Indications

Colonoscopy is recommended for evaluation of altered bowel habit, unexplained diarrhea, constipation or abdominal pain, occult or frank blood in stools, colon polyps or cancer or unexplained anemia.

Contraindications

It is generally not performed in cases of perforation or tear in the bowel, severe diverticulitis or colitis and clinically unstable patients.

Before the procedure

You will be given written instructions as to what to do before the test. This generally involves taking some kinds of laxatives to cleanse out the colon prior to the test. Other instructions involve the use of your medications like insulin, iron pills and any blood thinners that you may be taking. Be sure to tell your doctor if you require antibiotics prior to procedures like dental work.

The most common laxative is a gallon of freshly prepared PEG solution. It is preferred by many physicians because it provides gentle catharsis and is not absorbed into the body. PEG is commercially available as GoLytely, Colyte and NuLytely. , Because of the volume of the not-so-pleasant tasting solution, some patients find it hard to drink the entire gallon. Flavored forms are also available.

Alternatives to PEG include drinking a 1.5 ounces of Fleet phospho-soda with water at noon and repeating it in the evening before the procedure. It is avoided in patients with kidney failure. Some physicians use a combination of citrate of magnesia, Fleet enemas, laxative tablets and suppositories.

Above laxative protocols are effective in most, but not all patients. If you are unable to finish your laxative or are still having brown stools despite finishing your laxative, call your doctor. He/she may wish to give you additional laxatives. Remember, it is in your best interest to have a clean colon on the day of the exam. It will make the procedure easier, safer and more accurate. Patients with chronic constipation and neurological problems may require several days of colonic cleansing using combinations of various cathartics.

On the day of the test

Arrive at the test site at least one hour before the procedure. Bring someone with you or make arrangements to be picked up after the procedure. Because sedatives are administered during the exam, you cannot and will not be allowed drive home by yourself. After initial registration, a nurse will take history and make his/her assessment. A needle/catheter will be inserted into a vein for IV access. This catheter allows for administration for fluids as well as medications for the procedure.

Procedure

After a brief discussion with your doctor, sedatives will be administered intravenously. The goal is to keep you comfortable through conscious sedation and not general anesthesia. Majority of patients fall asleep and do not remember much about the test.

The flexible colonoscope looks like a black hose. It is about one and a half meters long and 1 cm in diameter. Its fibreoptic camera allows the doctor to see the inside of the colon on the TV monitor. If you are awake, you may be able to see your “insides” too.

After starting the sedation, the doctor will perform a rectal exam with a finger, and then insert the scope into the rectum. The scope is advanced all the way to the junction of the small intestine and the colon. This corresponds to the right lower part of the abdomen. Along the way, there can be some discomfort due to any sharp curves of the colon that may be encountered, as well as the air put into the colon to inflate it.

Inflation of colon using air allows the doctor to see the entire circumference of the wall of the colon. The doctor may give you additional sedatives during the procedure depending upon how you are feeling, as long as your heart, respiration and blood pressure are fine.

The doctor may take biopsies or excise polyps during the procedure. You will not feel that because nerves in the gut respond to distention by air or the scope, but not to cutting sensation.

Complications

Just like accidents while driving, complications may occur during colonoscopy. Bleeding, perforation of the bowel, cardiac, respiratory and blood pressure problems, and even death may occur. The rate of complications is low. Your doctor recommends the test if the benefits outweigh the risks.

After the test

You will be monitored in the recovery room for about 20-60 minutes depending upon your mental status and your heart and respiration. You will be discharged to home with the family member or friend that came with you. You will be groggy for the next few hours and cannot go to work that day. Full recovery by the next day is the norm, and you may drive and go to work.