You have been
scheduled for a colonoscopy. This procedure allows us to look at
the inside of your colon (large intestine) with a flexible tube created
with a specialized lens and video chip system at its tip. As the
instrument is passed through the bowel, a vivid image is displayed on a TV
monitor within the examination room.
Colonoscopy is most commonly recommended for:
-
Identifying and removing
colon polyps.
-
Identifying a cause for
rectal or “internal” bleeding.
-
Explaining abnormal or
changing bowel habits.
-
Further defining abnormal
findings on barium lower GI series, CT scan, etc.
-
Evaluating other problems as
deemed necessary by your physician such as anemia or weight loss.
This
exam is most commonly utilized to identify and remove polyps. Polyps are
usually benign or non-cancerous growths in the bowel. If identified and
removed at an early stage, they pose little health hazard. If allowed to
grow however, they may transform into malignant or cancerous polyps.
Therefore, it is best to remove them early when possible. Polyp removal,
or polypectomy involves slipping a wire loop through the
colonoscope and around the polyp tissue, tightening the wire, then heating
the wire so that the growth is both cut off and cauterized simultaneously.
This is usually a simple procedure and virtually always painless. In
addition to polyp removal, biopsies (or tissue samples) can be
obtained by painlessly pinching off a piece of tissue for microscopic
review.
This
procedure may sound uncomfortable but usually, this is not the case.
Before the procedure is begun, an IV is inserted into your vein. Sedatives
and pain relievers are administered into your IV both before and during
the examination. These medications are so effective that most patients do
not remember having had the colonoscopy performed.
Colonoscopy is quite safe and complications occur infrequently. It is
estimated that less than 1 patient in 2000 will have a serious side effect
from this exam. Potential problems include an adverse reaction to the
intravenous medications, bleeding from a polyp removal site, or the
inadvertent puncture or perforation of the bowel wall. Serious problems
such as bleeding or tears may require surgery. Remember however, that
these complications are rarely encountered.
THINGS TO REMEMBER
BOWEL PREPARATION:
In order to effectively visualize the bowel and to identify and treat any
abnormalities, you will need to be thoroughly cleaned out. This may be the
toughest, but most important element of a successful examination.
Cleansing instructions will accompany this form and should be followed to
the best of your ability.
ARRIVAL TIME AND
DURATION:
You will be asked to
arrive approximately one hour prior to your scheduled procedure time. This
will allow for registration, insertion of an IV, and introduction to the
staff. You can expect to be at the facility approximately 3 hours from the
time you arrive until the time you are released to go home.
TRANSPORTATION:
Because of the
use of sedatives, you will not be allowed to drive yourself home.
You must make arrangements for a friend or family member to take you home.
SPECIAL MEDICATION
INSTRUCTIONS:
In general, you will be able to continue your normal medications. There
are a few major exceptions, however. Coumadin, other blood
thinners, aspirin, and arthritis anti-inflammatory pain relievers may
increase the risk of bleeding from polyp removal.
We will therefore ask you to miss two day’s doses of each and any of these
medications so that the day of the colonoscopy will be your third day
without such blood thinners. In addition, insulin and oral diabetic
agents should not be taken on the day of your procedure until the exam is
complete. Your
blood sugar level will be checked at the facility.
BOWEL PREPARATION PRIOR
TO COLONOSCOPY
Cleansing of the bowel is the most
challenging, yet one of the most important aspects of colonoscopy. We are
aware of the burden that preparation places upon you and only ask that you
try your best to follow the instructions. If there are discrepancies
between instructions on this form and those on the product you purchase,
follow the instructions written here.
There are three choices available for bowel
cleansing. None involve enemas.
BOWEL PREP #1
produces the best results in our opinion, takes less time to complete, but
involves drinking nearly 4 quarts of fluid over 3-5 hours that will
“flush” the bowels clean. You will receive prescriptions for the prepping
agents.
BOWEL PREP #2
produces adequate results, takes longer to complete, may produce a few
more cramps, but has the advantage of avoiding the large volume of fluid
used in Bowel Prep #1. In general, Bowel Prep #2 is
not
recommended for patients undergoing afternoon colonoscopies. This prep
does not require prescriptions.
