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Colonoscopy

A colonoscopy is an exam of the colon (large intestine, or bowel) with a slim, flexible, lighted tube called a colonoscope. Colonoscopy is the most direct and complete way to see the entire lining of the colon. A colonoscopy is a very well tolerated procedure that could be life saving.

Anatomy

The colon is the last part of the intestines and is also known as the large intestine or large bowel. Fibers and digested food are passed through to the colon where the rest of the nutrients are absorbed and stools are formed. Stools are stored in the lower part of the colon, the sigmoid, and the rectum before being excreted through the anus.

Risks

A colonoscopy is a common and safe procedure. However, it has possible risks that you should learn about. These risks include:

Abdominal pain or swelling in your lower abdomen (this is due to the air that is pumped into your intestine during the procedure and usually lasts until your body passes the extra air shortly after the procedure.
Bleeding inside the colon, which may require additional surgery.
Damage to the colon (perforation) from the colonoscope, which may require additional surgery to repair.
Infection.

Be sure to talk with your caregiver if you are worried or have questions about your procedure, medicine, or care.

Before the procedure

Your caregiver (physician or nurse) will need to know your medical and surgical history, including whether you are or could be pregnant. They will also ask you about any medications you take (prescribed, over-the counter, or other nutritional supplements) and any allergies you may have to medications or other substances. You should always carry a list of these items with you in your wallet or purse.

Depending on your current and past history, your physician may order additional tests for you. These may include blood, urine, or stool tests.

If you need a minor pain reliever in the week before the procedure, choose Acetaminophen rather than Aspirin, Ibuprofen, or Naproxen. This helps avoid extra bleeding during the procedure. If you are taking daily Aspirin for a medical condition, ask your physician if you need to stop taking it before the procedure. If you have been taking Coumadin (a blood thinner), you will have to stop it several days before the exam.

Follow your physician’s instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6-8 weeks before surgery. Also, your wounds heal much better if you do not smoke after the surgery.

You should arrange to have someone be with you on the day of your procedure. If you are discharged after your colonoscopy, you will not be able to drive home due to the medications you are given during the procedure.

The day before your procedure your physician will want you to follow a special diet. You will be instructed to follow a clear liquid diet the day before your procedure. Clear liquids are water, broth, apple or white grape juice, tea or coffee (no milk or cream), and soda. Gelatin in any color except red may also be eaten.
You should not eat any solid food for 24 hours before the exam.
Increase the amount of water you are drinking. Make sure you drink 8 to 10 (eight-ounce) cups of liquid, especially the day before your procedure.

Your bowel needs to be empty before your procedure so the scope will pass through your colon more easily and allow your physician to be able to see the colon and its lining more clearly. Your physician will give you written instructions on how to clear bowel movements from the colon. This will include taking certain medications (laxatives) to empty your bowel. These medicines will give you diarrhea (loose, watery stools), but will quickly clean out your bowel.

The day of your procedure

Do not take anything by mouth on the morning of your procedure, unless you have been instructed to do so by your physician or the nurse. This includes food, liquid, and medications. If you are instructed to take medicines, you may have them the morning of your procedure with a few small sips of water.

Bring with you any papers your physician has given you to sign as well as your list of medications and allergies.

Wear loose fitting, comfortable clothing on the day of your procedure.

Before your procedure

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your physician should also tell you about the risks and benefits of each treatment. You will be asked to sign a consent form that gives your physician and the hospital staff permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

You may need an enema, using warm water, the morning of your procedure.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

During the procedure

You will be taken on a stretcher to the Endoscopy room and then moved onto a special bed or table. The nurse will place pads on your chest to monitor your heart rate and attach a clip to your finger to monitor your oxygen levels. You will be given medication through your IV to relax and sedate you. You will be asked to lie on your left side and will need to raise one or both knees toward your chest. Your lower body will be covered with a sheet. The colonoscope is lubricated and gently placed into your anus. It is then passed through the rectum and into the colon. Air is put into the colon to help expand it. When the procedure is finished, the scope is slowly removed.

The test takes 30-45 minutes. If you are an outpatient, normally your stay will be 2-3 hours. This will include the check-in, procedure, and recovery time.

After your procedure

You are observed for about an hour. This is to make sure that the medicine given to you has worn off. You may continue to feel the same discomfort or symptoms that you had before the procedure. When you are alert and able to take food and fluids, you will be allowed to change clothes and go home.

Air was used to inflate the colon during the test to help the physician see inside of your intestines better. This may make you feel bloated and gaseous after the test. This is normal and will go away within a few hours.

Your physician will tell you how soon you can eat and drink. You should start eating slowly after the test. Eat a light snack as your first food. Be sure to drink lots of fluids after the test.

If a sample was taken from inside your colon, you may see blood in your BM.

If polyps or other tissue is removed, you may notice a small amount of blood in your stools for a short time. You should not take aspirin or any long car trips for the next 7 days.

Before the exam, ask your physician when and how you will be informed of the results. Someone may call you or you may need to call or make a follow-up appointment to get the results.

Call your physician if

You cannot make it to your appointment on time.
You get sick (a cold or flu) or have a temperature over 101oF.
You have constipation (dry, hard stools) and the medicines are not helping to empty your bowel.
You do not return to your normal bowel habits.
You have questions or concerns about your procedure.

Seek care immediately if

You are not able to eat or drink, or are urinating less or not at all.
Your abdomen becomes tender and hard.
Your signs and symptoms are getting worse.
Your vomit (throw up) has blood or bile in it.
You have severe pain in your abdomen (belly).
You have a large amount of rectal bleeding (a small amount of blood from the rectum is not serious, especially if hemorrhoids are present).
You feel too dizzy to stand up, short of breath, or you faint.