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Nov 07, 2022

Prep Tips for Barium Enema and Colostomy Reversal

This topic is about preparing for a colostomy reversal surgery, specifically focusing on the bowel preparation process, imaging procedures, and practical tips for managing the situation. The person involved is concerned about the amount of bowel prep required and is seeking advice on how to handle it effectively.

Here are some helpful insights and advice:

1. The full-volume Miralax prep, which involves mixing 238 grams of Miralax into 64 ounces of Gatorade, is a standard procedure. This is similar to what many people undergo for a colonoscopy. Be prepared for a very high, watery output from the ostomy, so it's wise to stay close to a bathroom and have extra pouches ready.

2. To make the prep more palatable, consider mixing the Miralax with different flavors of Gatorade or other clear liquids to avoid getting tired of the taste.

3. The goal of the prep is to have clear effluent, not necessarily to finish the entire bottle. Once the output is clear, you can stop the prep.

4. Miralax is often preferred over other solutions like GoLytely because it is generally easier to tolerate. Many surgeons recommend it for reversal procedures.

5. There are alternative prep regimens available. For example, one person used a 2-day Sutab regimen, which involves taking 12 large tablets with water each day, followed by five days of clear liquids and fasting after midnight before a series of procedures.

6. Even if only the rectum is imaged, expect output surges. Residual barium and laxatives can still reach the stoma and liquefy the stool.

7. Imaging through both the stoma and rectum may be ordered to assess how much colon remains, identify exact reconnection points, and check for conditions like diverticulitis or polyps.

8. Some hospitals start the bowel prep several days in advance, especially when multiple tests or procedures are scheduled close together.

9. Consider the following products for bowel prep and managing output:
- Miralax (polyethylene glycol 3350 powder, 238 g bottle)
- GoLytely (PEG-electrolyte lavage)
- Sutab (sodium sulfate, magnesium sulfate, potassium chloride tablet prep)
- Coloplast SenSura Mio pouches, which may need more frequent changes or sturdier alternatives during periods of liquid output.

10. A practical tip is to keep skin barrier rings, extra pouches, a towel, or disposable underpads nearby. Some people humorously suggest sitting on a tarp outdoors to manage the intense output.
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