Your physician has determined that colonoscopy is necessary
for further evaluation or treatment of your condition. This
sheet has been prepared to help you better understand the procedure.
It includes answers to questions patients ask most frequently.
Please read it carefully. If you have additional questions,
please feel free to discuss them with the endoscopy nurse or
physician before the examination begins.
WHAT IS COLONOSCOPY?
Colonoscopy
is a procedure that enables your physician to examine the lining
of the colon (large bowel) for abnormalities by inserting a
flexible tube into the anus and advancing it slowly into the
rectum and colon. The endoscope has its own video camera and
light source, and is about the thickness of your finger.
WHY IS COLONOSCOPY DONE?
Colonoscopy
is usually performed to evaluate symptoms of persistent lower
abdominal pain, chronic diarrhea. It is also the best test for
finding the cause of active or occult (slow, chronic) bleeding
from the lower gastrointestinal tract. Colonoscopy is more accurate
than x-ray films for detecting inflammation, ulcers or tumors
of the colon. Colonoscopy can detect early cancer and can distinguish
between benign and malignant (cancerous) conditions when biopsies
(small tissues sample) of suspicious areas are obtained. Biopsies
are taken for many reasons and do not necessarily mean that
cancer is suspected. A cytology test (introduction of a small
brush to collect cells) may also be performed. Colonoscopy is
also used to treat conditions present in the lower gastrointestinal
tract. A variety of instruments can be passed through the colonoscope
that allow many abnormalities to be treated directly with little
or no discomfort, for example, stretching narrowed areas, removing
polyps (usually benign growths), treating lower gastrointestinal
bleeding. Safe and effective endoscopic control of bleeding
has reduced the need for transfusions and surgery in many patients.
WHAT ABOUT MY CURRENT MEDICATIONS?
Most medications
may be continued as usual, but some medications can interfere
with the preparation or the examination. It is therefore best
to inform your physician of your current medications as well
as any allergies to any medications several days before to the
examination. Aspirin products, arthritis medications, anticoagulants
(blood thinners), insulin, and iron products are examples of
medications whose use should be discussed with your physician
prior to examination. You should alert your physician if you
require antibiotics prior to undergoing dental procedures, since
you may need antibiotics prior to colonoscopy as well.
WHAT CAN BE EXPECTED DURING COLONOSCOPY?
Colonoscopy
is usually well tolerated and rarely causes much pain. There
is often a feeling of pressure, bloating, or cramping at various
times during the procedure. Your doctor will give you a sedative
through a vein to help you relax and better tolerate any discomfort
from the procedure. You will be lying on your left side or on
you back while the colonoscope is advanced through the rectum
and colon. As the instrument is withdrawn, the lining of the
intestine is carefully examined. The procedure usually takes
anywhere from 15 to 60 minutes. In some cases, passage of the
colonscope through the entire colon to its junction with small
intestine cannot be achieved. The physician will decide if the
limited examination is sufficient or if other types of examinations
are necessary.
WHAT IF THE COLONOSCOPY SHOWS SOMETHING ABNORMAL?
If your doctor
thinks an area of the bowel needs to be evaluated in greater
detail, a forceps instrument is passed through the colonoscope
to obtain a biopsy (a sample of the colon lining). This specimen
is submitted to the pathology laboratory for analysis. If colonoscopy
is being performed to identify sites of bleeding, the areas
of bleeding may be controlled through the colonoscope by injecting
certain medications or by coagulation (sealing off bleeding
vessels with heat treatment). If polyps are found, they are
generally removed. None of these additional procedures typically
produce pain. Remember, the biopsies are taken for many reasons
and do not necessarily mean that cancer is suspected.
WHAT ARE POLYPS, AND WHY AND HOW ARE THEY REMOVED?
Polyps are
abnormal growths from the lining of the colon which vary in
size from a tiny dot to several inches. The majority of polyps
are benign (noncancerous) but the doctor cannot always tell
a benign from a malignant (cancerous) polyp by its outer appearance
alone. For this reason, removed polyps are sent for tissue analysis.
