For patients prescribed this exact regimen.
Morning dose: allow enough time
Wake up early enough to sip your morning prep slowly without rushing or making yourself nauseated, and finish the dose and all required liquids at least four hours before your procedure. Follow any earlier facility cutoff.
For the three-dose MiraLAX 32/32/32 regimen ONLY: if your bowel movements are completely clear on the procedure morning, Dr. Dainiak allows a minimum of 16 ounces of the correctly mixed morning MiraLAX solution instead of the full 32 ounces. Do not drink less than 16 ounces or skip the morning dose. If output is not completely clear, complete the prescribed 32 ounces. Do not use yesterday’s clear output alone to decide to reduce today’s dose. Keep the first two 32-ounce doses unchanged.
Mix the morning solution exactly as directed: the entire second 8.3-ounce bottle in 64 ounces of clear liquid. This exception changes only how much of that prepared solution you drink, not its concentration. Do not take dry powder or concentrate it into 16 ounces. This exception does not apply to any other prep regimen or remove required hydration.
Even when output looks clear, bile and mucus can accumulate in the colon overnight and obscure polyps. The morning prep helps wash them away. This is for your safety. If you cannot tolerate the required amount or finish before the cutoff, contact the procedure team; do not drink after the cutoff or substitute a few sips.
If the volume makes you feel sick
You do not need to gulp the prep or drink it all at once. Drinking too quickly can stretch your stomach and make you feel nauseated or vomit. Slowing down can make it easier to tolerate, although it cannot guarantee that nausea or vomiting will not occur. The prescribed liquid is important for cleaning the colon and preventing dehydration. This is for your safety.
For Bedford’s prescribed three-dose MiraLAX 32/32/32 prep, you have two days of clear liquids before the procedure. Sip each of the first two 32-ounce portions slowly over its assigned day rather than forcing it down in an hour. If mild nausea develops, slow down and take a break; a break of up to a couple of hours can help during those earlier prep days if you can still finish that day’s portion. Resume slowly as the nausea settles. Keep all three doses on their assigned days, including the essential morning dose.
Between sips, you can vary your permitted clear liquids with clear broth, non-red/purple Jell-O, or dairy-free sorbet without pulp or pieces that melts clear. These are separate clear-liquid choices, not ingredients to add to the prep mixture and not replacements for the prescribed prep volume or any required plain water.
The morning dose and all required liquids must be completed at least four hours before your procedure, or earlier if your facility directs. Do not take a long break that pushes intake past that cutoff. If you cannot finish in time, contact the procedure team rather than rushing, skipping liquid, or drinking after the cutoff.
Other preparations have their own dosing, spacing and water requirements; do not stretch those doses across the day without instructions from the practice. If a shorter preparation has been difficult to tolerate, ask the practice whether the extended three-dose MiraLAX preparation would help. Do not change regimens yourself.
Repeated vomiting, inability to keep fluids down, severe or increasing abdominal pain or swelling, fainting, or markedly reduced urination require prompt medical contact; seek urgent care for severe symptoms. Do not try to push through these symptoms by continuing to drink.
Five days before clear liquids begin
For the five days before you start clear liquids, avoid seeds, nuts, vegetables, granola, trail mix, corn, flaxseed, whole grains and other high-residue foods. These foods can leave material in the colon that is difficult to clean out. Temporarily changing your diet makes the bowel preparation easier and helps the doctor see the colon lining clearly. This is for your safety.
During this low-residue period, you can eat chicken, fish, eggs, meat, potatoes without the skin, white rice instead of brown rice, and white bread instead of whole-grain bread. Examples: eggs and white toast for breakfast; chicken and white rice for lunch; steak and mashed potatoes without skins for dinner.
If you are having trouble having a bowel movement during this low-residue period, one capful of MiraLAX in eight ounces of water daily may help. Talk to your doctor first to make sure this is right for you. This is optional constipation guidance before the clear-liquid phase, not an extra dose to add to your prescribed bowel prep.
