A Colonoscopy is a procedure that allows the entire colon and rectum to be examined using a thin and flexible tube called a colonoscope. Colonoscopes contain a tiny camera that transmits an image of the lining of the colon to the examining doctor.
The procedure is used to look for cancer in the colon, or for growths on the lining of the colon that may become cancerous. These growths are called polyps. They can also be used to diagnose and monitor other conditions of the bowel including colitis, diverticulosis and blood vessel abnormalities.
If you have recently had a positive result from a faecal occult blood test, your doctor will refer you to have a colonoscopy. A faecal occult blood test (FOBT) is a simple test that involves taking a small sample from two separate bowel motions using a test kit. Samples are then tested in a laboratory for signs of blood, which can be a sign of early bowel cancer or a polyp.
Dr Adams may also recommend a colonoscopy to investigate symptoms such as abdominal pain, chronic constipation or diarrhoea, or rectal bleeding.
Additionally, as bowel cancer risk increases with age, if you’re over the age of 50 it’s recommended that you have some form of bowel cancer screening – either a faecal occult blood test one to two yearly, or a colonoscopy ten yearly (or more frequently depending on individual circumstances).
The earlier bowel cancer is caught, the better the prognosis for survival.
In order for your doctor to get the best possible view during your colonoscopy, your large bowel needs to be cleaned out of all waste material prior to the procedure.
Preparation usually involves a diet consisting of low fibre food for a few days and clear fluids for a day before your colonoscopy. You will also take strong laxatives (known as bowel prep) the day before the procedure to assist in the emptying of your bowel. Noosa Hospital will provide a preparation kit and a nurse from the hospital will contact you with full instructions.
Dr Adams will take a medication history during your initial visit and advise which can be continued and which need to be temporarily stopped. Blood thinners are the most common medications that need to be stopped including warfarin, clopidogrel, apixaban, dabigatran, rivaroxaban and anti-inflammatories.
Prior to your procedure, your anaesthetist will meet with you to take a health history and put a drip in for the administering of medication. Dr Adams will greet you and confirm there is nothing further you wish to ask before starting the procedure. You will then be moved into the procedure room and asked to roll on your side.
Monitoring equipment is set up, an oxygen mask is fitted, and then your anaesthetist will administer the drugs that will keep you asleep but not unconscious during the procedure. This is called twilight sedation. You should not feel any pain, and usually patients don’t have any recollection of the procedure.
If you do happen to wake up during the procedure, your anaesthetist will administer another dose of medication. If you have any concerns about being over or under-sedated please discuss this with your anaesthetist on the day prior to your procedure.
Once you are asleep, an endoscope is gently passed through your anus into your bowel. A harmless gas is then used to distend the folds and twists in the bowel so the camera can be safely advanced. Sometimes fluid can be used for this too, or to wash the bowel wall.
Then your entire colon is examined. If Dr Adams finds growths or polyps, they can usually be removed there and then. Occasionally very large or difficult to reach polyps may need to be removed by during a second procedure.
If found, other abnormalities can also be biopsied and other treatments can be undertaken. If there are any cancers detected, they will require additional surgery as they cannot be removed at the time of colonoscopy.
When the test is finished, the endoscope is removed and you are sent to recovery. The time taken for the procedure can be anywhere between 20-50 minutes, depending on individual circumstances regarding each person’s bowel.
A nurse will be with you in recovery, to monitor you as you wake up from the sedation. Dr Adams may not see you following your procedure if she is performing procedures on other patients. Additionally, sometimes patients understandably forget some of the information given to them in the recovery room due to the effects of the sedation, so a follow-up appointment in Dr Adams’ clinic is preferable. Dr Adams will also have any biopsy results available at your follow up appointment.
However, if there is anything serious found during your procedure, Dr Adams will make sure you are informed on the day.
As you recover, you may be a bit drowsy or lightheaded for a short while. You may also feel a little bloated, pass some gas or have some mild abdominal discomfort. This is normal. If you have had any polyps removed or had biopsies, you may also notice small amounts of blood in your stool.
It’s also important to remember that the after-effects of your anaesthetic may last for up to 24 hours. So make sure you arrange for someone to drive you home and stay with you for 24 hours after the procedure. Also, do not drive a car or sign any legal papers for at least a day.
Dr Adams’ secretary should be in touch to arrange your follow-up appointment once biopsy results are available (in one or two weeks). If you don’t hear from her, please contact Dr Adams’ offices to arrange an appointment.
Colonoscopies are common and safe procedures that pose few risks. However, as with most medical procedures, it’s possible for some complications to occur.
The following complications are rare, yet possible:
- An adverse reaction to the sedative used during your procedure
- Bleeding from a biopsy or tissue removal site
- A perforation (hole) in the colon or rectum wall
- Inability to visualise the entire length of your colon
More serious risks associated with the test are extremely rare. Be assured that everything will be done to minimise your risk. If you have any concerns about the procedure, please bring them up with Dr Adams in your consult.