have questions about your costs, including deductibles or co-pays, it’s best to speak with your insurer.

What would someone on Medicare expect to pay for a colorectal cancer screening test?

  • Colonoscopy: Covered at no cost at any age (no co-insurance, co-payment, or Part B deductible) when the test is done for screening. Note: If the test results in the biopsy or removal of a growth, it’s no longer a “screening” test, and you will be charged the 20% co-insurance and/or a co-pay.
  • Flexible sigmoidoscopy: Covered at no cost (no co-insurance, co-payment, or Part B deductible) when the test is done for screening. Note: If the test results in the biopsy or removal of a growth, it’s no longer a “screening” test, and you will be charged the 20% co-insurance and/or a co-pay.

If you’re getting a screening colonoscopy (or sigmoidoscopy), be sure to find out how much you might have to pay for it. Also ask how much you will have to pay if a polyp is removed or a biopsy is done. This can help you avoid surprise costs. You may still have to pay for the bowel prep kit, anesthesia or sedation, pathology costs, and facility fee. You may get one or more bills for different parts of the procedure from different practices and hospital providers.

It’s important to understand that if you have a screening test other than colonoscopy and the result is positive (abnormal), you will need to have a colonoscopy. This is typically considered a diagnostic (not screening) colonoscopy, so you may have to pay the usual deductible and co-pay.

Medicaid coverage for colorectal cancer screening

Unlike Medicare, there’s no federal assurance that all state Medicaid programs must cover colorectal cancer screening in people without symptoms. Medicaid coverage for colorectal cancer screening varies by state. Some states cover fecal occult blood testing (FOBT), while others cover colorectal cancer screening if a doctor determines the test is medically necessary. In some states, coverage varies according to which Medicaid managed care plan a person is enrolled in.

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