BOWEL PREP #3 is
the newest bowel preparation system available. The encouraging aspect of
this prep is the use of pills, rather than liquid laxatives. The
downside is that there are a lot of rather large, but breakable, pills to
take (20 the night before and at least 9 the day of the procedure). Bowel
prep #3 is not
recommended for patients undergoing morning colonoscopies.
You will be asked to choose one of
these preparations and follow the instructions below.
Note that the instructions may change
depending upon whether your procedure is scheduled for the morning or the
afternoon.
BOWEL PREP #1
During the days prior
to your colonoscopy, take the attached prescription for Colyte (or
Nulytely) and Reglan (or Metaclopramide) to your pharmacy.
MORNING PROCEDURE
(if your arrival time is before 12noon)
One day prior to your
colonoscopy:
1.
In the morning,
add warm water to the fill line on the plastic jug, replace the cap and
shake well. Refrigeration is optional. These products are currently
available in several flavors. You may also add any flavorings of your
choosing to enhance the taste. Please avoid red or orange products if
possible.
2. Eat
breakfast and lunch as you normally would. Please avoid fresh fruits and
vegetables.
3. Eat
a light dinner, if desired. Avoid fresh fruits and vegetables. Many
patients skip dinner (that is your option) since the laxative tends to be
quite filling (although not very tasty or satisfying!).
4. At
approximately 5:30 pm, take one Reglan (metaclopramide) pill by mouth.
5. At
approximately 6:00 pm, begin to drink the laxative preparation. Attempt to
drink the entire bottle of fluid over three to five hours, if
possible. Keep in mind that the purpose is to cleanse the bowel of solid
and dark colored stool. Therefore, if your fecal contents become clear in
color, you needn’t complete the entire jug. If you develop bloating or
nausea, feel free to take a short break. Within 30 to 60 minutes, this
discomfort should resolve itself. It is better to take a longer period to
consume the laxative than to push yourself to nausea and perhaps,
vomiting. You may take another Reglan (metaclopramide) pill if needed for
nausea at any time after 8:00pm.
6. You
can expect some mild cramping and urgency, followed by several bouts of
diarrhea. This, of course, is the desired goal.
On the day of your
colonoscopy:
1. You
may have a small amount of liquids (1-2 cups) up to four hours before your
arrival time.
AFTERNOON PROCEDURE
(if your arrival time is 12noon or after)
One day prior to your
colonoscopy:
1. Eat
breakfast and lunch as usual.
2. Eat
a normal dinner but avoid fresh fruits and vegetables.
3. Add
warm water to the fill line on the plastic jug and shake well.
Refrigeration is optional. These products are currently available in
several flavors. You may also add any flavorings of your choosing to
enhance the taste.
On the day of your
colonoscopy:
1. At
approximately 6:30 am, take one Reglan (metaclopramide) pill by mouth.
2. At
approximately 7:00 am, begin to drink the laxative preparation. Attempt to
drink the entire bottle of fluid over three to five hours, if
possible. Keep in mind that the purpose is to cleanse the bowel of solid
and dark colored stool. Therefore, if your fecal contents become clear in
color, you needn’t complete the entire jug. If you develop bloating or
nausea, feel free to take a short break. Within 30 to 60 minutes, this
discomfort should resolve itself. It is better to take a longer period to
consume the laxative than to push yourself to nausea and perhaps,
vomiting. You may take another Reglan (metaclopramide) pill if needed for
nausea, but not before 9:00 am.
3. You
can expect some mild cramping and urgency, followed by several bouts of
diarrhea. This, of course, is the desired goal.
4. You
may take you medicines as normal one hour after you finish your laxative
preparation. Please do not take insulin or other diabetic medications
prior to your colonoscopy.
5. If
necessary, you may take small amount of juice, coffee, or tea up to two
hours before your arrival time.
BOWEL PREP #2
In anticipation of this
preparation, please purchase either two (2) 1.5 ounce bottles or one (1) 3
ounce bottle of FLEET PHOSPHO-SODA
BUFFERED ORAL SALINE LAXATIVE.
