A colonoscopy is a medical procedure that involves examining the interior of your large intestine, encompassing the colon, rectum, and anus, to detect any abnormalities or diseases. It is a kind of endoscopy whereby an endoscope, which is a flexible tube equipped with a camera and light, is introduced into the body. During a colonoscopy, the colonoscope is inserted through the anus and rectum, advancing into the colon. As it progresses, it captures images of the internal structures of the large intestine, which are then displayed on a screen for examination.
If required, during a colonoscopy test, any abnormal tissues or polyps can be eliminated through the colonoscope. Additional biopsies (tissue samples) can also be obtained during the procedure.
Who performs a colonoscopy?
Colonoscopies are typically performed by gastroenterologists, who are physicians who specialise in the diagnosis and treatment of diseases related to the digestive system. In some cases, other healthcare professionals, such as colorectal surgeons, may also perform colonoscopies.
Who Requires a Colonoscopy?
A colonoscopy may be required to determine the origin of unexplained symptoms such as:
• Bleeding from the anus (the rectum orifice via which faeces exits the body)
• Changes in bowel activity, for example, diarrhoea
• Pain in the stomach (belly)
• Unexplained cause of weight loss
A colonoscopy may also be performed for colorectal cancer screening, to diagnose conditions such as inflammatory bowel disease, and to identify polyps.(2,3)
Why is a Colonoscopy Needed?
A doctor may recommend a colonoscopy for the following purposes:
- Investigation of intestinal symptoms: When a patient presents with abdominal pain, chronic diarrhoea, rectal bleeding, or other gastrointestinal issues, a colonoscopy can be used to help the doctor examine and identify potential causes.
- Screening for colon cancer: Individuals who are 45 years or older and are at intermediate risk of colon cancer may be advised to undergo a colonoscopy every 10 years. If the patient has additional risk factors, such as a family history of colon cancer, the doctor may recommend more frequent screenings or earlier initiation. It is important for patients to have a discussion with their doctor to determine the most appropriate screening options for their specific situation.
- Surveillance for polyps: Patients who have previously had polyps detected during a colonoscopy may be recommended to undergo follow-up colonoscopies. These subsequent procedures allow the doctor to monitor for the presence of new polyps and remove them if necessary. This surveillance is aimed at reducing the risk of developing colon cancer.
- Treatment purposes: In some cases, a colonoscopy may be performed for therapeutic reasons. For instance, it can be used to place a stent to relieve a blockage in the colon or to remove an object that is causing an obstruction.
How is the Colonoscopy Test Performed?
Here is the procedural description of colonoscopy:
- During a colonoscopy, a colonoscope, which is a flexible, wide tube with a tiny camera, is introduced into the rectum.
- The small camera mounted at the tip of the tube allows the doctor to see the interior of the colon.
- The scope helps the doctor view the entire length of the colon.
- The doctor might collect tissue samples for analysis or remove diseased tissue, such as polyps, while performing the colonoscopy.
- The entire procedure is performed under sedation and roughly takes 30–60 minutes, depending on the case.
- Colonoscopy ensures an exact diagnosis as well as treatment in many cases without the need for a major procedure.
Is the Colonoscopy Procedure Painful?
During a colonoscopy, patients are typically given sedation to minimise pain and discomfort; therefore, most patients do not experience pain during the colonoscopy itself. However, it is not uncommon to feel some pressure or gas pain as the scope is moved through the colon. It is mainly due to the carbon dioxide gas blown into the colon to inflate it during colonoscopy for better visibility of the internal structures.
How to Prepare for a Colonoscopy?
The preparation for a colonoscopy is critical to the success of the procedure. The healthcare provider will provide specific instructions to follow for the individual undergoing a colonoscopy in the days leading up to their appointment. The main reason for these preparations is to ensure that the large intestine is thoroughly cleansed and free of any obstructions, enabling the endoscopist to obtain clear and accurate visualisations during the procedure. Failure to achieve a clean colon may require rescheduling the colonoscopy and repeating the preparation process at a later time.
Diet Prep for Colonoscopy
- A few days prior to the colonoscopy, the patient should follow a low-fibre diet, avoiding foods such as nuts, whole grains, seeds, raw vegetables or fruits, and dried fruit.
- On the day before the colonoscopy, solid foods should be completely avoided. Instead, patients should stick to clear liquids, which may include options such as clear broth, black tea or coffee, clear soft drinks, and clear juice (white grape, apple).
- On the day of the colonoscopy, the same guidelines apply, with patients continuing to consume only clear liquid foods. It is important to refrain from eating or drinking anything for two hours prior to the procedure.
Bowel Prep for Colonoscopy
- The day before a colonoscopy, the recommended bowel prep involves patients drinking a liquid that induces bowel movements, leading to diarrhoea and clearing the colon.
- The specific instructions for bowel prep may vary depending on the doctor’s preference, the timing of the colonoscopy, and any previous experiences one has had with bowel prep.
It is advisable for patients to consult their healthcare providers to discuss the most suitable bowel prep option. Healthcare providers can provide detailed information on approved bowel preparations and assist in determining the option that best meets the individual’s needs.
