What do you need to know about colonoscopies?

So your doctor has recommended you to have a colonoscopy.

What should you expect?

A colonoscopy may feel like a daunting procedure, but in fact it really is quite simple and typically painless with very low risk of complications.

First, preparation. You'll receive specific instructions from your doctor on how to prepare for your colonoscopy, including a bowel cleansing regime. This is crucial to ensure a clear view of your colon during the procedure. In the days leading up to the procedure, you may need to follow a certain diet, including avoiding foods such as grains or maintaining a white diet. You may also be required to stop specific medications, including blood thinners and diabetic medication. If you are unsure, always check with your doctor first before discontinuing or changing your medication schedule.

The day before the procedure, you will typically be on clear fluids.

This involves only consuming liquids that you can see through, including water, apple juice, black tea and black coffee. Depending on your doctor's instructions, yellow or green jelly may also be able to be consumed as a clear fluid. The final step of bowel preparation is taking a liquid preparation formula that is designed to have a laxative effect and stimulate bowel movements.

This, for most people, is the worst part of the procedure. The liquid bowel preparation can taste salty or have an off-putting effervescent consistency. This can be improved by cooling the preparation, drinking it through a straw or mixing it with an approved clear fluid, such as apple juice or flat lemonade.

Be prepared to go to the toilet at least four to six times after commencing bowel preparation, so it may be wise not to stray too far from a toilet. Other than the taste, most people tolerate bowel preparation without issue. However, some may have adverse reactions, including cramping, vomiting or a rash. If this occurs, you should inform your doctor or the hospital.

Next, you'll arrive at the hospital on the day. Once at the hospital or procedure facility, you'll be admitted and have some basic observations performed, including heart rate and blood pressure. You will usually change into a hospital gown and be requested to remove your undergarments.

Sedation and anaesthesia.

In Australia, almost all procedures are performed under sedation. This means you'll be looked after by an anaesthetist who will insert a cannula, which is a small flexible tube into a vein. This is used to administer medication that makes you drowsy and fall asleep.

Most procedures in Australia are performed under sedation and not general anaesthesia, which means you are still breathing on your own during the procedure without the need for a breathing tube or ventilator.

Positioning.

You will lie on your left side on an examination table with your knees bent towards your chest. Whilst you're asleep, the doctor will perform a rectal examination and then insert a thin, flexible tube called a colonoscope into your rectum. The colonoscope has a tiny camera and a light that allows the doctor to examine the lining of your colon.

The procedure will typically take between 20 to 30 minutes, depending on the complexity of your anatomy, and if any further interventional procedures are required.

During the procedure, carbon dioxide is gently pumped into the colon to improve visibility. This will dissipate through the wall of the bowel within 24 hours of the procedure, though you may experience mild bloating or flatulence when you wake.

The doctor will carefully examine the lining of the colon for any abnormalities, including the presence of inflammation, ulceration, polyps, or cancer. They may also perform biopsies, which involves taking a small sample of tissue a few millimetres in size for assessment under a microscope.

After the procedure, typically you'll wake up in recovery, where you'll be monitored until the effects of the sedation or anesthesia have worn off. Once you're awake, you'll usually be allowed to eat. For most patients, you can return to a normal diet the day of the procedure.

Following a colonoscopy, you may find your bowel motions take up to a week to return to a regular pattern. This is usually due to the effects of bowel preparation, and it is normal. You may also see small amounts of spotting blood, which can occur after a biopsy or following the removal of a polyp from the colon.

If you experience any significant pain, large amount, or persistent bleeding, or other concerns, you should always consult a healthcare professional. Other considerations. If you have been given anesthetic medication, including sedation, you will not be able to drive yourself home after a colonoscopy. It is important to have transport arrangements organized in advance.

Take it easy for 24 hours following the procedure, and try not to engage in highly physical or stressful activities, and don't make major life or financial decisions as your judgment may be impacted by anaesthesia.

Remember, colonoscopy is an important preventative health measure, especially for identifying underlying disorders of the bowel, and for the early detection of cancer or precancerous lesions. It is a very common procedure, and it could save your life.

Additional videos on a range of common conditions are available to view on the Gastroenterology Specialist Care YouTube channel.

Note, this video is not a medical consultation. Any medical information is general in nature and is not intended to provide individual clinical advice. You should contact your doctor or other healthcare professional in relation to any concerns they may have, as your own circumstances may be different.

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