Colonoscopy
What is a Colonoscopy?
A colonoscopy is a procedure that allows your specialist to look at the inside lining of the bowel by using a fine, flexible telescope called an endoscope. The endoscope is passed through the anus (back passage) into the rectum and along the length of the large bowel. The procedure is done under an anaesthetic so you are entirely comfortable and usually have no memory of the procedure at all. In men, a prostate examination is also done. The procedure takes between 10 and 30 minutes on average.
Why is a Colonoscopy done?
A colonoscopy is done to hopefully diagnose and remove polyps which can then prevent possible bowel cancer developing.
As a screening test in people with a higher than normal risk of developing of bowel (colorectal) cancer.
To detect abnormalities in the bowel of people who have symptoms or signs of bowel disease, such as bleeding, pain or a recent change in bowel habits.
In people who have had a positive FOB (faecal occult blood) test of the bowel motion.
Colonoscopy is also done to diagnose inflammatory diseases including anorectal diseases.
Who is at higher risk than normal of developing bowel cancer?
Those people who have had a first degree relative (parent, brother, sister or child) with bowel cancer. If more than two close relatives have had bowel cancer the risk is even greater.
In people who have multiple extended family members with bowel cancer.
If you (the patient) have previously had bowel cancer.
If other members of your family have a history of familial polyposis, or HNPCC (hereditary non-polyposis colon cancer), inherited diseases in which polyps (mushroom-like growths) develop along the lining of the bowel.
If you have had intensive ulcerative colitis for more than 10 years.
If a first degree relative suffered with bowel cancer when should screening commence?
Screening should generally start at the age of 40 years, or 10 years earlier than the age at which your relative had developed bowel cancer.
Frequency of colonoscopies should be determined by your specialist. If your first colonoscopy is free of polyps a repeat colonoscopy every four to five years is suggested. If an abnormality is present, and polyps are actually found and removed, the frequency depends on the type of polyp, as not all polyps convey a premalignant tendency. Colonoscopy will probably be advised more frequently if polyps have been removed, depending upon the type of polyp.
What about the results?
These will be discussed with you by Professor Danne before you go home in almost all cases, the results of your colonoscopy will also be sent to your referring doctor.
What is the risk of developing bowel cancer if you are not in this high risk group?
Cancer of the large bowel is the commonest internal cancer in Australia. It affects about 1 in 24 Australians and the risk increases after the age of 40. It is thought that bowel cancer takes some years to develop and may begin in polyps that can develop on the inside of the bowel wall. It is believed that 97% of bowel cancers begin in this way. Removal of these polyps can, therefore, prevent bowel cancer development.
Should people with a normal risk of developing bowel cancer have screening colonoscopy?
If you have none of the above risks, a colonoscopy is not necessary, unless you develop symptoms of bowel disease. A faecal occult blood test (FOB) can be done as a simple screening test and it is recommended for people over the age of 40 who have no symptoms of bowel disease and no risk factors. People with risk factors or symptoms of bowel disease should move straight to having a colonoscopy and FOB tests are not indicated then. Your doctor can advise you further on this. If FOB is positive, Colonoscopy is indicated.
Is a colonoscopy painful?
Generally, a colonoscopy is quite a comfortable procedure with intravenous sedation anaesthetic given making you extremely unlikely to have any memory of the colonoscopy procedure at all. If any polyps are found during the colonoscopy they can be removed at the same time in most instances. A biopsy, which is a simple sample of the tissue lining of the bowel, may also be taken. None of this causes any pain. Sometimes there is some “wind colic” after the procedure which can be intermittent over a few hours and is relieved usually by the passage of wind.
What is the likelihood of having complications?
Complications are rare. Accidental perforation of the bowel wall, or bleeding, especially if the polyp is removed at the time of colonoscopy, are all slight risks. They occur in less than 0.1% of cases.
If haemorrhoids are treated it is usual to have some minimal bleeding after the elastic band ligation treatment.
Haemorrhoid Treatments
Internal haemorrhoids can be treated with elastic bands (EBL) at the time of colonoscopy. External haemorrhoid tags can also be treated surgically associated with colonoscopy. The treatment of haemorrhoids internally can leave small amounts of pain or discomfort over the next two to three days, but this treatment does not usually interrupt your daily activities too much. Excision of external haemorrhoid tags results in some significant anal pain and it is advised to take several days off work. Details of this will be discussed with you by your specialist.
Are there any special preparations before a colonoscopy?
It is essential to make an appointment for a colonoscopy and to get clear instructions about the procedure and the bowel preparation. It is important that the bowel is completely empty for a colonoscopy to be successful and you will receive specific instructions about the preparation for this, and it is important that you carefully read all of these instructions and follow them closely. You can arrange if you wish, to consult with Prof Danne
What happens after the test?
There may be some discomfort in the abdomen but it normally does not last long. There may be some small amount of blood passed in the toilet if you have had procedures done including biopsies, polyps removed or haemorrhoids treated. You are able to eat normally after the colonoscopy test unless you are advised otherwise. If the bleeding or discomfort is either severe or lasts over several hours you should contact the doctor who performed your test, or your own doctor, or the nearest hospital.
