Colonoscopy is a major part of screening for bowel cancer and polyps. It involves a colonoscope, a long, thin tube with a camera on it, being inserted into the large intestine.
During the procedure, doctors can take pictures and samples of the bowel lining, and sometimes can remove polyps and tumors. You will need to follow a special diet and take laxatives to prepare your bowel for the test.
The day before your procedure, you will be given a special combination of laxatives to empty your bowel. This preparation is essential to allow your doctor a clear view of the colon during the procedure. The laxatives will cause diarrhea so make sure you have a lot of wet wipes and are close to a toilet. It is also a good idea to clear your schedule on the days you start your bowel prep. It is important to drink extra fluids as well, to prevent dehydration.
During your colonoscopy, you will be sedated, which means you’ll feel sleepy and relaxed. The sedation is administered through a small tube (a catheter) placed in your vein. The type of sedation you receive will depend on your age, health conditions, and other factors.
Most people have minimal or light sedation. If you are at high risk of colorectal cancer, your gastroenterologist will discuss whether you should have moderate or deep sedation.
When you arrive for your procedure, you will be asked to sign a consent form. This is a legal document that you should read carefully before signing. It is important to let your doctor know if you have any questions or concerns about the test.
You will be taken to the endoscopy unit where you will be offered some painkillers and a medicine that makes you drowsy (sedation). This medication is usually given through a tube in your vein (an intravenous, or IV, line). It is important to tell your doctor about any medications you are taking, including vitamins, supplements, herbs, aspirin products, arthritis medicines, blood thinners such as warfarin (Coumadin(r)), heparin or clopidogrel (Pradaxa(r)), insulin or iron products.
If you receive sedation, you will not be allowed to drive yourself home afterwards. It is best to arrange for someone to drop you off at the hospital and take you home after the procedure. Depending on the type of sedation you receive, it may take up to a few hours for the effects to wear off. Be sure to rest for the remainder of the day.
Procedure
The procedure usually takes 20 minutes and can be done in a hospital, medical office or outpatient center. You’ll be asked to lie on an examination table, and a health care professional will put an intravenous (IV) line into your arm or hand to give you sedatives, pain medicine or both, as well as oxygen. The sedatives will make you very sleepy and relaxed, but you’ll still be awake enough to respond to questions. The sedatives will also affect your breathing, so the doctor may monitor your heart rate, blood pressure and oxygen level throughout the test.
You’ll be asked to drink a liquid diet the day before and the day of your colonoscopy. Acceptable liquids include water, Gatorade and broth; tea and coffee without milk or creamer are allowed, as well as clear fruit juices. You will not be able to eat solid food on the day of your procedure, and you should stop drinking fluids at least two hours before your exam. Your doctor will discuss the dietary instructions with you.
During the exam, you’ll be lying on your back and your doctor will insert the colonoscope into your anus, rectum or colon. The doctor will use the scope to look for polyps, which are usually small and noncancerous but can turn cancerous if they’re not removed.
After examining the area, your doctor will remove any polyps that are larger than a pea and send them to a lab for testing. The doctor will also remove any areas of abnormal tissue and take a biopsy, if necessary. You may have a little bit of bleeding from your anus during this time, but this is normal.
You may feel some cramping or bloating after the procedure, and you’ll likely have to go to the bathroom frequently. If the doctor took polyps or a biopsy, you’ll probably have to wait a few days for the results of your test. It’s a good idea to arrange for someone to drive you home after the procedure, as the sedatives and anesthesia will keep you from being able to safely operate a vehicle.
Recovery
Most people who undergo a colonoscopy are sedated for the procedure. Depending on the type of sedation you receive, you may have only a vague memory of what happened during the test or you may recall everything.
You can expect to be put into a hospital gown and given a pair of paper shorts to wear. The hospital staff will ask you to remove any jewelry and other valuables before the procedure. You should also consider leaving your phone at home or putting it on airplane mode so it doesn’t record any unnecessary data during the examination. You should also arrange for a ride to get you to the doctor and back again after the procedure. It’s not safe to drive after sedation.
Once the test is over, you will be wheeled to a recovery room or cubicle and monitored until you awaken from the sedation. A nurse will explain what to do if you experience any problems, such as difficulty breathing or chest pains.
Your doctor will probably advise you to drink clear liquids such as water, tea or coffee without milk or cream, broth and carbonated drinks. You can eat foods that are easily digested, such as scrambled eggs, mashed potatoes, skinless chicken, fruit juices and toast. Gradually add solid foods as your digestion improves. It’s important to eat enough so you don’t lose too much weight after the procedure.
Some people may experience gas or bloating after the test. This is normal, but if you experience a lot of discomfort, contact your doctor. In addition, it’s common to find small amounts of blood in your first bowel movement after the colonoscopy. This is usually harmless, but if the blood continues to flow for several hours, you should call your doctor.
If your doctor finds a polyp or other growth during the procedure, he or she will probably take a sample of it for further testing. It can take a few days to a week for the lab to send back the results, but your doctor will discuss them with you at a follow-up appointment.
Follow-up
Having regular screening colonoscopies can save lives by detecting polyps and removing them before they progress to colorectal cancer. The American Cancer Society recommends a first colonoscopy by age 45, or earlier if at higher risk of the disease. Follow-up colonoscopies, or surveillance colonoscopies, are essential for identifying residual or recurrent polyps, monitoring high-risk patients, guiding management strategies, preventing colorectal cancer and ensuring quality of care.
If you are due for a colonoscopy, it is important to schedule the procedure with your gastroenterologist or primary care physician. Most health insurance companies cover the procedure, and many will reimburse for the preparation if you’re at increased risk of colon cancer or have a family history of the condition.
When you’re ready for your colonoscopy, make sure you have a friend or family member drive you home after the procedure, as sedation may cause dizziness and fatigue. You should also avoid strenuous activity and heavy lifting for 24 hours after the procedure. It is a good idea to have someone at home to help you with housework and grocery shopping, too, as you will be on a restrictive diet for the day or two after your colonoscopy.
The day before your procedure, you’ll begin taking the bowel prep your doctor prescribes. This may include a liquid diet of water, clear broth or bouillon, black tea or coffee (without milk or creamer), Jell-O and popsicles. Avoid high-fiber foods like nuts, seeds, whole grains and popcorn, as these are difficult to digest.
Once the bowel prep starts working, you will feel frequent and urgent urges to have a bowel movement—probably more often and quickly than you ever have before. It is best to go to the bathroom on a designated time schedule so you don’t overdo it and cause yourself more discomfort.
As you return to your normal diet, you should avoid eating anything that is fried or spicy and take it easy on acidic foods. It’s also a good idea to avoid carbonated drinks, as they can cause gas. Most people are able to return to their regular diet the day after their colonoscopy, but if you have polyps removed, your doctor may require a longer restricted diet for a few days or weeks.