Medication Adjustments
- Patients should inform their doctors about any medications they are taking, including over-the-counter drugs or supplements. If these medications can affect the colonoscopy procedure, the doctor may advise the patient to temporarily discontinue them. This includes medications such as blood thinners, certain diabetes medications, and vitamins containing iron.
- To prepare the colon for the procedure, the doctor may prescribe a laxative to be taken the night before the appointment. In some cases, an enema may also be recommended on the day of the procedure to thoroughly cleanse the colon.
Transportation Arrangements
Patients should make arrangements for a ride home after the colonoscopy appointment. The sedative administered during the procedure can impair driving abilities, making it unsafe for patients to drive themselves.
How to Get Prepared for a Colonoscopy When Pregnant?
A colonoscopy test while expecting a baby is usually only advised when absolutely required; however, it is fairly safe for both the expectant parent and the infant. If it is performed only as routine screening, your doctor may advise you to postpone it until after having given birth.
Given that nutrition is so essential throughout pregnancy, one will want to talk to the doctor regarding the proper bowel prep ahead of time and which types of laxatives (if any) would be required and safe to use.
What to Expect on the Day of the Colonoscopy Procedure?
- Before undergoing a colonoscopy, individuals will be required to wear a hospital gown.
- In preparation for the colonoscopy, a nurse will place an intravenous line into the individual’s arm. This allows for the administration of sedatives and pain medication directly into the bloodstream. It is also possible to request lower levels of sedation after consulting with a medical professional.
- The individual’s blood pressure, heart rate, oxygen level, and respiratory rate, will be monitored and assessed throughout the procedure.
What to Expect During a Colonoscopy Test Procedure?
The patient will be instructed by the doctor to lie down, typically with their knees brought up towards their chest, for the colonoscopy procedure. The doctor will then proceed with the following steps:
- A colonoscope will be inserted into the rectum.
- The colon will be expanded by introducing a small amount of carbon dioxide gas, allowing the doctor to examine the walls of the colon.
- The colonoscope is equipped with a tiny camera at its tip, which transmits images to an external monitor for analysis.
- If the patient experiences cramping during the procedure, the doctor may advise them to take slow, deep breaths.
- During the colonoscopy, if any abnormality is detected, the doctor may take small tissue samples for further analysis (known as a biopsy) and identify and remove abnormal growths or polyps.
- The colonoscope is gradually withdrawn as the lining of the intestines is thoroughly examined.
What to Expect After a Colonoscopy?
- After the colonoscopy procedure, the individual will be kept under observation for a period of time.
- Once the effects of anaesthesia have faded away, they will be allowed to be discharged.
- If any polyps were eliminated during the procedure, the doctor may recommend a special diet for the individual. They may experience temporary cramping or gas, although these symptoms are expected to pass quickly.
- The doctor may advise the individual to take short walks to find relief.
- The patient will be instructed to refrain from alcohol use for at least 24 hours following the procedure.
- Inform the doctor if you happen to exhibit any of the following symptoms:
- Chills or fever
- Bloody stools (frequent)
- Pain or swelling in the abdomen
- A hardened stomach
- Inability to release gas
Depending on the condition, the physician may give patients additional advice.
What are the Possible Risks and Complications of a Colonoscopy?
Complications and risks are uncommon but possible. They are as follows:
- Colon wall injury, for example, a tear
- Uncontrolled bleeding as a result of tissue removal
- Infection
- Anaesthesia-related reactions
How Much Time does a Colonoscopy Take?
The duration of a colonoscopy procedure typically involves advancing the colonoscope through the large intestine for approximately 15 minutes to reach the end, followed by another 15 minutes to retract it back along the same path. This allows the doctor to thoroughly examine the entire large intestine twice.
If any abnormalities requiring removal or treatment are detected during the examination, additional time will be required. It is common for colon polyps to be found during routine colonoscopies. Although the majority of polyps are noncancerous, it is standard procedure to remove them immediately. This additional step may extend the duration of the procedure by another 15 minutes.
Is Virtual Colonoscopy the Same as Colonoscopy?
Virtual colonoscopy and colonoscopy differ in several aspects. Virtual colonoscopy is an x-ray test that is quicker and does not require anaesthesia. However, it does not provide a complete view of the entire colon like a traditional colonoscopy does. A virtual colonoscopy may also be less effective in detecting certain types of polyps compared to a colonoscopy. Additionally, virtual colonoscopy does not allow for the removal of polyps or the treatment of certain other issues. It is important to note that insurance coverage may vary for these two procedures.
Takeaway
A colonoscopy is a valuable medical procedure that serves multiple purposes in diagnosing, treating, and preventing diseases related to the colon. It allows healthcare providers to investigate intestinal symptoms, screen for colon cancer, detect and remove polyps, and address specific issues within the colon. By undergoing regular colonoscopies, individuals can significantly reduce their risk of developing colorectal cancer and other related conditions. While the procedure may seem daunting, its potential benefits for detecting diseases early and promoting overall health make it a crucial component of preventive healthcare. It is important to consult with a healthcare professional to determine the appropriate timing and frequency of colonoscopies based on individual risk factors and medical history.