What about the results?
These will be discussed with you by Professor Danne before you go home in almost all cases, the results of your colonoscopy will also be sent to your referring doctor.
COLONOSCOPY: FLEET BOWEL PREP
It is essential that the bowel is thoroughly cleansed to enable it to be clearly examined with the colonoscope. There are different ways that the bowel can be prepared. The Fleet Phosphate prep can cause dehydration if large volumes of fluid are not drunk before, during and after taking the prep. It can also cause electrolyte imbalances in some people with kidney and cardiac diseases, and should only be taken by these people, on specific advice from the doctor. It is quite safe for the average person.
YOU WILL NEED TO PURCHASE 2 BOTTLES OF FLEET AND 4 DULCOLAX TABLETS FOR THIS PREPARATION. AVAILABLE OVER THE PHARMACY COUNTER
ON EACH OF DAY 3 AND DAY 2 BEFORE THE PROCEDURE
Take 2 Dulcolax Tablets at 7.00pm.
Foods you should avoid until after the procedure: Seeded fruits or breads eg tomatoes, kiwi fruit, passionfruit, corn, multigrain bread. You should drink a minimum of 2 – 3 litres of any fluid you desire to ensure you are well hydrated before taking the Fleet.
FOR MORNING COLONOSCOPY (AM)
Drink only CLEAR LIQUIDS for breakfast, lunch and dinner. Solid foods, milk or milk products are NOT allowed.
- 2.00 pm: Add 45 ml (1st bottle) Fleet Phospho-Soda to 250mls of cool clear fluids (eg - water, dry ginger, lemon squash). Follow with one FULL glass (250ml) of approved clear liquid. Drink plenty of clear fluids.
- 8.00 pm Add 45ml (2nd bottle), Fleet Phospho-Soda to 250mls of cool clear fluids. (eg - water, dry ginger, lemon squash). Follow with one FULL glass (250ml) of approved clear liquid. Drink plenty of clear fluids.
FOR AFTERNOON COLONOSCOPY (PM):
-
You can eat a light breakfast followed by drinking only CLEAR LIQUIDS for lunch and dinner. Solid foods, milk or milk products are NOT allowed.
- 6.00pm: Add 45 ml (1st bottle) Fleet Phospho-Soda to 250mls of cool clear fluids (eg - water, dry ginger, lemon squash). Follow with one FULL glass (250ml) of approved clear liquid. Drink plenty of clear fluids. Day before Examination
- 6.00 am Morning of examination Add 45ml (2nd bottle), Fleet Phospho-Soda to 250mls of cool clear fluids. (eg - water, dry ginger, lemon squash). Drink plenty of clear fluids.
DAY OF EXAMINATION
Nil by mouth (including water) for 4 hours before procedure. Arrive for colonoscopy at scheduled time.
MEDICATIONS
You will need to cease some medications for 7 days before your procedure - these are High Dose Aspirin (more than 100mg), Clopidogrel, Persantin, and anti-diarrhoeal agents. You will also need to cease Warfarin for 3 nights prior to your procedure. Discuss this with your doctor. Take your usual medications at 6:00am however Diabetics should not take their morning insulin or Diabetic tablets but should bring them to the hospital. For Gastroscopy (Upper GI Endoscopy) you should cease “Anti-Ulcer” tablets for two weeks before the procedure if time allows (but Mylanta or similar can be continued).
CLEAR LIQUIDS INCLUDE: Strained fruit juices without pulp (apple), clear broth or Bonox, coffee or tea (with no milk or non dairy creamers). Also, all of the following that are not coloured red or purple: Staminade or Exceed, Carbonated or non-carbonated soft drinks, fruit flavoured cordials, plain jelly and clear ice blocks. If you have any trouble tolerating the preparation, please contact the Rooms on 9428 4466.
COLONOSCOPY: PICOPREP BOWEL PREP
It is essential that the bowel is thoroughly cleansed to enable it to be clearly examined with the colonoscope. There are different ways that the bowel can be prepared. Picoprep can cause dehydration if large volumes of fluid are not drunk before, during and after taking the prep. If you have any trouble tolerating the preparation, please contact the Rooms on 9428 4466.
PURCHASE 3 SACHETS OF PICOPREP AND 4 DULCOLAX TABLETS FOR THIS PREPARATION. THIS IS AVAILABLE OVER THE PHARMACY COUNTER.
ON EACH OF DAY 3 AND DAY 2 BEFORE THE PROCEDURE
Take 2 Dulcolax Tablets - late afternoon/evening at home.
Note: Occasionally these tablets can cause some sweating and colicky pains. If severe, do not have the second dose.
Foods you should avoid until after the procedure: Seeded fruits or breads e.g. tomatoes, kiwi fruit, passion fruit, multi grain bread.
You should drink a minimum of 2 - 3 litres of any fluid you desire to ensure you are well hydrated before taking the Picoprep.
MORNING COLONOSCOPY (AM):
Drink only CLEAR LIQUIDS, between 2-3 litres. Solid foods, milk or milk products are NOT allowed.