Removal of colon polyps is an important means of prevention
and early detection of colon cancer. Tiny polyps may be totally
destroyed by fulguration (burning), but larger polyps are removed
by a technique called snare polypectomy. The doctor passes a
wire loop (snare) through the colonscope and severs the attachment
of the polyp from the intestinal wall by means of an electrical
current. You should feel no pain during the polypectomy. There
is a small risk (0.1%) that removing a polyp will cause bleeding
or result in a burn to the wall of the colon, which require
emergency surgery.
WHAT HAPPENS AFTER COLONOSCOPY?
After the
test, you will be monitored in the endoscopy area until most
of the effects of the medication have worn off. You may have
some cramping or bloating of air introduced into your colon
during the test. This should disappear quickly with passage
of flatus (gas). In most circumstances, your doctor can inform
you of your test results on the day of the procedure; however,
the results of any biopsies or cytology samples will take several
days.
WHAT ARE POSSIBLE COMPLICATIONS OF COLONOSCOPY?
Colonoscopy
and polypectompy are generally safe when performed by physicians
who have been specially trained and are experienced in these
endoscopic procedures. One possible uncommon complication is
a PERFORATION tear through the bowel wall that could require
surgery. BLEEDING may occur in approximately 0.1% from a biopsy
site or where a polyp was removed. It can occur during the procedure
or be delayed up to 7 to 10 days later. It is usually minor
and stops on its own or can be controlled through the colonoscope.
Rarely blood transfusions or surgery may be required. PHLEBITIS
or localized irritation of the vein into where medication was
injected may rarely cause a tender lump that may last several
weeks, but this will go away eventually. The application of
heat packs or hot moist towels may help relieve the discomfort.
Other potential risks include a REACTION TO THE SEDATIVES used
and complications from heart or lung diseases. Although complications
after colonoscopy are uncommon, it is important for you to recognize
early signs of any possible complication. Contact your physician
who performed the colonoscopy if you notice any of the following
symptoms: sever abdominal pain, fever and chill, or rectal bleeding
of more than one half cup. Bleeding can occur several days after
polypectomy.
WHAT PREPARATION IS REQUIRED?
There
are three different preps offered. Depending on the doctor
and the health conditions of the patient, a prep will be recommended.
The colon
must be completely clean for the procedure to be accurate
and complete. Follow your doctor's instructions carefully.
If you do not, the procedure may have to be canceled and the
preparation repeated later. You can have as much of the clear
liquids as you want until midnight. It is easy to become dehydrated
during your preparation. Drink at least 2 liters of fluid
prior to starting your laxative. If you experience any problems,
such as nausea or vomiting, please contact our office. A loose
or watery bowel movement will occur within 1-2 hours of beginning
the laxative and is expected. Results vary with each individual.
You may take your medications in the morning with the exception
of NO INSULIN, OR DIABETES PILLS.
Your physican will recommend one of the following
preps:
Visicol Tablets Prep
- Have
a clear liquid diet all day. Clear liquids include coffee,
tea bouillon soup, Chicken broth, water, apple and white
grape juice, lemonade, lemon lime or white Gatorade or other
sports drinks that are clear. If you can see through the
liquid it is ok to drink it. NO RED, PURPLE, OR GREEN COLORED
LIQUIDS.
- Starting
at 1:00 pm begin taking Visicol tablets by taking 4 tablets
at the top of The hour with 8 oz. of water every 15 minutes
for a total of 20 tablets. After completing this drink a
12 oz. can of ginger ale.
- Continue
drinking clear liquids the entire day.
- Starting
at 7:00 pm begin taking Visicol tablets by taking 4 tablets
at the top of the hour with 8 oz. Of water every 15 minutes
for a total of 20 tablets. After completing this drink a
12 oz. can of ginger ale.
