What preparation is required?

Follow your doctor’s instructions carefully. If you do not, the procedure may have to be canceled and repeated later.

Please follow the below Preparation Instructions:

The day prior to the examination:

Evening Prep

• Have only clear fluids all day
• Starting at 5:00pm every thirty minutes take 30ml (1ounce) of milk of Magnesia for a total of four doses. Drink a glass of clear fluids between each dose of milk of Magnesia
• Take 40mg if Dulcolax (either four 10mg tablets or eight 5mg tablets) at a 8.00pm with a large glass of water
• Have nothing to eat or drink after midnight.

The day of Examination

• Two hours before the scheduled procedure time, take two Fleet Enemas (rectal) thirty minutes apart.
• Have nothing to eat or drink until after you or procedure has been completed.

Clear fluids

Clear fluids include clear soup broth, jello, tea or coffee (without milk or cream), soft drinks, clear fruit juice, PowerAde, Gatorade or Crystal Light.

What about current medications?

Most medications should be continued as usual but some medications interfere with the preparation or the examination. In particular, iron tablets and fiber supplements such as Metamucil and Prodium must be discontinued for at least five days prior to the preparation. It is therefore; best to inform your physician of your current medications several days prior to the examination. Aspirin products, arthritis medication, anticoagulants, (blood thinners), diabetic pills, and insulin will require special instructions from your physician prior to the examination. You should alert your doctor if you required antibiotics prior to undergoing past dental procedures, since you may need antibiotics prior to colonoscopy as well.

What can be expected during the colonoscopy?

Colonoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating or cramping at times during the procedure. Your doctor will give you medication through a vein to help you relax and better tolerate any discomfort from the procedure. You will be lying on your side or on your back while the colonoscope is advanced slowly through the large intestine. As the colonoscope is slowly withdrawn the lining is again carefully examined. The procedure usually takes fifteen to thirty minutes. In some cases, passage of the colonoscope through the entire colon to junction with the small intestine cannot be achieved. The physician will decide if the limited examination is sufficient or if other examinations are necessary.

What if the colonoscopy shows something abnormal?

If your doctor thinks an area of the bowel needs to be evaluated in greater detail, a forcep instrument is passed through the colonoscope to obtain a biopsy (a sample of the colon lining). This specimen is submitted to the pathology laboratory for analysis.

If colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be controlled through the colonoscope by injecting certain medications or by coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain.

Remember the biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

What are polyps and why are they removed?

Polyps are abnormal growths of the lining of the colon, which vary in size from a tiny dot to several centimeters. The majority of polyps are benign (non – cancerous) but the doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone.

For this reason, removed polyps are sent for tissue analysis. Removal of colon polyps is an important means of preventing colorectal cancer.

How are polyps removed?

Tiny polyps may be destroyed by fulguration *(burning), but larger polyps are removed by a technique called snare polypectomy. The doctor passes a wire loop (snare) through the colonoscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. You should feel no pain during the polypectomy. There is a small risk that removing a polyp will cause bleeding or result in a burn to the wall of the colon, which could require emergency surgery.

What happens after a colonoscopy?

After colonoscopy, someone must accompany you home from the procedure because of sedation used during the examination. Even if you feel alert after the procedure, your judgment and reflexes may be impaired by the sedation for the rest of the day making it unsafe for you to drive or operate any machinery.

You may have some cramping or bloating because of air introduces into the colon during the examination. This should disappear quickly with passage of flatus (gas).

Generally, you should be able to eat after leaving the endoscopy but your doctor may restrict your diet and activities especially after polypectomy. If biopsies have been taken or polyps removed it is normal to experience a small amount of rectal bleeding afterwards (several drops or tablespoons). If more bleeding occurs (i.e. More than a cup full) you must notify your physician’s office for further instructions.

What are the possible complications of a colonoscopy?

Colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures.

One possible complication is a perforation or tears through the bowel wall that could require prompt surgery. Bleeding may occur from the site of biopsy or polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely, blood transfusions or surgery may be required.

Other potential risks include reaction to the sedatives used and complications from heart or lung disease. Localized irritation of the vein where medications were injected may rarely cause a tender lump lasting for several weeks but this will go away eventually. Applying hot packs or hot moist towels may help relieve discomfort.

Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact your physician who performed the colonoscopy if you notice any of the following symptoms: severe abdominal pain, fever and chills, or rectal bleeding of more than one cup. Bleeding can occur several days after the polypectomy.

To the Patient

Because education it an important part of complete medical care. Dr. Griffith is providing you with this information to prepare you for this procedure. If you have any questions about your need for colonoscopy, alternative tests, please do not hesitate to contact Dr. Griffith’s office: 629-4489. If you have questions that have not been answered, please discuss them with the endoscopy nurse or Dr. Griffith before the test begins.