What is a colonoscopy?
A colonoscopy is one of the most common tests used on possible IBS sufferers. Doctors use a small camera to check on the health of your colon and small intestine.
The colonoscopy lets the doctor identify inflamed tissue, abnormal growths, ulcers, and bleeding. The doctor can check on the health of the entire large intestine, from the lowest part, the rectum, all the way up through the colon to the lower end of the small intestine.
How do you prepare for a colonoscopy?
Your colon must be completely empty for the colonoscopy to be thorough and safe. To prepare for the procedure you may have to follow a liquid diet for one to three days beforehand. A liquid diet means things like strained fruit juice, water, plain coffee, plain tea, or diet soda. Gelatin or Popsicles in any color but red may also be eaten.
You will also take one of several types of laxatives the night before the procedure. Also, you must arrange for someone to take you home afterward after the colonoscopy has finished - you will not be allowed to drive because of the sedatives. Your doctor may give you other special instructions. Inform your doctor of any medical conditions or medications that you take before the colonoscopy.
What about current medications or diet before colonoscopy?
As usual medications should be continued, but some may interfere with the examination. It is best that the doctor is informed of all current prescriptions or over-the-counter medications. The colonoscopist will also want to be aware of a patient's allergies and any other major illnesses. The colonoscopist should be alerted if, in the past, patients have required antibiotics prior to surgical or dental procedures to prevent infections. Instructions may also be given to avoid certain foods for a couple of days prior to the procedure, such as stringy foods, foods with seeds, or red Jello.
What happens during a colonoscopy?
For the procedure, you will lie on your left side on the examining table. You will probably be given pain medication and a mild sedative to keep you comfortable and to help you relax during the exam. The doctor will insert a long, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a colonoscope.
The colonoscope transmits an image of the inside of the colon, so the doctor can carefully examine the lining of the colon. The scope bends, so the doctor can move it around the curves of your colon. You may be asked to change position occasionally to help the physician move the scope. The scope also blows air into your colon, which inflates the colon and helps the physician see better.
What if the Colonoscopy shows something abnormal?
If anything abnormal is seen in your colon, like a polyp or inflamed tissue, the doctor can remove all or part of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. If there is bleeding in the colon, the doctor can pass a laser, heater probe, or electrical probe, or can inject special medicines through the scope and use it to stop the bleeding.
A colonoscopy takes 30 to 60 minutes. The sedative and pain medicine should keep you from feeling much discomfort during the exam. You will need to remain at the colonoscopy facility for one to two hours until the sedative wears off.
What are Polyps?
A colon polyp is a small clump of cells that forms on the lining of the colon. Although most colon polyps are harmless, some become cancerous over time.
Anyone can develop colon polyps. But you're at higher risk if you're 50 or older, are overweight or a smoker, eat a high-fat, low-fiber diet, or have a personal or family history of colon polyps or colon cancer.
Usually colon polyps don't cause symptoms. That's why experts recommend regular screening. Colon polyps that are found in the early stages usually can be removed safely and completely. Screening helps prevent colon cancer, a common disease that's often fatal when it's found in its later stages.
How are Polyps Removed?
The medical term for removing polyps is polypectomy. Most polypectomies can be performed through a colonoscope. Small polyps can be removed with an instrument that is inserted through the colonoscope and snips off small pieces of tissue. Larger polyps are usually removed by placing a noose, or snare, around the polyp base and burning through it with electric cautery. The cautery also helps to stop bleeding after the polyp is removed.
What happens after a Colonoscopy?
Now is the time to take it easy. The most challenging part of the procedure is over and done with. Still, there are a few things to know about as you get back on your feet.
Right after the procedure
You'll still feel sleepy immediately after your colonoscopy. You'll be taken to a recovery area and given time to rest and regain your senses as the sedative begins to wear off, which can take one or two hours. You may be feeling crampy or gassy as a result of the air that was used during the procedure.
You'll also receive instructions about aftercare. You'll be told when you can eat and drink normally, which is often immediately but may depend on whether or not you did have any polyps removed. You might be asked to refrain from taking certain medications for a short time afterwards. You will also be told when you can expect the results of any biopsies that are done.
After you're home
Since the sedative may linger in your system for 24 hours, you shouldn't drive or operate machinery during that time. Make sure a family member or friend is with you to take you home. Then give yourself permission to lay low for the rest of the day.
Keep drinking lots of liquids to replace what you've lost, but do continue to avoid alcohol. Any leftover cramping or bloating should not be extreme and should disappear within a day.
What are the Possible Complications of Colonoscopy?
A colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. 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: severe abdominal pain, fever and chills, or rectal bleeding of more than one-half cup. Bleeding can occur several days after polypectomy. One possible complication is a perforation or tear through the bowel wall which could require surgery. Bleeding may occur from the site of biopsy or polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely, blood transfusions or surgery may be required. Other potential risks include a reaction to the sedatives used and complications from heart or lung disease. Localized irritation of the vein where medications were injected may cause a tender lump lasting for several weeks, but this will go away eventually.
You should also make sure you follow your doctor's preparation instructions carefully.
DR. RAVINDRAN KUMERAN
MBBS, MSC (LON), DNB, FRCS (Ed (G.I.SURG), FRCS (GLASG)
Sr. Consultant Surgical Gastroenterologist, Laproscopy
& Obesity Specialist
MBBS, MD (Internal Medicine), DM (Medical Gastroenterology),
Consultant Medical Gastroentrologist