- 10.00 am: Add Picoprep to 250mls of chilled clear fluids (eg - water, dry ginger, lemon squash). Follow with one FULL glass (250ml) of approved clear liquid. Drink plenty of clear fluids.
- 2.00 pm: Add Picoprep to 250mls of chilled clear fluids. Drink plenty of clear fluids
- 8.00 pm: Add Picoprep to 250mls of chilled clear fluids. Drink plenty of clear fluids.
AFTERNOON COLONOSCOPY (PM):
You can eat a light breakfast followed by drinking only 2-3 litres of CLEAR LIQUIDS for the rest of the day. Solid foods, milk or milk products are NOT allowed.
- 2.00pm: Add Picoprep to 250mls of chilled clear fluids (eg - water, dry ginger, lemon squash). Follow with one FULL glass (250ml) of approved clear liquid. Drink plenty of clear fluids. Day before Examination.
- 6.00 pm: Add Picoprep to 250mls of chilled clear fluids Drink plenty of clear fluids. Day before Examination.
- 6.00 am: Morning of examination: Add Picoprep to 250mls of chilled clear fluids. Drink plenty of clear fluids.
NOTE: Diabetics should only take half their normal dose of medication on this day and monitor their blood glucose levels.
DAY OF EXAMINATION:
Nil by mouth (including water) for 4 hours before procedure. Arrive for colonoscopy at scheduled time.
- MEDICATIONS:
- You will need to cease some medications for 7 days before your procedure – these are High Dose Aspirin (more than 100mg), Clopidogrel, Persantin and anti-diarrhoeal agents. You will also need to cease Warfarin for 3 nights prior to your procedure. Discuss this with your doctor. Take your usual medications at 6.00am, however, diabetics should not take their morning Insulin or diabetic tablets but should bring them to the hospital
- CLEAR LIQUIDS INCLUDE:
- Strained fruit juices without pulp (apple), clear broth or Bonox, coffee or tea (with no milk or non dairy creamers). Also, all of the following that are not coloured red or purple: Staminade or Exceed, carbonated or non-carbonated soft drinks, fruit flavoured cordials, plain jelly and clear ice blocks.
COLONOSCOPY: DULCOLAX OR DUROLAX PREP
Naturally it is essential that the bowel is thoroughly cleansed to enable it to be examined clearly with the Colonoscope. There are several different ways the bowel can be prepared. The bowel preparation chosen for you has been Durolax. (Laxative Preparation)
For people who have found the use of usual bowel preparations difficult, for various reasons, the following regime is used.
- Three days prior - Light diet only (see below). Avoid heavy fatty food, and large amounts of fibre. TAKE TWO DURALAX TABLETS AT NIGHT.
- Two days prior - TWO DUROLAX TABLETS MORNING AND NIGHT.
No solid foods. Fluids only (can include milk)
- One day prior - TWO DUROLAX TABLETS, MORNING AND NIGHT.
No Solid foods, Clear fluids only. (No milk today)
- On day of procedure - No food. Clear fluids until 4 hours before arrival time to hospital, then nil by mouth.
FLEET ENEMA given on arrival at the Day Surgery
Clear Liquids Include
- Strained fruit juices without pulp (apple, orange)
- Water
- Clear broth or Bonox
- Coffee or Tea (with no milk or non – dairy creamers)
All of the following that are not coloured red or purple –
- Staminade or Exceed
- Carbonated or non-carbonated soft drinks
- Fruit flavoured cordials
- Plain jelly (with no added fruits or toppings)
- Clear ice blocks
Food you can eat 3 days before the procedure: boiled egg, cottage cheese, cooked pumpkin,/potato, low fat yoghurt, white bread, clear jelly, skim milk, steamed white fish, boiled chicken.
INFORMATION FOR DIABETIC PATIENTS PREPARING FOR COLONOSCOPY
The day prior to colonoscopy you should not have any solid food, but can drink all sorts of clear drinks, including glucose based drinks if needed. Nevertheless, there are risks of becoming hyper or hypo glycaemic depending upon how your diabetic state is managed.
If you are comfortable managing your diabetic condition, and can check your blood sugars two or three times a day prior to the colonoscopy, and of the morning of the colonoscopy, then it is quite safe to go ahead with bowel preparation, based upon half the dose of insulin that you normally have in the morning, or half the dose of tablet medication, and monitoring your condition during the day.
If you have any concerns during the day prior to colonoscopy, seek the advice of your local doctor or from the Hospital or Clinic where your procedure will be done or Endoscopist.
If you are not comfortable managing your diabetic situation, please consult the anaesthetist concerned with the procedure, or your local doctor, to make sure that you have appropriate monitoring and advice.
For those comfortable with managing your diabetic state the following course of action is recommended:
- Half your dose of tablets of Insulin on the day prior to the procedure.
- Three or four blood glucose estimations by Dipstick during the day.
- Consult your local doctor or the specialist endoscopist or hospital concerned with the procedure, later that day if you have a concern.
- On the morning of the procedure, check your blood glucose, if it is abnormally high or low, advise the Hospital of the reading. Otherwise, bring your medication with you to the hospital, so that you can have medication later in the day after the procedure.