Miss Boorman carries out a range of endoscopy procedures:
What is a Colonoscopy?
Colonoscopy is a procedure that enables your surgeon to examine the lining of the colon and rectum. It is usually done in the hospital or an endoscopic procedure room on an outpatient/ daycase basis. A soft, bendable tube about the thickness of the index finger is gently inserted into the anus and advanced into the rectum and the colon.
Why is a Colonoscopy Performed?
A colonoscopy is usually done:-
- as part of a routine screening for cancer,
- in patients with known polyps or previous polyp removal,
- before or after some surgeries,
- to evaluate a change in bowel habits or bleeding or
- to evaluate changes in the lining of the colon known as inflammatory disorders.
About the Procedure
What Preparation is Required?
The rectum and colon must be completely emptied of stool for the procedure to be performed. In general, preparation consists of consumption of a special cleansing solution or several days of clear liquids, laxatives and enemas prior to the examination. Your surgeon will provide you with instructions regarding the cleansing routine necessary for the colonoscopy.
Follow your surgeon’s instructions carefully. If you do not complete the preparation, it may be unsafe to perform the colonoscopy and the procedure may have to be rescheduled. If you are unable to take the preparation, contact your surgeon.
Most medications can be continued as usual. Medication use such as aspirin, Vitamin E, non-steroidal anti-inflammatories, blood thinners and insulin should be discussed with your surgeon prior to the examination as well as any other medications you might be taking. It is essential that you alert your surgeon if you require antibiotics prior to undergoing dental procedures, since you may also require antibiotics prior to colonoscopy.
You will most likely be sedated during the procedure and an arrangement to have someone drive you home afterward is imperative. Sedatives will affect your judgment and reflexes for the rest of the day. You should not drive or operate machinery until the next day.
Did you know?
1 in 3 adults between the ages of 50 and 75 have not undergone recommended screening for colon cancer? Of all colon cancer screenings, colonoscopy is by far the most commonly used, with more than 6 in 10 people choosing it over other tests.
What Can Be Expected During Colonoscopy?
The procedure is usually well tolerated, but there is often a feeling of pressure, gassiness, bloating or cramping at various times during the procedure. Your surgeon will give you medication through a vein to help you relax and better tolerate any discomfort that you may experience. You will be lying of your side or your back while the colonoscope is advanced through the large intestine. The lining of the colon is examined carefully while inserting and withdrawing the instrument. The procedure usually lasts for 15 to 60 minutes. In rare instances the entire colon cannot be visualized and your surgeon may request an additional test such as a barium enema or a CT colonography.
What if Colonoscopy Shows an Abnormality?
If your surgeon sees an area that needs more detailed evaluation, a biopsy may be obtained and submitted to a laboratory for analysis. A biopsy is performed by placing a special instrument through the colonoscope. Most polyps can be removed at the time of the colonoscopy. The majority of polyps are benign (non-cancerous), but your surgeon cannot always tell by the appearance alone. They can be removed by burning (fulgurating) or by a wire loop (snare).
It may take your surgeon more than one sitting to do this if there are numerous polyps or if the polyps are very large. Sites of bleeding can be identified and controlled by injecting certain medications or coagulating (burning) the bleeding vessels. Biopsies do not imply cancer, however, removal of a colonic polyp is an important means of preventing colon and rectal cancer.
What should I expect after the procedure?
What Happens After Colonoscopy?
Your surgeon will explain the results to you after your procedure or at your follow up visit. You will be given a copy of the report done at the end of the procedure. You may have some mild cramping or bloating from the air that was placed into the colon during the examination. This should quickly improve with the passage of the gas. You should be able to eat normally the same day and resume your normal activities after leaving the hospital. Do not drive or operate machinery until the next day, as the sedatives given will impair your reflexes.
If you have been given medication during the procedure, you will be observed until most of the effects of the sedation have worn off (1-2 hours). You will need someone to drive you home after the procedure. If you do not remember what your surgeon told you about the examination or follow up instructions contact your surgeon’s secretary that day or the next to find out what you were supposed to do.
If polyps were found during your procedure, you will need to have a repeat colonoscopy. Your surgeon will decide on the frequency of your colonoscopy follow up.
What Complications Can Occur?
Colonoscopy complications include bleeding from the site of a biopsy or polypectomy and a tear (perforation) through the lining of the bowel wall. Other complications of the procedure include the possibility of missed polyps or other lesions.
Should a perforation occur, it may be necessary for your surgeon to perform abdominal surgery to repair the intestinal tear. Blood transfusions are rarely required. A reaction to the sedatives can occur. Irritation to the vein that medications were given is uncommon, but may cause a tender lump lasting a few weeks. Warm, moist towels will help relieve this discomfort.
It is important to contact your surgeon if you notice symptoms of severe abdominal pain, fevers, chills or rectal bleeding of more than one-half cup. Bleeding can occur up to several days after a biopsy.
This information is not intended to take the place of your discussion with your surgeon about the need for a colonoscopy. If you have questions about your need for a colonoscopy, your alternatives, do not hesitate to ask your surgeon or her secretary about it. If you have questions about the procedure or subsequent follow-up, please discuss them with your surgeon before or after the examination.
Flexible sigmoidoscopy is a test to look inside the lower part of your large bowel. It is also called bowel scope or flexi sig.
