What Is A Colonoscopy?
A colonoscopy is a diagnostic screening test to detect the health of the large intestine (also known as the colon or bowel). It is often used to detect pre-cancerous conditions such as polyps, inflammatory diseases such as Crohns Disease, or cancerous conditions such as tumors. A flexible scope is passed through the anus and up into the large intestine while the patient is sedated and unaware of what is happening. Through this scope, the physician can visualize the entire colon. When necessary, a polyp(s) or other sampling of colon tissue (biopsy) can be extracted to be sent to the pathology lab in order to confirm a diagnosis.
Who Performs The Colonoscopy?
The test is performed by a Gastroenterologist who is a medical doctor specializing in diseases of the stomach and intestines.
Who Should Have A Colonoscopy?
In the normal individual, the first baseline colonoscopy should be performed at the age of 50. This will provide the doctor a baseline picture of the colon that future colonoscopies can be compared to. Since colon cancer is slow growing, most repeat colonoscopies are only being done every 10 years. Of course if you are having signs and symptoms of colon problems, you should report this to your doctor and a colonoscopy can be scheduled as needed to rule out disease of the colon.
If there is a family history of colon cancer, the age for that first baseline test may be much younger. This age will be determined by the family physician. The author’s niece was 5 weeks old when her 33 year old father passed away from colon cancer. It turns out that the father’s mother and maternal grandmother both had colon cancer. Subsequently, that niece has been having colonoscopies every 2 years since she turned 21.
How Do I Prepare For This Test?
The worst part about the colonoscopy is the preparation for it during the 24 hours prior to the test. Since the physician will be looking up your colon, the colon needs to be cleaned of all waste.
Once you make your appointment for the procedure, your gastroenterologist’s office will send you a written prescription for the cleansing prep that you will take on the evening before the test. You will need to get the prescription filled at your local pharmacy. This prep will clean out your large intestines of waste. This will not be fun. This will be the worst part of the whole process. You will want to be home for the prep. You will need to be near a functional bathroom with plenty of toilet paper and reading materials.
Alert your gastroenterologist as to any and all drugs, vitamins, supplements, herbs, etc you are currently taking. He will send you written instructions on which medications may have to be temporarily stopped a few days before the test. If there are medications that can’t be stopped, he will discuss this with the prescribing physician (such as Plavix, Insulin)
On the day before the procedure, you will begin a clear liquid diet which you will stay on for the entire day. Clear liquids include: coffee (black or with sugar, no milk), tea (black or with sugar, no milk), white grape juice, white cranberry juice, apple juice, jello, frozen ices, pineapple juice, sprite, ginger ale, Pepsi, Coke or diet cola, popsicles, broth (chicken, vegetable, beef), bouillon ( chicken, vegetable, beef). No red, purple, blue, green, or orange colored products are permitted. Yellow is OK. Dairy products and milk are not permitted nor is alcohol.
You will carefully follow the instructions for the intestinal prep. Once you mix it, put it in the refrigerator to get it cold. It will be very salty. Adding some yellow lemonade powdered mix to it will help mask the saltiness. Some people hold their nose when they drink it to help get it down. Some people add ice cubes. Some people use a straw to help get it down. It doesn’t matter what you do as long as you complete the prep. Yo certainly don’t want to go through this prep and then sedation, only to find that you bowel hasn’t been adequately cleaned out and you have to come back on another day for a repeat performance!
You will eat or drink nothing after midnight on the night before the test. The only exception to this may be if you take blood pressure, heart and/or breathing medicines. If so, you will take them as ordered with a small sip of water.
The Morning Of The Test:
Bring your PatientAction.com online Health History with you. Bring your health insurance ID card. Leave all of your valuables home. You will not need any money or jewelry. You may need your credit card if you do not have health insurance. You may need photo ID for identification purposes. Bring your reading glasses if you need them in order to fill out any written questions. Remember not to eat or drink anything, unless it is for your blood pressure, heart and/or breathing medicine which can be taken with a sip of water. Plan on arriving for your test 1-2 hours before the scheduled appointment time.
How Long Will The Procedure Take?
On the day of the procedure, you will generally show up 1-2 hours before your scheduled test time. You will need to allow at least 3-4 hours from the time of arrival to the time of departure. Let your advocate or driver know this. Make sure the hospital has your driver’s telephone number so if they are not waiting for you in the colonoscopy waiting room, they can be notified when you have completed your procedure.
Can I Come For The Test Alone?
No, you will need to have someone drive you to the test and pick you up. You will not be allowed to leave by yourself, drive yourself or take a taxi home alone. You will be too groggy from the medication. Your ride doesn’t have to remain with you during the test, but they must be available by telephone so they can be contacted as needed.
What Happens When I Arrive?
the receptionist goes over the standard preliminary questions and makes a copy of your insurance card, you will fill out some paperwork. You may also be asked if your companion or driver is a designated patient advocate that the doctor can share pertinent test information with. Once the admission process is finished, you will be escorted to the pre-procedure area. Leave any personal items with your companion if possible. Once in the procedure area, you will be greeted by the nurse who will be caring for you throughout the procedure. S/he will ask you to undress and get into the bed in your private cubicle. An Intravenous infusion will be started in one of your arm veins through which you will receive wonderful drugs that will make you totally unaware of the procedure. You will feel nothing. You will remember nothing. You will be taken very good care of by the staff in the unit. If you have to go to the bathroom, let the nurse know and s/he will help you navigate the trip with the IV.
