Colonoscopy

Colonoscopy is an endoscopic procedure in which the large intestine and rectum are examined. During colonoscopy, polyps in the large intestine can be removed if necessary, or a tissue sample can be taken for laboratory analysis. In this procedure, colonoscope is inserted through the rectum. This procedure can be performed for both diagnosis and treatment purposes. The intestine is examined via a flexible tube with a light and camera at the tip.

Why is Colonoscopy Performed?

For Diagnostic Purposes: Colonoscopy can be performed to diagnose problems in the intestine. Colonoscopy should be performed when there are symptoms, such as:

• Persistent abdominal pain
• Rectal bleeding
• Chronic constipation
• Unexplained anemia or iron deficiency
• Chronic diarrhea
• Unexplained weight loss

Intestinal cancer screening: Colonoscopy should be performed for early diagnosis of colon cancer and rectal cancer even if there is no symptom. People over the age of 50 are recommended to have colonoscopy performed every 5 years. The frequency of colonoscopy may vary if there is someone who had colon or rectal cancer in family history of a person.

Polyp surveillance: People who have had bowel polyp problems before may need to have a colonoscopy surveillance at regular intervals. Early diagnosis and removal of bowel polyps during colonoscopy is one of the most important ways to prevent intestinal cancer.

What are the Risks of Colonoscopy?

Colonoscopy is a safe procedure. However, from time to time, undesired situations may occur during or after the procedure.

• Bleeding
• Inflammation
• Outward herniation of the large intestine wall (Diverticulum)
• Severe abdominal pain
• Negative reaction to sedatives used during the procedure
• Rupture in the colon or rectum wall (perforation)
• It may cause problems in people with cardiovascular diseases.

What Should Be Done Before a Colonoscopy Procedure?

Before the colonoscopy, the gastroenterologist who will perform the procedure should be informed about issues, such as:

• Pregnancy
• Lung diseases
• Heart diseases
• Diabetes
• Medications currently being taken and drug allergy (if there is any)

The intestines must be empty and cleaned for colonoscopy to be successful. Different methods can be applied for this. If the intestines are not cleaned properly, lesions or polyps may be overlooked during the procedure, the duration of the procedure may get prolonged (prolonged colonoscopy may bring risks), and the procedure may have to be repeated.

Diet for preparation to colonoscopy: There may be some diet or fluid restrictions before the colonoscopy procedure. However, whether such a diet will be given or not depend on the patient. The doctor decides whether a diet is required before colonoscopy after evaluating the patient's condition.

The purpose of the colonoscopy diet is to avoid high-fiber plant foods that leave behind residue. Since consuming fibrous foods will leave too much residue, colon cleansing may be troublesome.

A few days before the colonoscopy: Foods such as whole grain foods, nuts, seeds, dried fruits, stone fruits, fruits with skin, pasta, peas, dried beans should be avoided. Low-fiber diet should be followed. Eggs, yoghurt, cheese, red or white meat and fish, excluding offal, can be consumed until one day before the colonoscopy.

The day before the colonoscopy: Solid foods should not be consumed. Instead, water, tea, fruit juice can be consumed. Yogurt can be consumed once or twice. It is important to avoid consuming red fluids that can be mixed with blood during a colonoscopy. You must not eat or drink anything after the midnight before the colonoscopy. After 6 pm, the drugs recommended by the doctor should be taken to cleanse the intestine.

Colonoscopy day: You should not consume solid or liquid foods at all.

Since a sedative anesthetic will be used during colonoscopy, smoking and tobacco products should be avoided.

Drugs for preparation to colonoscopy: There are different medications and methods to cleanse the intestines for colonoscopy.

The doctor who will perform the colonoscopy will adjust the medications and dosages according to the patient. In addition to the colonoscopy diet, many drugs such as sodium phosphate, laxatives, drugs containing macrogol, mannitol, polyethylene glycol are used for cleansing the intestines. These drugs must be finished 8 hours before the colonoscopy.

In addition to these drugs, the colon can be cleaned with methods such as enema and intestine irrigation.

How is Colonoscopy Performed?