The flexible sigmoidoscopy is a thin flexible tube called a colonoscope. This has a small light and camera at one end. The endoscopist (specially trained doctor) puts the tube into your back passage (anus) and gently moves it up into the lower part of your bowel. They can see the pictures of the inside of your bowel on a TV monitor.
You usually have this test in the endoscopy unit at the hospital. It may take between 5 to 15 minutes. But you should expect to be in the department for up to 2 hours.
Before your test
You will be sent written instructions before your test about what you need to do.
Your bowel needs to be empty of poo for a flexible sigmoidoscopy. This is so the endoscopist has a clear view of your bowel.
To prepare you for the test:
- you may have an enema - you might be sent this to do at home or you may have it when you get to the hospital
- instead of an enema, you might be sent a liquid bowel preparation (laxative) to drink and follow a special diet for a couple of days beforehand
- you usually can't eat or drink for a few hours before your appointment time
If you're taking iron tablets or drugs that can cause constipation, you need to stop taking them about a week before your appointment. Your appointment letter gives you more details about this.
Contact the hospital for advice before your appointment if you're diabetic or taking medicines to thin your blood.
How you have a flexible sigmoidoscopy
Just before the test
When you arrive at the hospital you're seen by a nurse who will check your temperature, blood pressure, breathing and heart rate.
You'll also be seen by your endoscopist who will explain what will happen and ask you to sign a consent form. This is a good time to ask any questions you may have.
Your nurse will give you a hospital gown to change into.
During the test
You'll lie on a bed on your left side, with your knees tucked up to your chest. You don't normally need medication to make you relax while you have the test.
The endoscopist will first check your back passage for any abnormalities. They then gently put the colonoscope into your back passage and up into the large bowel. This is uncomfortable but is not usually painful. They put gel on the colonoscope to make it more comfortable. The gel usually feels cold.
The doctor or nurse puts a small amount of gas and water through the colonoscope into your bowel. This opens the bowel so they can see the lining of the bowel clearly. This can make you feel bloated and like you want to go to the toilet. Don't worry you won't as your bowel will be empty. You may pass wind during the procedure, this is expected so don't be embarrassed.
If you find it too uncomfortable at any stage tell the endoscopist and they will stop.
You might have pain relief using gas and air (Entonox). This is a fast- acting pain relief breathed in through a mouth piece.
During the test, they take photographs of your bowel lining. If your doctor sees any abnormal areas they will take tissue samples (biopsies).
If you have any growths in the bowel lining (polyps), they can remove them with a wire loop they put down the colonoscope. They send samples to the laboratory to be checked by a pathologist.
A pathologist is an expert who looks at and identifies cells.
After the test
- You might feel bloated and have mild cramping pain after the test.
- You can eat and drink as usual.
- You can usually go home after the test.
Flexible sigmoidoscopy is a very safe procedure but your nurse will tell you who to contact if you have any problems after your test. Your doctors will make sure the benefits of having a sigmoidoscopy outweigh any possible risks.
Tummy discomfort or pain
You may have some bloating, cramping or pain in your tummy (abdomen) after the test. This is due to the gas or air put into the bowel. This should go away after a few hours. Walking around, warm drinks and peppermint water may help you to pass wind.
After having a biopsy or polyp removed, you might have some bleeding. This is usually a small amount and stops on its own within a couple of days. Sometimes people with piles (haemorrhoids) may have some bleeding after the test.
This is rare, but you may get a high temperature and generally feel unwell.
Tear in your bowel
Very rarely there is a small tear in the bowel wall (perforation). If this happens it's likely you need surgery to repair the tear.
Your nurse will give you instructions about what to look out for and who to contact if you have any problems at home.
Contact the department where you had your test or your GP if you have the following symptoms:
• severe tummy or bottom pain
• continuous or heavy bleeding from your back passage
• passing blood clots from your back passage
• passing black poo (stools)
• high temperature
• generally feeling unwell
Getting your results
You should get your results within 2 weeks. They may be sent to you and your GP or you may get them at a follow up appointment.
The endoscopist will explain to you at the time if they've taken any biopsies or polyps. They won't be able to give any more information than this because the pathologist needs to look at them in the laboratory under a microscope.
A rigid sigmoidoscope is a straight, hollow plastic tube, with a tiny light at the end, that allows a detailed examination of the rectum. An instrument that can take tissue samples for biopsy may be inserted through the hollow tube.
Why is a sigmoidoscopy done?
A sigmoidoscopy is done to:
- Detect disease in the rectum or anus.
- Find the source of anal bleeding.
- Find the cause of diarrhea or constipation.
- Remove or monitor the development of existing polyps or growths.
- Screen for colon cancer or monitor rectal cancer that has already been treated.
What should I expect during a sigmoidoscopy?
- Sigmoidoscopy can be performed in either a hospital or outpatients. Most sigmoidoscopy examinations do not require anaesthesia.
- The doctor will first do a preliminary rectal exam with a gloved lubricated finger, then gently insert the sigmoidoscope. As the scope is slowly and carefully passed through, you may feel as if you need to move your bowels. Because air is introduced into your bowel to help the doctor see better with the sigmoidoscope, you may feel some cramping or fullness. Generally, there is little discomfort during the procedure.
What are the risks of a sigmoidoscopy?
There is little risk associated with sigmoidoscopy. It is possible that a patient may experience rectal bleeding as a result of the insertion of the sigmoidoscope or if the lining of the rectum is irritated. A patient may also develop an infection after the procedure. Both complications are rare.