Colonoscopy / sigmoidoscopy

What is a colonoscopy? You have been advised to have a colonoscopy to help find the cause of your symptoms (a sigmoidoscopy is a limited examination of your large bowel). This booklet has been prepared from talking to patients who have the test. It may not answer all your questions so if you have any worries please do not hesitate to ask. The staff who are doing the test will be available to answer any queries. Not every hospital does things in exactly the same way. Colonoscopy is a test which allows the endoscopist to look directly at the lining of the large bowel (the colon). In order to do the test a colonoscope is carefully passed through the anus into the large bowel. The colonoscope is a long flexible tube, about the thickness of your index finger, with a bright light at the end. Looking down the tube, the endoscopist gets a clear view of the lining of the bowel and can check whether or not any disease is present. Sometimes a endoscopist takes a biopsy - a sample of the lining for examination in the laboratory. A small piece of tissue is removed painlessly through the colonoscope, using tiny forceps. It is also possible to remove polyps during the colonoscopy. Polyps are abnormal projections of tissue, rather like warts, which the endoscopist will want to examine in more detail. 1 2

What should you expect? Colonoscopy - are there any alternatives? A colonoscopy is recommended as it is the best way of diagnosing any problems with the large bowel. A barium enema or CT colography are other possible investigations. Under some circumstances these tests may give additional information. However, for most bowel conditions they are not as effective in providing the same level of clinical information which we may require for your diagnosis and treatment. Also, if an abnormality is found with a barium enema, you may still need a colonoscopy to treat the problem or take biopsies (removing small pieces of tissue). What is a sigmoidoscopy? Flexible sigmoidoscopy is a procedure that allows your doctor to examine the rectum and the left hand side of the colon. The flexible sigmoidoscope is a flexible tube about the thickness of your little finger. It is inserted gently into the anus and advanced slowly into the rectum and the lower colon. It is an accurate and simple method of investigating the cause of rectal bleeding, change in bowel habit, and rectal symptoms such as pain and diarrhoea. The preparation You will need to have a special diet and oral bowel preparation. See enclosed instructions. If you are taking medication or insulin for diabetes, please telephone the diabetes sister on: 0161 212 2095 (9.30am to 12.30pm). Please have the names of your medication to hand. The diabetic nurse will then be able to advise you of any alterations needed. When you come to the department, an endoscopist will explain the test to you and check that you have signed your consent form. This is to ensure that you understand the test and its implications. Please tell the nurse or endoscopist if you have any allergies or bad reactions to drugs or other tests. They will also want to know about any previous colonoscopy you may have had. If you have any worries or questions at this stage, do not be afraid to ask. The staff will want you to be as relaxed as possible for the test and will not mind answering any queries. You will be asked to take off your trousers or skirt and to put on a hospital gown. You will also be asked to remove any jewellery or metal objects in case a special piece of equipment is used. During the test The test will always be carried out by an experienced endoscopist or a trainee under appropriate supervision. In the examination room you will be made comfortable on a couch, resting on your left side, with your knees slightly bent. A nurse will stay with you throughout the test. with your knees slightly bent. A nurse will stay with you throughout the test. Some endoscopists may give you a sedative injection to make you sleepy and relaxed. When the tube has been gently inserted through the anus into the large bowel, air will be passed through it to distend the colon and give a clearer view of the lining. This may give you some wind-like pains but they will not last long. You may get the sensation of wanting to go to the toilet, but as the bowel is empty, there is no danger of this happening. You may pass some wind but, although this can be embarrassing, remember that the staff do understand what is causing it. It usually takes up to thirty minutes for the colon to be examined, but the test may last longer. When the examination is finished, the tube is removed quickly and easily. 3 4

After the test If you do not have sedation you will be able to go home immediately. If you have had sedation, you will have to stay in the recovery ward for at least 2 hours afterwards before being allowed home. You may feel a little bloated with wind pains but these usually settle quickly. Going home If you have had sedation it is essential that someone comes to the unit to pick you up after the test. Once home, it is important to rest quietly for the remainder of the day. Sedation lasts longer than you think so you should NOT: l Drive a car l Operate machinery l Drink alcohol The effects of the test and injection should have usually worn off after 24 hours, when most patients are able to resume normal activities. If you live alone and have no relative who could support/care for you over the 12 hour period following your endoscopy you will not be able to have sedation. General information When do I know the results? Details of the results and any necessary treatment should be discussed with your General Practitioner or hospital specialist - whoever recommended you to have the test. You may contact your General Practitioner one to two weeks after the test. Risks Colonoscopy can result in complications such as reactions to medication, perforation (tear) of the intestine, and bleeding. These complications are very rare (around 1 in 1000 for perforation and 1 in 500 for bleeding) but may require urgent treatment, and even an operation. The risks are slightly higher when colonoscopy is used to apply treatment such as removal of polyps. Be sure to inform us if you have any pain, black tarry stools or persistent bleeding in the hours or days after colonoscopy. If you are unsure about information given or have any other queries, please contact: GI Endoscopy Unit Salford Royal Telephone: 0161 206 4720 / 5959 09:00 and 17:00 Notes 5 6

G16102616W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2016. This document MUST NOT be photocopied. University Teaching Trust Information Leaflet Control Policy: Unique Identifier: MED 66 (16) Review Date: November 2018 For further information on this leaflet, it s references and sources used, please contact 0161 206 4720. Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Under the Human Tissue Act 2004, consent will not be required from living patients from whom tissue has been taken for diagnosis or testing to use any left over tissue for the following purposes: clinical audit, education or training relating to human health, performance assessment, public health monitoring and quality assurance. If you object to your tissue being used for any of the above purposes, please inform a member of staff immediately. Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients