Questions

 

What I should know
A colonoscopy is a procedure which allows the inside of the colon (also called large intestine or large bowel) to be examined using a long thin flexible tube with a tiny video camera at the tip.
What are some of the common reasons for having colonoscopy?

Colonoscopies help doctors diagnose possible causes of rectal bleeding, diarrhea and sometimes, chronic abdominal pain. In Crohn’s disease or ulcerative colitis, colonoscopy is also used to assess colon inflammation.

Colonoscopies are used to screen for colon polyps and early signs of colon cancer. Most polyps are harmless, but some can turn into cancer if they’re not removed. On average, one in fifteen (7%) Canadians will get colon cancer. Most often this happens at an older age. Screening for colon cancer decreases the risk of developing and dying from colon cancer.

What are the risks of colonoscopy?

Complications are rare. They are less common among younger persons and those with no other medical problems. The risks are also less if you do not require removal of a polyp or other special procedures during colonoscopy.

Some people have a bloated feeling after the colonoscopy because of the air inserted to view the colon. These people find it helpful to walk around a bit once they are feeling steady.

Minor complications: Abdominal discomfort, bloating, medication reactions or temporary bleeding occur in about 1 in 100 people having a colonoscopy (1%).

Major complications, such as perforation or a hole being made in the intestine and large amounts of bleeding, are rare and occur in less than 1 in 1000 persons (0.1%). Surgery and/or hospitalization may be required to manage this in about 1 in 3000 (0.03%). Death occurs in 1 of 10,000 people having a colonoscopy.

How do I prepare for a colonoscopy?

Some people are anxious/nervous about the procedure. Please let your nurse or doctor know about any of your concerns. 90% of people having a colonoscopy report a comfortable experience.

Your doctor or other staff on behalf of your doctor will give you detailed instructions about preparation. It is important that you follow the instructions carefully, starting a week before the test. This allows your colon to be thoroughly clean providing your doctor a clear view of the lining.

What will happen at the hospital/endoscopy facility when I go for colonoscopy?
  1. Bring a list of your medications to the facility. Do not bring valuables, wear jewelry, or wear nail polish.
  2. Bring your medical card and register when you arrive.
  3. You will change into a hospital gown.
  4. A nurse will meet with you to briefly review your medical history and your medications.
  5. Sedation: Usually an intravenous (IV) line will be placed in your arm. This IV line will be used to provide medicines (usually midazolam and fentanyl) to make you sleepy when your procedure is started.Although, most people in North America get these medicines for colonoscopy, some people have colonoscopy without any sleeping medicines.  People who do not use these medicines will remember the procedure and may experience some discomfort and possibly some pain. They will also be able to view the video display (if they wish) to see the appearance of the colon.  They can return to normal activities immediately after the colonoscopy. Persons who have sedation are less likely to have pain or discomfort. They should not drive for up to 24 hours afterward and should have someone who can take them home and stay with them after the colonoscopy. If you have preferences or questions about sedation and the medicines used, ask the doctor doing the test or their nurse about this before the day of the colonoscopy.  Most doctors have medicines that they prefer to use for a colonoscopy.
  6. You will be taken on a stretcher to the colonoscopy room. You will be met there by your doctor and other staff.
Questions about referral for colonoscopy
How long does it take to receive colonoscopy appointment date?
This varies in different practices and regions according to the urgency of the situation. In the Winnipeg Regional Health Authority a goal is to send out the appointment date within two months of receiving the request from the referring doctor.
How long does it take until I have my colonoscopy?
Again this varies in different practices and regions according to the urgency of the situation. In the Winnipeg Regional Health Authority a goal is to schedule the appointment within 3 months of receiving the request from the referring doctor.
Questions about bowel cleansing preparation
Why are there different bowel cleansing preparations?

Several bowel cleansing laxatives are available. Each has pros and cons. People with certain health problems (for example, kidney failure or heart failure) can use some laxatives and not others. The laxative that can be used by people with most health problems involves taking a large amount of liquid laxative (4 litres). There are some laxatives for preparation that involve a smaller amount of liquid laxative, but it is necessary to take a large amount of water with these.

It is important to follow the preparation instructions you receive carefully so that the colonoscopy doctor will be able to see your bowel clearly during the colonoscopy.

