Surgical colon cleanser is used in preparation for surgical procedures such as a colonoscopy where it is important for the doctor to have a clear view of the mucosal surface of the colon.
Cleansers are designed for the following: Convenience to the patient as in limited dietary restrictions and ease of use; safety, as in minimal side effects; and effectiveness, with respect to cleansing efficacy so the surgeon doesn’t miss anything that would require a second procedure.
There are several types of colon cleansers used for bowel preparation.
Stimulant Laxatives: In the past, stimulant laxatives, such as castor oil, senna, and bisacodyl were the most commonly used form of bowel preparation. These were abrasive and not very effective and have been abandoned by most endoscopists.
Hyperosmotic Laxatives: Also used in the past were hyperosmotic purges with non-absorbable carbohydrates, such as mannitol, sorbitol, and lactulose. They work by drawing water into the intestine, which leads to bowel distention and stimulation to rid the bowl of contents. Use of this method is infrequent due to the risk of explosion during electrosurgical procedures, such as when a lesion is cauterized.
Oral Gastrointestinal Lavage Solutions: These oral solutions use balanced electrolytes with polyethylene glycol (PEG) and have become one the preferred methods for colon cleansing. The standard commercial cleansers available are Golytely, Nulytely, and Colyte, plain or flavored. These are very effective and have added advantages for patients having other bowel preparations. The disadvantages are the taste and the large amount of the fluid solution needed to be consumed by the patient. New trials have shown that a split-dosage method where a patient takes half the dose the day before the procedure has resulted in more tolerability for some patients. The above surgical colon cleansers are in accordance with a doctor’s order and coincide with other surgical preparations such as a limited, clear liquid diet for 24 hours and the discontinuing use of Aspirin and other nonsteroidal anti-inflammatory drugs, anticoagulants, and oral iron for a period of time determined by the doctor. Patients who do not follow these procedures often require another procedure because the surgeon is unable to get a clear picture of the colon to make a proper diagnosis.