When you switch to clear liquids, stop solid foods and follow your assigned clear-liquid and bowel-prep instructions. Do not carry this optional daily MiraLAX dose into the prep phase unless your doctor specifically directs you to do so.
No Dulcolax (bisacodyl) in this three-dose regimen. This updated instruction replaces the older sheet that included it. Keep all three prescribed MiraLAX doses and the simethicone/Phazyme steps below.
Clear liquids and the morning dose
Clear liquids only during your clear-liquid phase. All Bedford colonoscopy preparations use clear liquids for the entire day before, including breakfast. Some start earlier; use the days listed for your regimen.
Choose water, ginger ale, plain black coffee or tea, pulp-free apple or white grape juice, clear chicken, beef or vegetable broth, and non-red/purple sports drinks. Jell-O, popsicles, Italian ice, and dairy-free sorbet are allowed when they contain no pulp or fruit pieces and melt to a clear liquid.
No red or purple coloring, milk, cream, almond/oat milk, creamers, ice cream, sherbet, alcohol, or solid food. Red coloring can resemble blood during the examination. Low-residue foods allowed earlier are not allowed during this phase.
Do not skip the morning dose even if you looked clear the evening before. Follow the morning-dose instructions below, including the specific exception for three-dose MiraLAX when output is completely clear that morning. Bile, mucus and other intestinal secretions can accumulate overnight and coat the colon, making polyps harder to see.
This is for your safety. Bedford fasting rule: no solid food for at least 24 hours before your procedure. Have clear liquids only until four hours before the procedure, then nothing by mouth. Follow any longer clear-liquid period in your assigned regimen.
Finish the entire morning prep and all required water at least four hours before the PROCEDURE. Then do not eat or drink anything—not even water—until your care team says you may. Do not drink until arrival or until your IV is placed. Do not chew gum or tobacco or suck on hard candies during the fasting period. If your facility gives an earlier stop time, follow it. Arrival time is not procedure time. If you only know your arrival time, ask the facility for your procedure time; do not guess. Do not shorten dose intervals or omit required water to meet the cutoff; have the practice resolve a conflicting schedule before starting.
Why this matters: during sedation, fluid or food in the stomach can travel back up the esophagus and enter the lungs. This is called aspiration. It can cause lung inflammation (aspiration pneumonitis) or a lung infection (aspiration pneumonia), sometimes requiring antibiotics or hospitalization. Fasting reduces this risk; it does not guarantee an empty stomach or eliminate all risk.
If you have already eaten or drunk within the four-hour window, stop and tell the procedure team what you had, how much, and when. The team will decide whether the procedure needs to be delayed. Do not assume a small sip is safe. Take oral medicines during this fasting window only if the procedure/anesthesia team specifically directs you to do so.
Severe pain, repeated vomiting, inability to keep liquids down, fainting, or markedly reduced urination need prompt medical help. Do not force the prep through these symptoms.
Before you start
COLONOSCOPY–MIRALAX 32oz/32oz/32oz BOWEL PREPARATION
Date & Location
You should have received the date and location of your colonoscopy from our practice by
phone, through the portal, and/or email and text messaging. If you do not know your
procedure date or location, please contact our practice. Your procedure time will be
communicated to you by the facility the day before your procedure.
Shopping List
Our practice can provide a kit containing all medications needed for your colonoscopy for
$30 or you can purchase them over the counter:
□ Two (2) 238-gram (8.3 oz) bottle of MiraLAX (or generic named polyethylene glycol
3350)
□ Four (4) 80 milligram tablets of simethicone or two (2) 250 milligram tablets of
Phazyme
□ One hundred twenty-eight (128) ounces of clear liquid which may include:
Gatorade, Pedialyte, water, lemonade, clear fruit juices, clear (no coloring) soft
drinks, seltzer water (please avoid red or purple-colored beverages)
Medications
If you take any of the following medications, please inform our scheduling staff as soon
as possible so we can coordinate stopping these medications with your prescribing
physician:
□ Blood thinners including but not limited to Coumadin (warfarin), Plavix
(clopidogrel), Xarelto (rivaroxaban), Eliquis (apixaban).
