Q. I’m 52 and in my 27th year as a T8 paraplegic. My primary care doctor referred me to see a gastroenterologist to have a colonoscopy. I’m not too worried about the test since, with my injury level, I won’t feel it. However, I am worried about dealing with “bowel cleanse” the day before. I’ve heard the laxative drink tastes really bad, and I’ve also heard it makes you poop like crazy for two to four hours. How am I supposed to manage this without having serious bowel accidents?
— Patti

A. Patti, kudos to your primary care physician for referring you to a specialist for this important health screening! According to the American Cancer Society, colon cancer is the fourth most common cancer diagnosed in the United States and results in approximately 40,000 deaths per year.

Dr. Jerome Stenehjem, medical director at Sharp Rehabilitation Center, explains that although a spinal cord injury doesn’t put a person at increased risk of colon cancer, managing all the medical details that go along with SCI can shift focus to a point where important tests like a colonoscopy are overlooked. Stenehjem says if you’re over 50 and haven’t had a colonoscopy, it is important to ask your doctor about it.

A colonoscopy is usually done on an outpatient basis and takes approximately 30 minutes to perform. During the procedure a thin tube with a camera on the end is fed through the rectum and goes the full length of the colon.  The instrument enables a doctor to view the entire colon on a monitor, see and remove polyps, and biopsy any suspicious-looking areas for testing.

During the procedure an anesthesiologist generally gives the person a mild sedative via an IV and monitors for signs of dysreflexia.

Let’s get back to your question about bowel cleanse. Also known as bowel prep, it is extremely important because the colon must be clean and free of stool so a doctor has a clear view of the colon to see and remove polyps and/or biopsy suspicious areas that may be signs of cancer.

Stenehjem explains it is important for people with SCI to thoroughly discuss the bowel prep method with a gastroenterologist, including information on how fast, or slow, their bowels work, and their level of paralysis. The prescription medication used for bowel prep creates such fast bowel evacuation that it has the potential to cause dysreflexia in people with paralysis at T6 or above. They should discuss this with their physical medicine and rehab doctor so they are prepared to deal with it if it occurs.

A colonoscopy is recommended every 10 years — the recommendation drops to ever five years if polyps are discovered. At age 52, I am in my 27th year as a T10 complete paraplegic and I recently had my second colonoscopy. I used the standard bowel prep protocol. I was put on a clear liquid diet two days prior to the procedure. The day before the colonoscopy I prepared a standard bowel prep laxative, a prescription mix called “Golytely” (also known as Nulytely or Colyte) in the gallon container provided by the prescription. It must be mixed in warm water. On advice of a nurse, I prepared it about eight hours in advance and put it in the refrigerator, as chilling it makes the taste more tolerable.

The afternoon before the procedure, I drank 8 ounces of Golytely every 10 minutes. I found chugging the mixture from a soda bottle is easier and more tolerable than drinking it from a glass, so I measured 8 ounces into a clean soda bottle and drank from that. A small swig of clear lemonade after chugging each bottle gets rid of the taste.

The directions say it takes about an hour for Golytely to take effect. I sat on a couple of towels draped over my cushion on my chair, and also had plenty of towels near the commode to deal with any mess that might occur. I had a timer set for one hour — by then my stomach was gurgling like a scene from the movie Alien. I transferred to the commode and kept a good book on hand. About five minutes later I started to empty just like clockwork.

Stenehjem explains that during the bowel prep it is important to do a digital stim every five to 10 minutes to make sure the sphincter muscle opens to let everything out.

In my case, the total time it took to drink the entire mixture was about two and a half hours — which is also the length of time it took before I was completely empty. I stayed on the commode for an extra half hour just to be safe, then transferred to the bathtub. A mirror skin-check that evening revealed that sitting on the commode for three hours left a few red areas that didn’t fade away until the next morning — a reminder that it is time to invest in a good toilet seat cushion to protect my aging skin.

An easier-sounding option for doing a bowel prep is checking into a hospital the night before a colonoscopy and letting the pros do the work. This is what Candace Cable did a few years back and Medicare covered the overnight stay. As always, be sure to get pre-authorization before doing this.

When she was 54, in her 33rd year as a T10 para, Cable contacted a friend who is also a highly recommended gastroenterologist and discussed  and then scheduled a colonoscopy. “The bowel prep sounded really difficult and I didn’t want to have to deal with cleaning up accidents and everything,” says Cable. “I checked into the hospital the night before the procedure and drank the stuff, pooped my brains out and it was easy. The next morning I had the colonoscopy and it worked out really well.”

Since she has a low injury, Cable also chose to stay awake during the procedure so she could watch it on the monitor. “I was surprised at what my colon looks like — pink and cute and cool looking,” she says. “They found one little polyp that I watched them remove. The whole procedure was amazing.”

Another option for bowel prep is to have it done at a clinic that does colon hydrotherapy, often referred to as colonics. Sharon Gardner had a very bad experience with bowel prep in a previous colonoscopy, so when she was due for her next one, she had it done at a colon hydrotherapy clinic using the Angel of Water pulsed irrigation evacuation system, an FDA-registered Class II device that gently puts 101 degree gravity-fed water into the colon to do a complete bowel cleanse. Gardner reports the cost was $75 and took about an hour. She wrote an article about the procedure for NEW MOBILITY called “My Beautiful Colonoscopy” [January 2010]. As in any procedure, Gardner says it is important to discuss this with your doctor, including getting a prescription for a colonic.

Best of luck, Patti. The piece of mind knowing your colon is healthy is well worth the effort for the procedure.

Resources
• Angel of Water, 877/564.3185 or 512.707.8383; www.angelofwater.com
• PIE* Med (a pulsed irrigation evacuation device invented by a polio survivor), 770/447-1275; www.piemed.com

Advice in this column is supported by Craig Hospital’s SCI Nurse Advice Line, a toll-free hotline for people living with SCI, a community service partially funded by grants from the PVA Education Foundation, Craig H. Nielsen Foundation and Caring for Colorado Foundation. For non-emergency nursing information about SCI health, call 800/247-0257 between 9 a.m. and 4 p.m. Mountain time. If you have a health question, contact Bob Vogel at rhvshark@mac.com.