Colonoscopy

A colonoscopy is a test that we use to look inside of the bowel. A colonoscopy involves a long, thin, flexible tube (colonoscope) being inserted into the bowel via the anus. It is then gently passed through the large bowel and sometimes into the last part of the small intestine.

You may feel the colonoscope go in, but it shouldn’t hurt. At the end of the tube is a camera and a light which allows the endoscopist to investigate problems in the bowel and diagnose conditions affecting the colon.

The procedure can take 30-40 minutes however these times may vary as we will want to ensure we have investigated and treated everything we can. If we find any small growths called polyps, we will remove them during the procedure by passing a tiny wire loop through the colonoscope. We may also take a biopsy to help confirm or rule out causes of symptoms. You will not feel anything if a biopsy is taken or if a polyp is removed so we will let you know at the time if we do this.

A colonoscopy is an extremely common procedure and is often performed to examine symptoms including a change of bowel habit, as part of the bowel cancer screening program or to monitor pre-existing conditions like polyps. You may be referred by your hospital consultant or directly by your GP. Our department has JAG accreditation to reflect the specialist services and resources our staff are dedicated to maintaining. 

Please be aware that 30-40 minutes is the average time in the procedure room, and we recommend preparing to spend about 2-4 hours in the hospital on the day of the procedure. 

Preparing for the procedure

Prior to the procedure our pre-assessment team will contact you. We will try to contact you by phone so that we can tailor the procedure as much to you as possible and arrange a convenient time for your appointment. If we cannot reach you, we will send a letter in the post regarding the time of your procedure and pre-assessment phone call. If you cannot make your appointment time, please contact our administration team on 01752 438407.

We may ask for some information regarding certain medical conditions which may affect your procedure. The information we need is usually already on the endoscopy referral that has been sent to us by the doctor who wants you to have the endoscopy. We may need to contact you to ask some more questions or to alter your use of certain medications before the procedure. Therefore, your appointment letter will ask you to contact us if you have any of the following: Pacemaker or other implanted device, Diabetes, Sleep Apnoea or if you take any blood thinning medication.

Please read all the information in the leaflets and on the consent form. If you have no questions or queries you can sign the consent form at home, otherwise this will be done prior to the test after you have had the opportunity to speak to a nurse or your endoscopist. Please bring the consent form with you to your appointment. If you forget your form, we will be able to supply you with another however this can cause delays.

You will be asked to take some bowel preparation. It is very important to follow the instructions carefully in order to achieve a clean bowel. The endoscopist will need to see the lining of the bowel clearly in order to check for anything suspicious or treat any abnormalities. If the bowel is not clean enough the procedure may need to be delayed and you will need to have another appointment. We understand that following a different diet can be challenging and that the bowel preparation can be unpleasant however it is very important that the instructions are followed.

Please see our pre-procedure pages to help prepare for your appointment and make your experience as pleasurable as possible. We have shared some techniques suggested by patients and healthcare professionals which we hope will improve your experience.

Pain Relief

Colonoscopy can cause some discomfort and it is completely normal to feel anxious. We have different options at our disposal which will help you to relax.

Sedation reduces discomfort and helps you to relax, it does not put you to sleep but it does make you feel sleepy. It is important we can communicate with you during the procedure. Sedation can make the procedure more comfortable however your recovery will take longer. If you choose to have sedation you will need a friend or family member to accompany you home after the procedure and have someone stay with you for 24 hours. You cannot use public transport to get home. You also must not drive, operate machinery or sign any important documents for 24 hours after the procedure. Sedation doses and the type of sedation used may have to be altered if you have certain medical conditions such as sleep apnoea or breathing problems. You will have a chance to talk about this with the doctor and endoscopist on the day of the procedure.

Gas and Air (Nitrous Oxide or Entonox) provides quick pain relief which wears off quickly. You will be completely awake and your time in the recovery room will be short, meaning that you can go home sooner. You inhale the gas and air using a handheld mouthpiece. It is often used to relieve labour pain. It will be offered to you on the day of your procedure.

During the procedure

During the procedure, you will have a nurse with you at all times. They will be focused on your comfort. Your endoscopy team want to make you feel as relaxed as possible so please communicate anything you think may be helpful and we will always listen.

If you are on your period at the time of your procedure, please bring sanitary pads, tampons or a menstrual cup with you with you and let the admitting nurse know. We may ask you to remove them before the procedure but please do not worry, it is standard practice to place a sterile pad or cloth underneath anyone having the procedure; it will be disposed of afterwards. It is important to communicate anything you feel is relevant to your procedure so that endoscopy team can make accurate decisions and helpful suggestions. 

Once you are in the procedure room you will be introduced to your endoscopy team. The endoscopist will start any pain relief you have requested and insert the endoscope carefully to begin the procedure. 

Gas is introduced to the bowel so that the endoscopist can see where to guide the scope. Inflating the bowel and passing the endoscope through can cause some discomfort so we move carefully and keep the amount of gas we put into the bowel to a minimum. You may experience bloating from the air which can be relieved by passing wind; this is completely normal and the endoscopist will expect this to happen.