This is available at
any pharmacy (and most supermarkets) without a prescription.
One day prior to
your colonoscopy:
1. You
may eat a “light” breakfast before 9:00 am. Please avoid fresh
fruits, vegetables or fiber cereals.
2. You
may take medications as normal.
3. Lunch
and dinner should consist of liquids only. This may include fruit juices,
water, milk, broth or bouillon, coffee or tea. In addition, Gatorade-type
drinks, carbonated or non-carbonated soft drinks, Jell-O, popsicles and
powdered drinks are acceptable BUT PLEASE avoid red or orange colored
liquids.
4.
At approximately 1:00 pm, add 1.5
ounces (or 3 tablespoons) of Fleet Phospho-Soda to one-half glass of water
or juice and drink it. Follow with one full glass (approximately 8 ounces)
of one of the liquids mentioned above.
5. Over
the next 2-4 hours, drink at least three more 8 ounce glasses of the
liquids listed above.
6. At
approximately 7:00 pm, add 1.5 ounces (or 3 tablespoons) of Fleet Phospho-Soda
to one-half glas of water or juice and drink it. Shortly thereafter,
follow with one full glass (approximately 8 ounces) of one of the liquids
listed above.
7. You
may drink additional liquids as you desire through the night.
On the day of
your colonoscopy:
1.
You may have liquids up until 3-4
hours prior to your arrival time.
BOWEL PREP #3
This relatively new
preparation involves pills rather than liquid laxatives to flush out your
bowels. The pills are somewhat large but can be easily broken in half if
necessary. You will still need to drink a fair amount of liquids for this
bowel prep, but your choices are quite wide and are can be largely suited
to your tastes.
If you are using this
bowel prep, your exam could be scheduled for the very late morning,
but an afternoon appointment is preferable, since you’ll be taking these
pills both the night before and the morning of the day of
your colonoscopy.
You’ll
notice that the prep schedule requests that you take the pills 15 minutes
apart. Sometimes this is hard to do and you might feel a bit full.
If so, please don’t be concerned—simply take a bit longer between doses to
let your stomach empty. We’d rather you get the prep done slowly than
experience nausea or vomiting and risk having to start over.
Several days prior
to your colonoscopy:
1.
If not yet done, please have your prescription for Visicol tablets
filled at your pharmacy.
The day prior to
your colonoscopy:
1.
You may eat a regular breakfast.
2.
You may eat lunch, but please complete this meal by 1:00pm. Please
do not eat fruits or vegetables with this meal.
3.
If you’d like, you may have a liquid dinner, but if you read on,
you’ll see that there will be plenty of liquids for you to drink this
evening.
4.
Beginning at 6-7:00 pm, you should take three (3) Visicol
tablets every 15-20 minutes, for a total of twenty (20) pills (the
last dose will have only 2 pills).
5.
Each dose should be followed by a large glass of fluid
(approximately 8 ounces). You can use any kind of clear or nearly clear
fluid you wish. Suggestions include water, apple juice, lemonade, or
Gatorade (there are several colorless flavors—please no red or orange
colored drinks).
6.
Of course, don’t stray from home. You’re to expect diarrhea and
rarely, mild cramping.
On the day of your colonoscopy:
1.
Sorry, no solid food breakfast and no more than one cup of black
coffee or tea.
2.
Approximately 3-4 hours before you’re scheduled to leave home, you
should take three (3) Visicol tablets, followed by a large glass
(approximately 8 ounces) of fluid as described above.
3.
Thereafter, take three (3) tablets every 15-20 minutes with a large
glass of the approved liquids, for a total of nine (9) pills.
4.
Your stools should be clear or liquid yellow this morning, perhaps
with small stool fragments. If you are still passing dark or solid stools
at this time, take an extra three (3) to six (6) pills (again doses are to
be separated by 15-20 minutes and followed by liquids)—these final doses
are not usually necessary.
5.
You may take any of your daily medications 1-2 hours after your
last dose of Visicol except do not take aspirin, blood thinners,
anti-inflammatory arthritis pain relievers, or diabetic medications.