• The patient is recommended to wear loose-fitting clothes on the day of colonoscopy to be comfortable after the procedure.
• Before starting the colonoscopy, the patient is given sedative drugs and painkillers.
• During the procedure, the patient wears a clothing called colonoscopy pants which reveals his/her back.
• If deemed necessary, electrodes can be attached to the body to monitor the patient's breathing, blood pressure and heart rate.
• The patient lies on his/her side on the examination table and takes the colonoscopy position by pulling his/her knees towards his/her chest.
• After the patient takes the colonoscopy position, the doctor inserts a colonoscope through the patient's anus.
• The doctor can inflate the patient's intestines with some air to make the procedure more comfortable and to obtain a clearer view.
• If any abnormal areas are encountered, a biopsy will be performed with a special instrument on the colonoscope. Likewise, if a polyp is detected, it can be removed with a special wire loop on the colonoscopy.
• There is a small video camera at the tip of the colonoscopy device. The camera sends the images to an external monitor. In this way, the doctor can examine the inside of the colon more easily.
• The doctor removes the colonoscope after the images are recorded and the procedure is completed.

After the colonoscopy procedure:

• After the procedure, patients rest in the hospital for approximately 1 hour, and go home on the colonoscopy day.
• Since the patients are given sedatives for the procedure, it is important to have a person accompanying them.
• On the day of the colonoscopy, patients should not drive, make important decisions, and return to work.
• A few hours after the colonoscopy, patients may feel bloating and gas pain due to the air in their intestines. Walking can be helpful to relieve gas pain.
• Patients should avoid lifting heavy things and strenuous activities.
• A bit of blood may be seen in patient's stool after colonoscopy. Generally, it does not cause any problem. However, if the bleeding does not stop, the doctor should be consulted.
• Patients should wait a day to return to the daily life order.
• After the colonoscopy, patients can return to a normal diet. However, if a tissue sample was removed for biopsy or a polyp was removed during colonoscopy, the doctor may recommend a special diet.
• It is important to drink plenty of fluids after colonoscopy.
• Patients taking blood thinners may be asked to stop taking these medications for a while. However, patients should not discontinue taking any medication without a doctor's recommendation.

You should watch out for symptoms after the colonoscopy, and consult your doctor if you experience problems, such as:

• Shivering or fever
• Persistent dizziness and nausea
• Not being able to have a bowel movement
• Blood in stool
• Chest pain or heart palpitations
• Multiple rectal bleeding.
• Severe abdominal pain or bloating
• Vomiting

Especially severe abdominal pain, fever, shivering, nausea, and vomiting can be symptoms of colon perforation.

How Often Should Colonoscopy Be Repeated?

Colonoscopy is vital in the early diagnosis of intestinal cancer. People who do not have any risk factors should start routine colonoscopy screenings at the age of 45-50. People in the risk group whose family histories include people with colon cancer may need to start routine screenings at an earlier age. The frequency of screenings also depends on the results of the procedure performed. Patients whose colonoscopy results do not include any abnormalities, such as polyps, are recommended to repeat colonoscopy screenings every 5 years. The frequency of screenings changes if any abnormal structures or polyps are encountered during colonoscopy. The number, type, and size of the polyps are of great influence in determining the frequency of following colonoscopy screenings. Colonoscopy should be repeated within a year if there are so many polyps that prevent the colon from being examined or if the intestines cannot be cleaned completely.

What Should I Do If I Feel Nausea During the Preparation Period of Colonoscopy?

Liquid medications taken to cleanse the intestines before colonoscopy can sometimes cause severe nausea. If you feel nausea or queasy, you should stop taking these liquid medications for a short time. You should take the medications again after a break of 30-60 minutes. Taking the liquid medications slowly may be helpful for you to prevent the feeling of nausea or queasiness again. You can also take antiemetic drugs in consultation with your doctor.

Tips: You can cool the medication before taking it or you can drink cold water with the medication.

What Should I Do If I Experience Anal Fissure or Irritation During the Preparation Period of Colonoscopy?