You will be able to see the endoscope moving through your bowel on a screen in front of you. The endoscopist will keep you informed about what they are doing and may ask you to perform simple instructions to aid the movement of the endoscope and reduce discomfort.

During a colonoscopy the endoscopist will remove any polyps they can by passing a tiny wire loop through the colonoscope. We may also take a biopsy in order to help confirm or rule out causes of symptoms. You will not feel anything if a biopsy is taken or if a polyp is removed so we will let you know at the time if we do this.

Whilst all procedures carry risks, the chance of a major complication occurring in a colonoscopy is small. Please remember you can stop the procedure at any time and your endoscopy team will respect your wishes.

After the procedure

You will be discharged from the hospital the same day as your colonoscopy.

After the colonoscopy you will be accompanied to the recovery area. Your length of stay here is dependent on the pain relief method you have chosen. If you have had sedation you will need to recover here in the unit for a few hours.

While you rest in the recovery area a nurse will monitor you carefully and make sure you are comfortable. You may feel bloated or have stomach cramps after the procedure. Walking once you are ready or passing wind can help to relieve this discomfort.

Once you can stand and the nurse is happy you are ready, you will be able to change back into your clothes in privacy and transferred to the second stage of recovery. Here a nurse or a doctor will go through your procedure with you and explain the results. If you have had a biopsy taken, we will have the results from this in about two weeks.

We will give you a report of your procedure to take home with you. We find that sometimes sedation can cause patients to forget explanations they receive even once they have moved into the second stage of recovery. It is completely normal for the sedation to take some time to leave your system. If you cannot remember what the doctor or nurse has told you, you will be able to obtain details or results from the procedure from your GP or specialist.

If you have had sedation, you will also need someone to collect you from the endoscopy unit and take you home (not on public transport). Someone will also need to stay with you for 24 hours. You will also not be able to work, drive a car or operate machinery for 24 hours.

Before you leave the endoscopy unit the nurses will give you advice about what to expect and a contact number in case you experience any problems. If you have had any polyps or a biopsy removed, you may notice traces of blood coming from your back passage.

If bleeding persists, becomes more severe or you experience abdominal pain which becomes worse, you should contact either the Endoscopy Unit, your GP or go to your nearest Accident & Emergency Department. Please take a copy of your endoscopy report with you.

If you experience any problems or symptoms after your procedure, from 8am to 6pm please telephone the endoscopy unit in which you had the procedure for further advice on 01752 438407.

Results

A negative result is given if the endoscopist has not found any abnormalities during the colonoscopy.

It may be recommended that you have another colonoscopy even though you have received a negative result. The time between procedures will depend on a variety of factors. If you have an average risk of colon cancer, and you have no risk factors other than age or benign small polyps, it may be recommended you have another colonoscopy in about 10 years. If you have a family history of colon cancer, certain genetic syndromes or if the number, size and type of polyps removed require monitoring or special treatment, the recommended date of your next colonoscopy may be in one to seven years.

A positive result is given if the endoscopist has found any abnormal polyps or tissue during the endoscopy.

Polyps removed during a colonoscopy are analysed to determine whether they are cancerous, precancerous or noncancerous. A lot of polyps aren't cancerous, but some can be precancerous. Depending upon the number, size and type of polyps the doctor may recommend another colonoscopy in order to monitor or treat the bowel.

If there is a polyp or abnormal tissue which could not be treated during the colonoscopy it may be recommended that another appointment is made with a gastroenterologist who is a specialist in removing large polyps. It may also be necessary to consider surgery in order to treat certain abnormalities.

Repeat procedures

It may be necessary to have a repeat colonoscopy or an alternative examination.

If the lining of the bowel was obscured and therefore a complete examination of the colon was not possible, the doctor may recommend a repeat colonoscopy. The doctor may recommend alternative bowel preparation to ensure the bowel is clean for the next procedure.

If the endoscope could not be passed through the entire colon the doctor may recommend a virtual colonoscopy to ensure the whole of the colon is examined.

Medications

You can start taking any medications as normal after the procedure however if a biopsy was taken or a polyp was removed, we may need to delay any blood thinning medications and anti-inflammatory drugs. You can take stool softeners and bran but not laxatives. Please ask if you have any questions about medications.

Food and drink

You may eat and drink as normal after your procedure. If you have had any sedation and you drink alcohol after the procedure it can make you more tired than usual.

Risks

There are risks involved in a colonoscopy.

• A perforation or tear could occur in the bowel during the procedure which would then require surgery.
• If a polyp or a biopsy is taken, there may be bleeding from the site. It should stop on its own.
• A reaction from the sedative injection.

Complications can arise from a colonoscopy procedure. The risk increases with certain health conditions or if polyps are removed. If you experience any of the following symptoms please contact your GP, the endoscopy department between (8am and 6pm) or 111.

• Fever or chills
• Severe abdominal pain
• Vomiting
• Continual bleeding and the passage of large blood clots on more than one occasion.
• Redness, tenderness and swelling at the site of the intravenous injection which persists.