With the advice of Rosanna Ercole Mellone, popularizer of nutrition.
Scientific review by Gian Luigi De Angelis director of the complex structure of Gastroenterology and Digestive Endoscopy of the University Hospital of Parma.
Follow a colonoscopy diet, before performing the examination it is important to completely cleanse the intestine and make it more visible. In fact, colonoscopy is a diagnostic test that allows thedirect observation of the inside of the intestine. The investigation is invasive because it is done by inserting a flexible probe into the organ, through the anal orifice. There diet for colonoscopy consists avoiding, for about a week, vegetables with seeds and, in the last days, foods with fibers. However, in the diet, green light to foods of animal origin.
Instead, the day before the exam, the colonoscopy diet becomes liquid and you are also treated with purgatives and enemas. However, the most modern method, adopted in large structures, involves a single day of diet and an enema before surgery, without laxatives.
Colonoscopy is indicated for colorectal cancer screening and to diagnose numerous intestinal changes, including diverticula. The images obtained become three-dimensional on a computer screen.
What does the diet for colonoscopy, after examination? After the colonoscopy, you can gradually return to a normal diet. For the first few times after the test, you still need to avoid alcohol and elaborate dishes. In addition, you must stick to light dishes, prepared with simple and light cooking. Probiotics, such as yogurt, and prebiotics, such as bananas, are recommended. Together, the two elements facilitate the restoration of the bacterial flora of the intestine, which was lost with colonoscopy.
Colonoscopy: what it is
Colonoscopy is a direct examination of the intestine, to see it internally and diagnose problems of a different nature. With the procedure, which is outpatient, the conformation and walls of the colon, rectum and large intestine can be explored. The endoscopic and real-time observation of the organ takes place through a flexible tube, or probe, introduced through the anal canal. In the intestine, the instrument, which has a diameter of about 12 mm, equal to a finger, goes up along the passable sections of the organ.
Equipped on top of light and micro camera, the endoscope allows you to check:
- shape of the intestine
- width
- colore
- any alterations of the tissues.
During the test, the specialist can remove anomalous parts and suspicious fragments, For the 'microscopic examination, or biopsy.
The probe can reach the last part of the small intestine, in the case of a “pan-colonoscopy”, which is done in 30-45 minutes. Sometimes, as in the presence of inflammatory bowel disease, the times are lengthened because it is also necessary to examine the distal ileum. Therefore, with “pan-ileoscopy”, the specialist forces the ileocecal valve to proceed for another 20 centimeter length.
Instead, in the "rectosigmoidoscopy”, The tube only travels the last 60 centimeters of the intestine, that is rectum and final part of the colon, or sigma, in 5-15 minutes.
Finally, with the "rectoscopy", only the rectum is observed, in a few minutes.
Colonoscopy: what is it for
The complete view of the intestine is essential for the organ cancer prevention, according to Professor Gian Luigi De Angelis, director of the complex structure of Gastroenterology and Digestive Endoscopy of theUniversity Hospital of Parma.
Lo screening con colonoscopy should target people over the age of 50 and younger individuals, at risk. But the test is also strongly recommended for those who are familiar with colon / rectal cancers or with particular symptoms, such as occult blood in the stool.
For screening, “rectosigmoidoscopy” is usually done as 2/3 of tumors develop in the rectum and back of the colon.
Colonoscopy is the examination of choice for the assessment and diagnosis of some organ pathologies, from the most banal to the serious ones:
- recurrent and prolonged diarrhea or constipation
- bleeding from the anus, not attributable to hemorrhoids
- occult blood in the stool, even in small quantities
- tissue injury, inflammation or ulceration
- diverticula, which are protruding protrusions of the intestinal walls, particularly the sigmoid.
The small bags facing out are usually asymptomatic, due to the weakening of the muscles of the colon, due to constipation. However, the diverticula could become inflamed, perforated, bleeding and provoking
- peritonitis
- inflammatory bowel diseases such as Crohn's disease
- occlusions of the intestinal lumen
- polyps
- soft growths that grow on the mucous membrane of the organ.
Neoformations, especially typical of the colon and rectum, they are mostly benign but they could turn into malignant if left in place as masses, even of minimal size, which could degenerate or already be cancerous.
Preparation for colonoscopy
Upon booking in the health facility, the subject receives a card with instructions for preparing for colonoscopy. Traditional practice involves a long and uncomfortable preparation for the exam. However, in the highly specialized centers, the procedure has been reduced and modified, says the director of Gastroenterology in Parma. According to the Classic guidelines, one week before the exam, you should stop certain medications that can complicate the analysis such as:
- anticoagulants
- antiplatelet agents
- some supplements.
For example, the charcoal can reduce the amount of air in the intestines, which instead must be increased to dilate it. Compounds that contain iron should be abolished as they can distort the color of the mucous membranes, dyeing them black. In the three days preceding the analysis, the patient proceeds with the intestinal preparation, which consists in a total cleaning of the organ. To avoid the internal permanence of solid material, a low slag content feed is strongly recommended.
The day before the colonoscopy, you must take strong purgatives in high doses but also use enemas to evacuate the entire intestinal contents. On the contrary, the modern procedure, adopted by the large centers, is lighter and shorter, as the professor confirms.
To learn more, discover the guidelines of the European Society of Gastrointestinal Endoscopy (ESGE).
Procedure
Once the preparation is complete, the patient is ready for the exam. On the fixed date, a fasting from the night before, you must lie down on the bed on your left side and in the fetal position. In fact, being curled up and with the thighs bent over the pelvis makes it easier to introduce the tube. After that, the gastroenterologist gently and slowly inserts the probe, which has previously been lubricated, into the anus. The tube is inflated with air or carbon dioxide, which stretches the intestine and improves its visibility.
The instrument camera projects onto one high resolution screen images of the intestine, explains Professor De Angelis. The practitioner evaluates the situation and, if discovers anomalies, can operate with special surgical tools, such as tweezers. The specialist introduces instruments and into the tube channel removes pathological formations, eat i polipi, the parts of mucosa for biopsy. Finally, carefully withdraw the probe and collect any material taken for histological examination.
Why good preparation is important
Respecting the measures provided before the colonoscopy is essential for the success of the examination. All internal residues, such as faeces, must be eliminated. The solid material obstructs the vision of the intestinal walls, makes it more difficult to maneuver the probe and can annoy you. Certainly the traditional procedure of thorough bowel cleansing is not pleasant but only with rigorous preparation are truthful results obtained with colonoscopy.
In fact, only if theintestine is clear, i.e. empty and free of any dross, the probe can proceed quickly and without problems. In reverse, if you have neglected the recommended colonoscopy diet and the use of purgatives, the tube finds obstacles in its path. Images taken from a bumpy bowel path can be distorted and cause misdiagnosis. Your well-being is also affected, so much so that the specialist may be forced to stop the exam.
So, if you do not want to repeat the intestinal cleansing at the moment or postpone the examination, you must observe the prescribed indications.
Colonoscopy and pains
Any nuisance caused by the probe must be considered in advance, to get the most out of the investigation. During the exam, try not to be tense or afraid because, in case of unpleasant sensations and amplified by stress, you could contract the abdomen and fidget on the bed. In fact, the state of restlessness can hinder the operator's maneuvers and correct exploration.
During the test, you may feel cramped and swollen and need to evacuate. Especially i internal movements of the probe can cause pain, say De Angelis
Therefore in modern Centers, they prevent pain with deep analgesia. Indeed, with this method, you are asleep, but you breathe independently and are insensitive to painful stimuli.
Instead in the traditional technique, we use:
- painkillers
- antispasmodics
- anxiolytics
- tranquilizers, particularly if there are intestinal adhesions or malformations.
Sedation, even mild, relaxes you and makes colonoscopy easier. As a rule, there is no antibiotic therapy before or after the examination.
However, the professor explains, the antibiotic coverage is mandatory in certain situations, as in congenital heart patients because colonoscopy sends germs into circulation that can be dangerous for some patients.
Diet for split colonoscopy: 5/7 days before, 3 days before, the day before
In the classic protocol, for a suitable and trouble-free colonoscopy, a specific diet is therefore necessary. Even 10 days before, or at least the week before the exam, you have to abolish fruit and vegetables which contain seeds. In fact, these components of plants represent not only waste but also irritating elements for the walls of the intestine.
Two or three days before the analysis, you can not eat too fatty foods and those rich in slag. The fibers could make a mass, which can be confused with a growth and fill tracts of the intestine.
The day before the colonoscopy, you can have a light lunch, especially if the appointment is for the following afternoon.
In any case, on the night before the exam, you can only hydrate yourself, without eating solid foods. Instead, the the day of the analysis, you must fast.
Colonoscopy diet: what you can eat
According to the classic guidelines, nutrition before colonoscopy must be light, easy to digest and residue-free.
In the three days before the exam, you can consume eggs, lean white meat, fish, cheese and dairy products, such as cottage cheese and plain yogurt.
In your menu, you can include small portions of bread and pasta, but made with refined white flour. On the other hand, the night before the survey, you have to go on a liquid diet. You can drink:
- water
- chamomile
- lemonade
- infusions and broth, but not vegetable due to its possible fibers.
In addition, the sports energy drinks which provide electrolytes, deficient in the subject due to the numerous evacuations.
Green light (because they do not contain fibers) at:
- past
- juice
- fruit juices without pulp
- homogenized.
Colonoscopy diet: what you can't eat and why
Particularly relevant is the fact that, in view of the colonoscopy, you can not take food with slags.
Fruits, including nuts, vegetables, cereals, legumes and whole grain products, including bread, pasta and sweets, release a lot of fiber in the intestine. Bran and oats should also be avoided because they produce a "mass" in the intestinal lumen.
Furthermore, it is particularly not recommended to take, among fruit and vegetables:
- figs
- strawberries
- Kiwi
- grape
- tomatoes
- eggplant.
In fact, these foods are also a source of seeds, contraindicated for the state of the intestine to be investigated. Remember that the excessive presence of waste in the organ prevents you from looking carefully and thoroughly at the mucous membranes. A'incomplete or deformed intestinal exploration it can prevent diagnosis or generate false, negative or positive results.
What not to drink before colonoscopy
It is forbidden to drink:
- whole milk
- alcoholic beverages
- coffee
- cappuccino.
These drinks can stimulate and excite the nervous system. In addition, sodas containing fiber, such as plum juice, and colored ones. In fact i red, purple or orange pigments color the walls of the intestine with harmless nuances that could however be mistaken for pathological.
Diet for colonoscopy and laxatives
The diet with the abolition of waste, before colonoscopy, is appropriate in order not to clog the intestine and leave its interior clear. The walls of the organ must be free, smooth and without encrustations and solid substances. To remove all the contents from the organ, such as the remains of excrement, the traditional method also employs laxatives and enemas. Also, the day before the exam, you have to drink 3 or 4 liters of water in which you have to add the purgative powders in sachets.
Laxatives are administered in the early afternoon of the previous day analysis, if the appointment is for the following morning.
But if colonoscopy is for the afternoon, the purgative liquid should be taken half the night before. On the morning of the event, you must drink the rest of the preparation, but finish 4 hours before the investigation.
All the laxative liquid, which must be fresh, should be drunk in small sips, taking 5 or 6 hours. Despite the precautions, the unpleasant drink can cause nausea or vomiting. Then, your doctor can prescribe you an anti-nausea medication.
But if the vomiting is unstoppable or you have unbearable abdominal pain, the administration of the liquid must be suspended.
Evacuative enema
In the hours leading up to the colonoscopy, you must undergo warm water enemas, which completely wash the intestines. The advice is to stay near the bathroom, in order to meet the frequent and urgent evacuations.
The effectiveness of the provision is reported by theexit from the anus of only transparent and clear liquid. In superspecialized structures, diet and purgative systems are different from the classical ones, explains Professor De Angelis.
According to the new principles, vegetable-free feeding with seeds is provided for in 3 days prior to the exam. The day before your colonoscopy, you should only eat clear sugary liquids. Laxatives and enemas with intestinal irritating and painful substances are eliminated and replaced with another formulation.
The day of the investigation, 4 or 5 hours before, an enema is performed with 2 liters of water, and not 4. The polyethylene glycol, present in the liquid, is not absorbed by the intestine, attracts water into the lumen of the organ and washes it without irritating.
Virtual colonoscopy
The radiological method allows the evaluation of the intestine through a CT scan of the abdomen and the use of a computer. The practice is therefore not invasive, unlike normal colonoscopy, and is based on X-rays and digital systems.
In fact, the virtual procedure does not use probes but uses the images of the CT scan, which allows a vision similar to the endoscopic one.
To increase visibility, you need to take it by mouth a contrast agent that distinguishes polyps from faeces. Only in rare cases, contrast fluid may also be injected into a vein.
Procedure
For the exam, which takes about 20 minutes, anesthesia is not necessary, but antispasmodics can be given. In the intestine, through a tube inserted in the anus, carbon dioxide is insufflated, which stretches the walls of the organ. Then, in a tunnel, a CT scan is performed on the lower part of the patient's belly, the images of which are processed by software. In practice, it is about three-dimensional computer reconstructions of the CT images. The inside of the intestine is played in a graphic animation, like that of a computer movie.
The radiologist then examines the images and delivers them to the gastroenterologist for diagnosis. In clinical practice, virtual colonoscopy is mostly performed when invasive colonoscopy cannot be completed.
Virtual colonoscopy: when it is recommended
The main indications for virtual colonoscopy are:
- intestinal disorders, including pain, bleeding and changes in the hive;
- occlusions or semi occlusions of the lumen of the intestine that cannot be crossed by the endoscope;
- adhesions;
- mucus in the stool;
- tenesmus, or a feeling of incomplete evacuation;
- growths, including polyps;
- diverticula;
- risk situations for the patient;
- elderly or weakly ill people, who do not tolerate colonoscopy;
- pathologies such as cardiovascular ones;
- mass screening for colorectal cancer.
In the presence of intestinal obstacles, the virtual colonoscopy may be more suitable than the invasive one, which cannot overcome them. Virtual colonoscopy can represent an alternative to the classic one. This diagnostic is believed to be reliable and safe and is painless and well tolerated.
However, this one technique does not allow withdrawals and removal of diseased material, as it happens in traditional colonoscopy.
Virtual colonoscopy diet
In the three days leading up to the investigation, you must start an appropriate diet.
During this period, you must abolish:
- bread
- pasta
- fruit
- ingredients that may contain seeds, such as jams.
There are cheeses and fatty products are also banned, such as butter, nuts, and red meat.
You must follow a fish and egg based diet. Also, throughout the day, you need to drink 2 liters of water.
Early in the morning of the day before the exam, you can have breakfast.
The foods allowed are:
- non-wholemeal biscuits or rusks
- honey
- fruit juices without pulp
- tea or coffee, without milk.
For lunch, you can eat:
- a broth or semolina
- plain yogurt, without fruit or seeds.
You can also drink fruit juice, without pulp, or still water.
In the afternoon, you have to carry out intestinal cleansing for half of 2 sachets of laxative powder, dissolved in 1,5 liters of water.
At dinner, you just have to take:
- broth
- pulp-free fruit juices or plain water
- saline supplements.
Il test day, if set for the afternoon, you can have breakfast by 10am. But your diet should be liquid with sweetened coffee or tea and still water.
Three hours before the exam, you need to drink 2 glasses of water with the laxative and another ½ liter of water.
Virtual colonoscopy diet: what you can eat
- foods of animal origin are the most suitable before and after the survey. In fact, eggs, lean white meat, light cheeses and fish are nutritious and above all do not release waste.
In addition, you can eat and drink:
- White rice
- noodle soup
- crackers
- XNUMX/XNUMX cup sugar
- fruit juices without pulp.
Post-colonoscopy diet
Once the examination is complete, it takes time for bowel function and bacterial flora to be restored. After the total emptying, in order for the organ to go back to work, it is necessary to wait for it to fill up again, but little by little. After the colonoscopy, the intestine is weakened e undernourished and its bacterial flora practically disappeared.
The mucus, which protects the intestinal mucous membranes, is also reduced due to the procedures of the preparation for colonoscopy. After the test is finished, the intestine should no longer be stressed and it goes safeguarded from constipation and diarrhea.
For the first two days after the analysis, you must avoid alcohol, including wine and beer, and exciting substances, such as coffee and tea.
The list of prohibitions includes:
- chocolate
- condiments
- fatty products or products with too much salt
- spices,
- sausages
- elaborate dishes, such as baked pasta.
Also, fiber needs to be reintroduced into the diet gradually. For the first time, the soluble type is indicated, which is found in plant ingredients such as:
- peas
- carrots
- potatoes
- broccoli
- my.
These fibers dissolve in water, help the bacterial flora, give the right consistency to the stool and do not stimulate too much peristalsis.
Nutrition after the exam: what you can eat
Immediately after the colonoscopy, you can drink water, but in moderate quantities. At home, on the same day as the exam, you can eat light food, but you shouldn't have alcoholic beverages. In the 24 hours following the test, you can eat rice, veal and lettuce, dressed with extra virgin olive oil.
If tranquilizers have been used in the test, a liquid-based diet is ideal.
Vegetables and legumes, but also fruit, they must be eaten peeled and cooked, so as not to increase any nausea. You must also protect the intestines from toxic substances that can damage already tried tissues. Therefore the advice is to use light cooking, such as steam, which does not alter the food and does not release harmful molecules.
Also, you need to limit sausages, including sausage and salami, which bring harmful compounds, such as nitrates, which are potentially carcinogenic. Good hydration is important, achieved not only with water but also with broths and energy drinks. In addition, the consumption of yogurt, fermented milk, kefir and similar probiotics can help regulate the intestines, against constipation and diarrhea.
For this purpose, it is good associate prebiotics, which are not absorbed and stimulate the growth of good gut bacteria. Prebiotic foods are for example:
- bananas
- asparagus
- artichokes
- honey
- dried fruit.
However, the return to the usual diet must be decided by the doctor, according to appropriate times for each individual case.
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External links:
European Society of Gastrointestinal Endoscopy EETC
University Hospital of Parma
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