Will I Experience Pain During The Procedure?
An Intravenous (IV) Infusion will be started in one of your arms before the procedure begins. You will be given Procedural “Twilight” Sedation through the IV that will relax you and make you unaware of what is going on. You will be fully awake during the procedure but you will neither be aware of or remember what takes place. Versed is a commonly used drug that makes the test a breeze! Quite honestly, one minute you will be asked to turn on your left side on the table in the procedure room and the next minute you will be sitting in a wheel chair, completely dressed with post-procedure instructions in hand wondering if you even had the test! You will not have any pain during or after the procedure, although you will want to go home and sleep off the medication for a few hours. The doctor may take some biopsies of polyps or other colon tissue. You will not feel a thing.
What Happens When The Test Is Over?
Once the test is over, you will be assisted with dressing and be given some post-procedure instructions. Your doctor will share his preliminary findings with you and let you know if any biopsies were performed and when he will expect those results back to share with you. If you have designated your companion or driver as a patient advocate, the doctor may have that same discussion with that designee. Go home and sleep off the medications. Do not use any dangerous equipment. Do not drive. You should be able to resume all regular activities as soon as the medication is out of your system… usually about 12 hours.
How Should I Expect To Feel After The Test?
You will most likely feel a bit woozie after the test due to the sedation used during the procedure. Go home and sleep it off over the course of about 10-12 hours. Your abdomen may be swollen from air that they use to inflate the colon for better visualization. You may pass some excessive gas (flatus) after the test for the same reason. Don’t worry about this! Passing the gas will relieve any discomfort. Remember, gas in, gas out! You may also have a small amount of blood in your stool for the next day or two. It may take several days for you to have a normal bowel movement due to the bowel prep. Do not be alarmed.
You may experience a headache caused by the emotional stress associated with the test and/or because you did not eat any breakfast. Going home, relaxing, eating and taking your favorite headache medication will usually relieve this problem. You may also experience some nausea from the medication used for sedation. Resting quietly and taking small sips of clear liquids is suggested until you feel better. You should not use alcohol, tranquilizers, sleeping pills, or non-prescription medications for the first 24 hours after your test. You may notice a bruise or knot on your arm or hand where the Intravenous (IV) was inserted. Warm soaks to the area will ease the discomfort.
Do I Need To Call My Doctor After The Test?
Usually there is no need to call the doctor after the test unless you are directed to do so. If you do experience any chills, fever, severe abdominal pain, abnormal drainage, moderate+ amount of bleeding in your stool (more than one cup), call your doctor immediately.
Hopefully, your test results will be perfectly normal and you will not have to repeat the test for 7-10 years, depending on how often your insurance company will pay for it to be done. Do keep in mind that a change in bowel patterns such as constipation or diarrhea, blood in your stool or a tarry darkening can be indicative of serious disease. See your doctor immediately!
Anecdotes:
My husband had his first colonoscopy at age 50. It was my birthday present to him! At that time, colonoscopies were being repeated every 7-8 years. When we tried to reschedule another colonoscopy for my husband when he turned 58, we were told that insurance companies were now only paying for repeat tests every 10 years and that my husband would have to wait for 2 years. Having lost a young brother-in-law to colon cancer and with my having a history of colon polyps, we are a family that tends to be proactive with our colon health. My husband and I felt that we did not want to wait another 2 years for him to have the test again. When we told the gastroenterologist why we were uncomfortable waiting to repeat the test, he told us that we needed to discuss this with our primary doctor, which we did. Before we knew it, my husband had a referral from our primary physician ordering the test. You have a voice… use it!
My 33 year old physician brother-in-law, Marty, was admitted to the hospital with right lower abdominal pain and right lower back pain. The back pain was clinically indicative of a kidney stone and an Intravenous Pyelogram (IVP) was performed. In this test, dye is injected into a large vein and the doctor ( radiologist) watches as the dye goes through the urinary system. If there is a stone in the system, it can see be visualized and watched as it hopefully makes its way into the bladder where it can then be easily excreted out in the urine. The preliminary verbal report from the radiologist to Marty’s personal physician came back negative for kidney stones. Marty responded to Intravenous antibiotics and was discharged 2 days later. Although the official written IVP report showed no kidney stones, it did show a suspicious looking mass in the ureter ( tube carrying urine from kidney to bladder) pressing on the colon which was why the patient was having both abdominal and back pain. Unfortunately for Marty, the report was sent to his chart which was already archived in the Medical Records department of the hospital. No one read the report and this brilliant young doctor walked around for 18 months undiagnosed and untreated until he finally died from colon cancer. If he had had a colonoscopy he might still be alive today. When he requested one at the onset of some vague symptoms, he was told he was too young for such a test.You have a voice- use it!