"Having to drink foul-tasting liquid medicine all night while running back and forth to the bathroom—just thinking about it makes me tired."
When I asked a colleague who came to work with a haggard face what was going on, he sighed and said, "I won't be getting any sleep tonight." He had booked a colonoscopy for the next morning, and the so-called "bowel cleansing"—taking medication to thoroughly empty the stomach and intestines—weighed heavily on him. Most people don't think much of the examination itself, since it is performed under sedation, but they struggle with the preceding stage. On an empty stomach, you must repeatedly mix powdered bowel cleanser with water and drink it, and the characteristic mix of bitter and salty tastes often triggers nausea. Among acquaintances who shudder at the thought of a colonoscopy, some have given up on the test after vomiting up everything while trying to drink 4 liters of bowel preparation the day before, unable to hold back the nausea. Others have had their tests called off because of poor bowel preparation. They say that when they wake up from anesthesia and are told the test couldn't proceed because stool remained, it is more than embarrassment—the fact that they have to go through that painful process all over again is enormously stressful. Most people can relate to this to some degree.
Fortunately, thanks to advances in medical technology, bowel cleansers are also evolving. As complaints continued that the grueling test preparation process lowers screening rates, pharmaceutical companies have devoted research and development efforts to producing improved new drugs that are easier to take. Bowel preparations are broadly divided into three types based on their mechanism: isotonic polyethylene glycol (PEG) laxatives, osmotic laxatives, and stimulant laxatives. PEG works by retaining water in the intestines to promote bowel movements, offering the advantages of excellent safety and efficacy, but its drawbacks were its characteristic salty taste and the dosage reaching 4 liters. In response, new formulations that added ascorbic acid to reduce the dosage to 1-2 liters, as well as fruit-flavored products, have also been launched.
The main ingredient in osmotic laxatives is sodium sulfate, which is not absorbed within the intestinal tract. The principle uses the osmotic pressure concentration gradient to draw water from the body into the intestines, thereby expanding the intestinal lumen and softening stool to induce bowel movements. Its advantages are a powerful bowel-cleansing effect and the ability to reduce the amount of additional water intake required. However, this too caused discomfort when taken because of its characteristic salty and bitter taste. Finally, stimulant laxatives such as picosulfate work by directly stimulating the intestinal mucosa to promote peristalsis of the large intestine, and are known to enable fast and effective bowel movements.
Above all, the recent trend in the bowel preparation market is tablets. In 2019, a domestic company introduced an improved new drug that converted a liquid bowel preparation containing sodium sulfate into tablet form, which received very positive reactions in clinical settings. The fact that tablets alone can produce an effect similar to all that liquid medicine is thanks to the sophisticated combination of the various mechanisms of bowel preparations listed above. The convenience of dosing was enhanced by optimally blending an ingredient that retains intestinal water to aid bowel movements, an osmotic ingredient that draws water into the intestinal tract, and a stimulant ingredient that stimulates the intestinal mucosa to induce movement.
On the evening before the test, you take 14 tablets of bowel preparation with 425 ml of water, then drink another 425 ml of water twice over the following hour to complete the first dose. After 10-12 hours, you take the remaining 14 tablets in the same way as the first dose. Having to take 28 tablets may seem daunting, but those who have experienced it say it is much easier than mixing powdered medicine with water. Above all, since you only need to take the tablets with water, you are much more free from the foul taste. With less suffering during the preparation process, the state of bowel cleansing improved, and test accuracy increased along with it. In other words, there is no need to insist on liquid medicine out of concern that tablets might be less effective. Subsequently, with the launch of products that reduced tablet size and lowered the dosage to 20 tablets, there are reports that nearly half of domestic bowel-preparation sales have already shifted to tablets.
However, tablets do not mean you can drink less water. Sufficient water intake is essential for the tablets to dissolve properly in the intestines and soften stool. Drinking two cups of water before taking the medication helps prevent damage to the stomach lining. Don't forget to strictly follow the dosage and administration instructions, such as split dosing. Taking the tablets divided between the evening before and the early morning of the day produces both better cleansing results and a higher polyp detection rate. Cramming them all in at once because it's a hassle is strictly forbidden.