- Take
4 Dulcolax tablets at bedtime with an 8 oz. Glass of water.
IT IS EXTREMTLY IMPORTANT TO DRINK LARGE AMOUNTS OF CLEAR
LIQUIDS THROUGHOUT THE PREP!
IT
IS EXTREMTLY IMPORTANT TO DRINK LARGE AMOUNTS OF CLEAR
LIQUIDS THROUGHOUT THE PREP!
Miralax
Capsule Endoscopy Prep
- Clear
Liquid diet dat before the exam starting at lunch (no red
or dark green fluids)
- Take
Dulcolax (Bisacodyl) one tab in the AM, one at noon and
a third in the evening (medication is over the counter)
- Mix
the 255gm Miralax (prescription) in a 64oz. bottle of Gatorade
or water (no red colored fluids) and drink over about about
3-4 hours starting around 6PM day before exam
- Drink
plenty of water throughout the day so you don’t get
dehydrated
- Nothing
to eat or drink after midnight before exam
- Stop
any iron or sucralfate 5 days before exam as this coats
the bowel wall
- Avoid
narcotic pain medications 1-2 days before exam as this well
slow down the bowels and capsule may not make it through
in time
Fleets
Phospho Soda Prep
- Have
a clear liquid diet all day. Clear liquids include coffee,
tea bouillon soup, Chicken broth, water, apple and white
grape juice, lemonade, lemon lime or white Gatorade or other
sports drinks that are clear. If you can see through the
liquid it is ok to drink it. NO RED, PURPLE, OR GREEN COLLORED
LIQUIDS.
- Between
4:00-5:00 pm mix 45 cc (or 1 _ ounce) of Fleets Phospha
Soda with 4 to 6 ounces of ginger ale. Drink this down quickly,
and follow with something pleasant tasting.
- Four
Hours Before you leave for your appointment, mix another
45cc (or 1 _ Ounces) of Fleets Phospha Soda with 4 to 6
ounces of ginger ale. Drink this down quickly, and follow
with something pleasant tasting.
- Do
not have any thing to eat or drink until your exam.
Miralax
Prep
- Have
a clear liquid diet all day. Clear liquids include coffee,
tea, bouillon soup, Chicken broth, water, apple and white
grape juice, lemonade, lemon lime or white Gatorade or other
sports drinks that are clear. If you can see through the
liquid it is ok to drink it. NO RED, PURPLE, OR GREEN COLORED
LIQUIDS. It is important that your drink as much fluid as
you can throughout the day.
- You
will take one Dulcolax tablet in the morning, one at noon
and a third in the evening. (Medication is over the counter).
- Mix
the 255 gm of Miralax (prescription) in a 64 oz bottle of
Gatorade or water (no red, purple, or green fluids) and
drink over a 3-4 hour period starting around 4 PM day before
exam.
IT IS EXTREMELY IMPORTANT TO DRINK LARGE AMOUNTS OF CLEAR
LIQUID THROUGHOUT THE PREP!
- You
will have nothing to eat or drink after midnight before
exam.
Half-Lytely
Prep
- In
the morning, prepare your Half Lytely solution and refrigerate.
Have clear liquids all day. Clear liquids include coffee,
tea, bouillon soup, chicken broth, water, white grape juice,
apple juice and any clear sports drink. You may also make
lemon jell-o. No red, purple, or green colored products.
- At
12 noon take all four time-released Bisacodyl tablets provided
in the prep kit box.
- Continue
drinking clear liquids all day.
- At
6:00 pm begin drinking Half-Lytely as instructed 8 oz. Every
10-15 minutes until the bottle is empty. (Rapidly drinking
a glassful is better than sipping an ounce or two at a time).
A. You will have consumed several glassfuls before having
the first loose, water bowel movement.
B. Initially, you may feel slightly bloated, but will become
more comfortable as you continue to have bowel movements.
- Do
not eat anything until after your exam.
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