What types of medications or supplements do I have to stop taking?
Most medications can be continued. Usually you will be asked to stop medications containing iron (including multivitamins and supplements that contain iron) a week before the colonoscopy. Medications to treat diabetes and blood thinners may need adjustment. If you are unsure about this please talk to your doctor.
Why must I stop eating seeds, nuts and flax one week before the colonoscopy?
These tend to stick in the inner lining of the colon and can obstruct the colonoscopy doctor’s view.
Why do the instructions usually say to stop eating solid foods the day before the colonoscopy?
Solid food takes longer to clear from the colon so many doctors ask you not to eat solid food the day before the colonoscopy.
Why is it recommended to drink one glass of liquid each hour that I am awake during preparation?
Using the laxative removes water from your body with the diarrhea it causes. It is important to your health to replace this water. Drinking liquids also helps in cleansing the colon.
Are there health problems if I do not have enough water in your body (you become dehydrated)?
Lack of water can damage many parts of your body. It can make you feel weak and tired.
Why is it sometimes recommended to also take laxatives tablets and the bowel preparation liquid?
Some colonoscopy doctors recommend taking both laxative tablets and the liquid laxative to better clean the colon.
Why is there such a large volume to drink?
In order to completely clean your colon it is important to take the full amount recommended by your colonoscopy doctor.
How long will I spend going to the toilet?

Within about three hours from starting the laxative you will begin to have bowel movements. Following this you will likely be going to the toilet for quite a few hours. A lot of stool (poop) and liquid must be passed to fully clean your bowel.

On the day of your colonoscopy, if you have time, you should wait an hour after finishing the liquid laxative before you leave your home.

What types of discomfort could I experience? What can be done to lessen the discomfort?

You may have stomach cramps. For cramps, walking and taking a short break from drinking the laxatives can help. At the same time remember that it is important to finish all of the laxative well before your colonoscopy.

You may have irritation around the anus. Skin cream around the anus can help with irritation.

What can I do if I find it hard to drink all of the liquid or if I dislike the taste?

Some people find that drinking with a straw helps – so you don’t taste it as much. If the liquid laxative is not flavored you can add flavor crystals. You can rinse your mouth with a clear liquid such as water after each drink of liquid laxative.

Cooling the liquid in the fridge can also help. If you start to feel cold you can take it out of the fridge or drink some clear warm liquid like clear broth or herbal tea.

What fluids are clear fluids and okay to drink?

Fluids that are okay:

Food and Fluids that are not okay:
✔ clear soups ✖ no bread, grain or rice
✔ apple juice, white grape juice, white cranberry juice ✖ no soups with chunks of food
✔ clear of lemon Gatorade/Powerade ✖ no meat
 ✔ ginger ale, and water  ✖ no fruit or vegetables
 ✔ coffee or tea (sugar and sweetner are okay)  ✖ no milk or dairy products
 ✔ popsicles (not red or purple)  ✖ no red, blue or purple liquid
 ✔  lemon or orange Jello  ✖ no alcholic drinks
When should I stop drinking clear fluids?
Do not drink any fluids in the two hours before the time of the colonoscopy. For some people, their colonoscopy doctor may ask them to stop a little earlier.
How do I know my bowel/colon is clean enough?
You know that your bowel preparation is complete when your stool (poop) is a yellow to clear coloured liquid: Clean sample
Should I stop taking the liquid laxative when I think the colon is clean enough?
No. It is important to take all of the laxatives.
Why do I have to get up very early in the morning to drink half of the laxative (if the instructions say this)?

Research shows that taking half of the liquid laxative the evening before the test and half the morning of the test is better for cleaning the bowel. The colonoscopy doctor will be able to see your bowel more clearly.

Remember that people often have to get up early before a long trip also. Plan ahead for some activities you can do early in the morning (radio, music, TV, computer) while taking frequent trips to the toilet.

I have a long drive to reach the colonoscopy facility/hospital. How should I plan the trip?
Most people find that they do not have to make frequent visits to the toilet in the two hours before the colonoscopy. If you have to travel for more than one hour, it may be best to stay somewhere closer to the location for your colonoscopy starting the evening before the colonoscopy. You should finish your laxative in the morning at least one hour before you leave your home or hotel.
More questions about the colonoscopy
Why does someone have to accompany me after the procedure?

The medicine used during the colonoscopy often makes people feel tired and sleepy for a few hours afterwards. This makes it unsafe for people to drive or to travel alone.