During the process of cleansing of the intestines, problems like anal fissure and irritation may occur because of having frequent bowel movements. It is very useful to apply diaper rash cream or Vaseline in preventing such problems. Wet wipes can be preferred instead of toilet paper. You can also sit in a warm tub of water after the bowel movement and then dry the skin in your rectal area with a soft cloth.

What are the Length and Width of a Colonoscope?

There is a tiny camera and light at the tip of the colonoscope, which is a flexible tube. In addition, there is an inflator apparatus on the colonoscopy device that helps the doctor to obtain a view from the inside of the large intestine more easily, and another apparatus to remove polyp-like structures from the intestine, if necessary. Colonoscope is approximately 60 cm long and has 1 cm diameter.

Are There Alternatives to Colonoscopy?

Although colonoscopy is the most effective method for detecting colon cancer at an early stage, there are also alternative tests. The effectiveness of these methods, which are applied to patients who do not want to undergo colonoscopy or who are not suitable for colonoscopy, in detecting colon cancer is different.

1. Fecal Occult Blood Test (FOBT): It is an essential test for the detection of colon cancer.
2. Capsule colonoscopy: The large intestine can be screened via a capsule containing a camera that captures the images of the digestive system, which the patient swallows. The results of this application, which is not very common, are also not considered satisfactory.
3. Virtual Colonoscopy: It is the screening of the large intestine with computed tomography (CT). The large intestine must be cleaned to obtain a better view. Before virtual colonoscopy, the patient is given a contrast material for the doctors to better view the colon. There are several advantages of virtual colonoscopy in comparison to colonoscopy. It involves less risk, it can be easily applied to the elderly and those who use blood thinners, it is faster, and patients can return to normal daily life immediately after the procedure. However, it has also disadvantages. Some small details can be skipped, the patient is exposed to radiation even it is a low amount, and normal colonoscopy is necessary for intervention in polyps or other abnormal structures.
4. Sigmodoscopy: It is a method in which the nearest part of the large intestine is examined. Changes in the left half of the large intestine can be observed with this method. Contrary to colonoscopy, the patient does not need to prepare the day before the procedure. Enema in the hospital is sufficient. It is mostly recommended for young patients with rectal bleeding, changes in stool diameter, hemorrhoidal or fissure accompanied by bleeding.

Which Conditions Prevent the Performance of Colonoscopy?

Patient's consent is required for colonoscopy to be performed. Even if the patient gives consent, it is not true to perform colonoscopy in patients,

• Whose intestines are not cleaned sufficiently
• Whose intestines are more likely to have perforation during the procedure
• Who have severe intestinal inflammation
• Who have peritoneal inflammation
• Who have a risk of suffering heart attack

How Long Does A Colonoscopy Procedure Take? How Long Does Its Effect Last?

Colonoscopy procedure takes between 20-60 minutes. However, it may take 1-2 hours for the sedation, which is given to the patient to undergo a comfortable colonoscopy, to wear off. In addition, the gas pain and the feeling of bloating caused by the air given to the intestines to obtain a better view disappear in1-2 days.

Is Colonoscopy A Painful Procedure?

During colonoscopy, patients do not feel pain because they are anesthetized or sedated. Patients mostly complain of gas pain experienced after colonoscopy. Therefore, patients should consume plenty of fluids and walk after the procedure.

What Should Diabetics Pay Attention to During the Period of Preparation to Colonoscopy?

Maintaining the blood sugar at healthy levels is very important for diabetics. Diabetics should pay more attention to the diet during the cleaning of the intestines before colonoscopy. Remember that liquid foods can be consumed, although solid foods are prohibited on the day before colonoscopy. Drinks such as apple juice and pulp-free orange juice can be consumed to maintain blood sugar levels.

Does Having Colonoscopy Prevent Breastfeeding?

The effect of anesthesia or sedative drugs given in the colonoscopy application is eliminated from the body approximately 1 day later. Although anesthetic drugs are unlikely to be passed on to the baby through breastfeeding, patients can take measures such as breastfeeding the baby before colonoscopy and storing some amount of milk beforehand to feed the baby with later. If the patient does not have the chance to store the milk and has to breastfeed, she can express some milk and put it aside. Then, she can feed her baby with the milk that she expresses for the second time.