□ GLP1 medications such as Trulicity (dulaglutide), Ozempic (semaglutide), Victoza
(liraglutide), Bydureon (exenatide) used for diabetes or weight loss.
Transportation
Driving is not permitted until the day after your procedure. Arrange for a ride to and from
the center from someone 18 or older who can take responsibility for your care. That
person should arrive no later than 1 hour after your procedure time.
Cancellation/No-Show
Our practice charges $100 for a colonoscopy and $200 for a combined colonoscopy/EGD
that is cancelled within 7 business days of a procedure. For patients who have canceled
in the past, a $100 refundable deposit will be taken to secure your appointment. The
deposit will be refunded after your procedure is completed if your account is in good
standing.
The day-by-day checklist below starts 7 days before your procedure date. You can
find details regarding low residue foods and clear liquids on our website at
https://bedfordgastro.com/colonoscopy-faqs/
Please feel free to call us with any questions you may have about these instructions
BEDFORD GASTROENTEROLOGY
7 Days or More Before Procedure
Make sure you’ve completed your shopping list.
Contact your insurance company with benefit questions.
If you take iron supplements, stop taking them 7 days before your procedure.
If you take insulin, ask your prescribing physician (primary care or endocrinologist) for instructions on how much insulin to take 1 day before and on the day of the procedure.
If your location is Bedford Ambulatory Surgery Center or Surgical Center of NH, complete your health history in One Medical Passport (sent by facility).
To cancel without incurring a fee, you must call our office at least 7 business days before the procedure.
5 Days Before Clear Liquids Begin
Begin a low-residue diet. Continue until the clear-liquid phase listed below; then follow clear liquids only. Use the low-residue food examples above.
Confirm your ride to and from the procedure as described above.
2 Days Before Procedure
Drink a clear liquid diet the entire day. Do not consume dairy or solid food on this day including breakfast.
Examples of clear liquids can be found on our website in the diet guidance above.
Mix the entire 8.3 oz bottle of MiraLAX with 64 ounces of clear liquid.
Sip half of the mixture (32 ounces) slowly over this day. You do not need to finish it in one hour. For mild nausea, pause and resume slowly as described above; complete this day’s portion.
Save the remaining half for the next day.
1 Day Before Procedure
Continue to drink a clear liquid diet the entire day. Do not consume dairy or solid food on this day including breakfast.
Between 3PM and 6PM, take either two 80 mg simethicone tablets or one 250 mg Phazyme tablet.
Sip the remaining 32-ounce mixture slowly over this day. You do not need to finish it in one hour. For mild nausea, pause and resume slowly as described above; complete this day’s portion.
Day of Procedure
Take two 80 mg simethicone tablets or one 250 mg Phazyme tablet 5 to 6 hours before your arrival time.
Mix the remaining 8.3 oz bottle of MiraLAX with 64 ounces of clear liquid.
Drink half of the mixture (32 ounces) slowly this morning unless your output is completely clear: in that case, drink at least 16 ounces of this correctly mixed solution as directed above. Do not gulp or force it down. Finish this dose and all liquids at least four hours before the procedure; contact the team if nausea prevents completing it before that cutoff. Do not skip this morning dose or drink the unused half.
Do not drink any liquids, chew gum or tobacco, or suck on hard candies for at least four hours before your procedure. Do not smoke anything the morning of your procedure.
Please take your medications as prescribed EXCEPT for those listed below. Oral medicines must be taken before the four-hour fasting cutoff unless your procedure/anesthesia team specifically directs otherwise. Take insulin according to PCP or endocrinologist instructions.
Do not take diuretics (water/fluid pills), oral diabetic medications, iron pills, vitamins, or Carafate (sucralfate). If you have questions about what to take, please call us at least 1 business day before your arrival time.
Bring a list of your current medications to your procedure.
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