It is important to have someone with you who can stay to hear the results after the test and then take you home. Ask them to write down the results and whether another colonoscopy is suggested in future years. You will feel drowsy after the colonoscopy due to the medications used to relax you. You may not remember things you are told about the results.

If you cannot find someone to be with you after the test, colonoscopy doctors may do the colonoscopy but give you less (or no) sedating medications andor keep you longer in the hospitalendoscopy clinic after the colonoscopy. They may ask you to take a taxi home.

Can someone accompany me into the room? Do I have to be alone?

Some doctors are okay with the person accompanying you to go with you to the examining room if your test is not performed in an operating room. When the test is performed, they will be asked to leave.

If you have some special needs it is best to speak to the colonoscopy doctor well before the day of the test to discuss how these can be handled.

Do you have to wear anything specific on the day of the colonoscopy?
No, but you will be asked to change into a hospital gown. It is usually best to leave most of your valuables home and only take what you need that day including your medical card.
What types of medications (sedatives) are used for the colonoscopy?

Different medicines are used by different doctors. Most commonly used are small amounts of medications for sedation or pain (such as fentanyl, midazolam (also called versed) and propofol). Because of these medicines, many people do not remember anything about the colonoscopy after it is completed. You may not remember well or be steady on your feet for an hour or two after the colonoscopy is finished.

Fentanyl has been in the news a lot lately and some people may be concerned about this. This medicine is routinely used for colonoscopy and other medical tests and it is safe when used in this way. If you have questions about this you can ask your family doctor or the colonoscopy doctor.

Will there be an I.V.?
An intravenous (IV) line will usually be placed in your arm. This IV line will be used to provide medicines (usually midazolam and fentanyl) to sedate you (make you sleepy) and reduce the possibility of pain.
Do you need sedating medication?

Although, most people in North America use medications for colonoscopy (to make you sleepy), some people have colonoscopy without any sedation medications. Colonoscopy is often done without sedation medications in Europe. People who do not use sedation medicines will remember the procedure and may experience some discomfort and possibly some pain. They will also be able to view the video display (if they wish) to see the appearance of the colon. They can return to normal activities immediately after the colonoscopy.

Persons who have sedation medications are less likely to have pain or discomfort. They should not drive for up to 24 hours afterward and should have someone who can take them home and stay with them after the colonoscopy.

If you have preferences or questions about sedation medicines used, ask the colonoscopy doctor or their nurse about this before the day of the colonoscopy. Most doctors have preferences on the medicines they use for a colonoscopy.

Why don’t people having a colonoscopy have a general anesthetic as they would for a major surgery?

General anesthetic requires anesthesia doctors and a breathing tube and artificial breathing machine when you are not able to breathe enough on your own. There is a slightly higher risk of problems with a general anesthetic than with the medicines usually used in colonoscopy.

Most people do very well without general anesthesia.

How painful is the colonoscopy?

Everyone has different pain responses to the colonoscopy. Most people do not remember any pain during colonoscopy. Discomfort can occur for short times during the colonoscopy, which most people do not remember. Medications are used to decrease the discomfort. Your doctor may do other things such as asking you to turn positions to help decrease the discomfort.

Your colon is filled with air during the colonoscopy which may cause bloating and discomfort afterwards.

How many people are involved in the colonoscopy room?
Other than the colonoscopy doctor, there is a nurse in the room. Other nurses, doctors, student doctors or nurses may also be present.
What are the roles of these additional people?
These other people help your doctor with the test by passing instruments or giving you medications.
Can you feel if polyps are removed?
You will not feel removal of the polyps since there are no nerve endings in the colon that can sense pain.
What will happen during colonoscopy?
  1. You will be positioned on your left side. In many hospitals/ endoscopy facilities, you will be given oxygen, and your blood pressure, heart rate and breathing will be monitored throughout the procedure.
  2. You will be given the medicines to make you drowsy. The purpose of these medications is to keep you comfortable throughout the test. Some people sleep through the test. Others are more awake.
  3. The doctor will start the examination by inserting an examining finger into the rectum. Then the colonoscopy tube, which is the thickness of the examining finger, will be inserted into your rectum and inside of your colon (large bowel/large intestine) examined.
  4. The procedure is done over approximately 20 to 45 minutes. Your doctor spends this time carefully moving the tube through your colon and viewing the lining of the colon. The colonoscope may be used to insert air or water to improve the viewing. The instrument may be used to take tissue samples or to remove polyps, but you will not feel anything when this is done.
Questions about recovery after Colonoscopy
What is recovery like after the colonoscopy?
  1. If you have sedation with your procedure: After the procedure, you spend 30 to 60 minutes in the recovery room until you are more awake and alert. After recovery, you will be discharged from hospital. You should not drive for 24 hours and should have someone with you who will take you home, and stay with you until you have fully recovered. Your doctor may require that you arrange for someone to stay overnight with you.If you have no sedation with your procedure: You can go home or back to work immediately after the colonoscopy. You do not need anyone to stay with you and are able to drive yourself.
  2. Your doctor will provide you with a note regarding the test outcome. The doctor or a nurse will also discuss the results with you and the person accompanying you. If you were given sedation during the colonoscopy, you may not remember the discussion. It is important that you bring someone with you who can listen to the results and pass them on to you later.
  3. Any polyps or tissue samples (biopsies) that are removed will be sent for review by a pathologist. The results are generally available within a month. If there are any concerning or important findings, you will be called directly by your doctor’s office, or you may be asked to return to clinic to discuss the results. A letter will also be sent to your referring doctor or nurse to inform them of the results and outline further treatment plans if necessary.
How long will it take until I can think clearly after sedation?
It depends upon the type and amount of sedative medication given to you. Many doctors ask you not to drive and to take it easy for the first 24 hours. You may not be able to do activities requiring concentration during that time.
What is recovery like after the colonoscopy?
  1. If you have sedation with your procedure: After the procedure, you spend 30 to 60 minutes in the recovery room until you are more awake and alert. After recovery, you will be discharged from hospital. You should not drive for 24 hours and should have someone with you who will take you home, and stay with you until you have fully recovered. Your doctor may require that you arrange for someone to stay overnight with you.If you have no sedation with your procedure: You can go home or back to work immediately after the colonoscopy. You do not need anyone to stay with you and are able to drive yourself.
  2. Your doctor will provide you with a note regarding the test outcome. The doctor or a nurse will also discuss the results with you and the person accompanying you. If you were given sedation during the colonoscopy, you may not remember the discussion. It is important that you bring someone with you who can listen to the results and pass them on to you later.
  3. Any polyps or tissue samples (biopsies) that are removed will be sent for review by a pathologist. The results are generally available within a month. If there are any concerning or important findings, you will be called directly by your doctor’s office, or you may be asked to return to clinic to discuss the results. A letter will also be sent to your referring doctor or nurse to inform them of the results and outline further treatment plans if necessary.
How long will it take until I can think clearly after sedation?
It depends upon the type and amount of sedative medication given to you. Many doctors ask you not to drive and to take it easy for the first 24 hours. You may not be able to do activities requiring concentration during that time.
What if I feel bloated and I am passing gas after the colonoscopy?
Some people feel this way after the test because of the air put into the colon to help the doctor properly examine your colon. Walking may help with this feeling.
When can I eat solid foods?
Although in general there are no restrictions, you should start with fluids (juice, soup) and light food and then gradually increase to a more regular diet. Light foods are easy to chew and digest. Immediately after a colonoscopy, you may not be able to tolerate heavy foods such as steak and greasy foods.
What types of side effects are normal if no polyps were removed?
Bloating, passing gas, tinge of blood in stool, feeling tired, feeling forgetful.
If a polyp is removed what is a normal effect?
You may see small amounts of blood in the stool.
After a colonoscopy, what is abnormal and what should I do?
If you start having severe pain or more than a limited amount of blood in your stool, you should seek medical attention.
When should I feel back to normal?
You can expect to feel good enough to return to normal activities the day after colonoscopy.
Questions about results of Colonoscopy
How will I get my results?

You will receive the results before you go home. Some colonoscopy doctors provide a written report to the patient.

If pieces of tissue or polyps are removed it can several weeks to get the results.

If a polyp or other tissue was removed and sent to a laboratory how will I know the results?
Different doctors will provide this information in different ways. Some colonoscopy doctors contact the patient themselves. Others provide information by sending a letter to your family doctor who can discuss the results with you.
How long will this take?

The results of the pathology findings are not usually available for several weeks. If you do not hear about the results you may contact your family doctor or the colonoscopy doctor.

If you have any questions regarding the procedure, your medications, or preparation instructions, please call your endoscopy doctor’s office.