How can a patient slow the rate of ingestion of a bowel preparation solution, such as polyethylene glycol (PEG), to minimize gastrointestinal side effects?

How to Slow the Rate of Ingestion of Bowel Preparation

If you are experiencing gastrointestinal side effects like nausea or abdominal discomfort during bowel preparation, slow down your drinking rate by extending the ingestion time over 2-4 hours rather than rushing through it, and consider taking small breaks between glasses. 1

Practical Strategies to Slow Ingestion Rate

Extend Your Drinking Window

• Spread the consumption over a longer time period rather than drinking the solution rapidly—aim for 2-4 hours to complete each portion of your preparation 2
• Take small breaks (5-10 minutes) between each 8-ounce glass to allow your stomach to adjust 3
• Drinking at a slower, steady pace reduces the sensation of abdominal fullness and nausea that commonly occurs with rapid ingestion 1

Optimize Temperature and Palatability

• Chill the solution to improve taste tolerance, which naturally encourages slower, more comfortable drinking 4
• The FDA label for polyethylene glycol allows mixing with cold, hot, or room temperature beverages—choose whichever temperature you find most palatable 5
• Some patients find that drinking through a straw positioned toward the back of the tongue reduces unpleasant taste and makes slower consumption easier 4

Consider Lower Volume Alternatives

• If you are struggling with high-volume (4 L) PEG preparations, ask your physician about switching to a 2 L low-volume regimen, which has similar efficacy but significantly better tolerability (72.5% vs 49.6% tolerability) and higher patient willingness to repeat (91.9% vs 66.9%) 1
• Low-volume preparations naturally require less time to consume and cause fewer symptoms of nausea and abdominal pain 1
• Patient adherence is significantly better with low-volume regimens (92.8% vs 86.8%) 1

Important Timing Considerations

Maintain Adequate Completion Time

• You must still finish your preparation at least 2 hours before your colonoscopy to ensure adequate bowel cleansing and meet anesthesia safety requirements 6
• Each additional hour between your last dose and the procedure decreases preparation quality by approximately 10% 6
• Slowing your ingestion rate is acceptable as long as you complete the entire preparation within the recommended timeframe 2

Split-Dose Advantage

• Split-dose regimens allow you to divide the preparation into two smaller sessions (evening before and morning of procedure), which naturally reduces the burden of drinking large volumes at once 1, 6
• This approach provides better bowel preparation quality, higher adenoma detection rates, and superior patient tolerance compared to drinking everything the day before 6

Common Pitfalls to Avoid

• Do not skip portions of the preparation even if you slow down your drinking—incomplete preparation leads to inadequate cleansing and potentially canceled procedures 2
• Ensure the powder is fully dissolved before drinking and avoid consuming if clumps remain, as this can worsen gastrointestinal symptoms 5
• Do not combine PEG with starch-based thickeners, which can interfere with the preparation 5

When Symptoms Persist Despite Slower Ingestion

• If nausea becomes severe, take a 30-minute break and then resume drinking at an even slower pace 3
• Consider adding adjuncts like chewing gum between glasses, which may improve satisfaction with the preparation regimen (97.4% vs 90.7% satisfaction) 1
• For future colonoscopies, discuss with your physician whether you are a candidate for ultra-low-volume regimens (1 L) combined with adjunctive agents, though these are not yet recommended for general use 1