Good bowel habits boost colonoscopy prep

Teach patients steps to regularity

To make sure patients are able to accomplish good bowel prep before a colonoscopy, find out if they have regular bowel movements, advises Annette Bisanz, RN, BSN, MPH, clinical nurse specialist for bowel and symptom management at University of Texas MD Anderson Cancer Center in Houston, TX.

"Assess patient's bowel habits," Bisanz says. If a patient eats three good meals a day, he or she should have a daily bowel movement.

"Health care professionals can assess the patient and see if he or she is having adequate elimination. If there are signs in the history the patient is packing up with stool, they need to do something before the bowel prep," she explains. For example, if the patient has hard, ball-like stools, he or she might need mineral oil to soften the stool and a bottle of magnesium citrate to clean out the bowel.

Patients need to be educated on good bowel habits, Bisanz says. She tells her patients if they do not have a bowel movement by 4 p.m. on the day they expect it, they should take 4 oz of prune juice and follow it with a hot liquid, such as tea, coffee, or soup. Prune juice is a natural laxative, and the hot liquid increases gastrointestinal motility, she says. If they don't have a bowel movement by bedtime, they should take a mild laxative, such as Milk of Magnesia.

People should respond immediately to prevent constipation, says Bisanz. Also, they need to routinely practice healthy habits to prevent problems. These habits include drinking 64 oz of fluid a day that includes water. At least 50% of the fluids should be non-caffeinated. Their menu should include 25-40 g of bulk-forming fiber as well, such as Fiber One cereal. Fluids and fiber are the frontline therapy for constipation, explains Bisanz.

When medications are prescribed, people need to know if constipation could be a side effect so they can be proactive as well. They can offset constipating effects of medicines by taking a stimulant laxative and stool softener, she adds.

A good assessment for healthy bowel habits should include how much fluid a person drinks, how much fiber they eat, what medications they take, how often they have a bowel movement, and whether it is quantity sufficient. A stool is quantity sufficient if it is the same size daily when meal size is the same. For example, if a person usually has a 12-inch stool and now it is 6 inches each day, yet eating patterns have not been altered, he or she is not having adequate elimination.

Constipation accounts for 2.5 million physician visits annually, and people spend $400 million on laxatives, Bisanz says. "Bowels have never been the emphasis in healthcare," she says. "It is a neglected field."


For more information about assessing good bowel habits or educating patients on this topic, contact:

• Annette Bisanz, RN, MPH, CNS, Clinical Nurse Specialist for Bowel and Symptom Management, MD Anderson Cancer Center, Houston, TX. Telephone: (713) 792-6012. E-mail: