Colonoscopy is the most frequently performed non-surgical procedure in our practice. We have compiled this list of questions and answers to help educate both our patients and physicians who refer patients to our practice.

Colonoscopy Brochure

Please click on the link below to view a printable version of Cheboygan Surgical Associates' Colonoscopy Brochure.

File Download: Colonoscopy_Brochure.pdf

What is colonoscopy?

Colonoscopy is a procedure that enables your surgeon to examine the lining of the rectum and colon (large bowel) by inserting a colonoscope into the anus and advancing it slowly into the rectum and lower part of the colon. Air is inflated to keep the colon walls from collapsing, allowing for viewing of the colon lining.  The colonoscope is a thin, flexible tube about the thickness of your finger with a light on its end. The tube has several openings through which instruments can be passed for removing growths or taking tissue samples. Your surgeon views an enlarged picture of your colon on a television screen. It also allows for photography of colon lesions and procedures.

Why do I have to see the physician before I schedule a colonoscopy?

It is important that you be seen by your surgeon prior to undergoing a colonoscopy. During this visit, they can determine the appropriateness of performing the procedure and whether or not it is safe to proceed. It is also important to review all current medications, past and current medical conditions, and allergies or adverse reactions to sedation. Some patients require special precautions such as stopping certain medications, alteration of medications, or ordering special medications.  A thorough history and physical examination will be performed in preparation for your colonoscopy. Often previous endoscopy reports and/or radiologic studies (i.e. barium enema) will be reviewed by your surgeon.

During your visit, you will have the opportunity to have all of your questions answered.

Is it normal to be a little nervous about having a colonoscopy?

Some patients are anxious about having a colonoscopy performed. This may be due to fear of the procedure, its possible complications, or the possible detection of colon cancer. Our staff is prepared to answer any questions or address any concerns you may have. Education about the procedure is the best reassurance we can provide. Most patients feel better about undergoing the procedure if they understand it and have their concerns addressed adequately prior to the procedure.

What preparation is required?

Colonoscopy requires a thorough bowel cleansing program including dietary restriction and cathartics. Most patients undergo bowel preparation  at home; however, frail, elderly, or mentally challenged patients may require hospitalization or home health care support for supervised bowel preparation. The most commonly used bowel preparation in our practice is Fleets Phospho-Soda. It has been shown to be safe, effective, less expensive and better tolerated then other preparations that require ingestion of huge amounts of fluid or vigorous emenas.  Your surgeon will help determine the best bowel preparation for your circumstance.

It is very important to have a thoroughly cleansed bowel in order to ensure proper evaluation of all of the colon and rectal lining. Your surgeon and staff will give you detailed instructions regarding the cleansing routine to be used.

What kind of diet should I be on before colonoscopy?

Various preparations require drinking clear liquids for one to three days prior to the colonoscopy. This type of diet includes items such as clear broth or bouillon, coffee without milk or non dairy creamer, tea, fruit juices (without pulp), carbonated, and non carbonated beverages, plain gelatin, popsicles, hard candies (without a filling), and water. We recommend avoiding red colored juices or gelatin as the appearance may mimic blood during the colonoscopy. Your surgeon will provide you with appropriate written dietary instructions at your consultation.

What about my current medications and colonoscopy?

Most medications can be continued as usual; however, drugs such as Aspirin, anti-arthritis medications or anticoagulants (blood thinners such as Coumadin) are examples of medications whose use should be discussed with your surgeon prior to your colonoscopy. It is essential that you alert your surgeon if you require antibiotics prior to undergoing dental procedures or have a new prosthetic device ( i.e. artifical knee or hip) or valvular heart disease. You may need antibiotics prior to colonoscopy as well.

Click on the link below to view a printable version of our "Pre-procedure Patient Instructions" which includes a complete list of all medications to stop taking prior to a colonoscopy.

File Download: Pre-procedure_Patient_Instructions.pdf

What about diabetes and colonoscopy?

Diabetic patients who require daily Insulin or use oral hypoglycemic agents to help regulate their blood sugar levels will usually need adjustment of these medications while using the special diet and necessary bowel cleansing preparations.  Your surgeon and/or medical assistant will review this with you prior to your procedure.

Will I need antibiotics prior to my colonoscopy?

Only a small number of patients undergoing colonoscopy will require antibiotic treatment. Many dental procedures are associated with high rates of bacteria release into the blood while much smaller releases are found in patients undergoing colonoscopy. Patients who require antibiotics for dental procedures do not always require antibiotics for colonoscopy. Cardiac conditions for which prophylactic (given to reduce the risk of getting an infection) antibiotics are recommended for colonoscopy include prosthetic (artificial) heart valves, previous history of endocarditis (infection of heart muscle), and surgically constructed systemic/pulmonary shunts.

There are no specific guidelines for use of antibiotics in patients with non heart risk factors for infections.

What are the reasons (indications) for doing a colonoscopy?

1. Evaluation of suspected abnormalities seen on a barium enema (lower GI x-ray)
2. Presence of a polyp on sigmoidoscopy or barium enema
3. Unexplained gastrointestinal bleeding either overt (seen) or occult (unseen)
4. Unexplained anemia (low red blood cell count)
5. Change in bowel habits
6. Surveillance for colon cancer
7. Diverticulosis
8. Evaluation of patients at high risk for colon cancer (i.e. personal or family history of colorectal cancer)
9. Follow-up evaluation for prior colon surgery (especially for polyp or tumor)
10. Evaluation and follow-up for Inflammatory Bowel Disease (Ulcerative Colitis/ Crohn's disease)
11. Significant chronic diarrhea of unexplained origin
12. Intraoperative colonoscopy for localization of a polyp, bleeding source, or tumor

Therapeutic:

1. Treatment of a bleeding lesion
2. Excision of colon polyp/tumor
3. Reduction of a twisted colon (Volvulus)
4. Foreign body removal
5. Decompression of a dilated colon (Megacolon, Pseudo-obstruction)
6. Dilation (enlargement) of a stenotic lesion or stricture (i.e. colon narrowing)
7. Palliative treatment for obstructing or bleeding cancer

What happens during colonoscopy?

Colonoscopy is performed utilizing IV sedation while your vital signs are monitored. This is different then flexible sigmoidoscopy where a shorter scope is inserted to look at only the last part of the rectum and colon. Generally no sedation is given for sigmoidoscopy. Colonoscopy involves a longer scope moving throughout the colon through numerous twists and turns. There is often a feeling of pressure, bloating, and cramping at various times during the procedure as air is inflated to open the colon. For this reason, a sedative will be given. Most patients fall asleep during the procedure. The sedatives utilized during the procedure often cause an amnesic affect. It is common for patients to have no memory of the procedure or what was told to them afterwards. Because your surgeon needs a clear view, air is used to inflate your colon. As a result, you may feel some pressure and cramping after the procedure when the sedative wears off. Depending on what the colonoscopy reveals, your surgeon may take a biopsy. If a polyp is found, it will be removed at that time.

What can I expect on the day of my colonoscopy?

You will be instructed to come to the hospital an hour earlier than your scheduled procedure. You will be brought to a preoperative area where you will be asked to change your clothes and remove any jewelry or fingernail polish. The nursing staff will prepare you for the procedure and place an intravenous catheter, usually in your right arm, for use during the procedure. Be prepared to be asked numerous times to repeat your name, allergies and the procedure you have planned.  You will be moved to the Endoscopy Suite or Operating Room and be monitored by anesthesia personnel and an endoscopy nurse using a blood pressure cuff, heart and oxygen monitor. We will help position you comfortably on your left side and give you a series of medications to sedate you.

What happens after colonoscopy?

Normally patients remain sedated for a short time after the procedure. Although you will awaken and are able to talk and respond, you will have little or no memory of the procedure (due to the amnesic affect of sedation). Your surgeon will write down post colonoscopy instructions and your colonoscopy results on your discharge sheet. A follow-up appointment may be scheduled within 7-10 days after of the procedure. On the day of the procedure, you may experience some mild to moderate cramping or bloating because of the air that has been passed into the colon during the examination. This should disappear quickly with walking, rocking in a rocking chair and passage of gas. You should be able to eat and resume your normal activities within approximately 24 hours of your procedure. We do not recommend you drive, make important business decisions, or return to work on the day of the procedure.

How are biopsies performed during colonoscopy?

Colon biopsy forceps are inserted through an opening in the colonoscope under direct vision. A small pinch of tissue is grasped and removed. Small polyps or lesions can be removed by multiple biopsies, and bleeding controlled by the touch of electrocautery. Tissue removed during biopsy is sent to the pathology laboratory for the analysis.

What is a polyp, and how is it removed?

A polyp is an elevated growth within the lining of the colon. It is well established that most colorectal cancers arise from pre-existing benign (non cancerous) and abnormally growing (neoplastic) adenomas, and that removal of the polyps prevents subsequent development of colon cancer. The larger the polyp, generally the higher the risk of malignancy. Polypectomy (removal of a polyp) is curative if cancer is found in a polyp but has not invaded too deeply. Large polyps are removed with the aid of a wire snare connected to electrocautery. Sometimes cancerous growths are not removed using the scope but are biopsied and then removed later by surgical resection of the colon.

What is the role of colonoscopy in treating lower GI bleeding?

Therapies performed through a colonoscope can successfully treat bleeding from the colon. Bleeding sites may be due to polyps, cancer, polypectomy sites, abnormal blood vessels, or diverticulosis (pockets with bleeding blood vessels within them). Patients who have had radiation to the abdomen or pelvis have a higher risk of lower gastrointestinal blood loss. Electrocautery heater probes as well as injection therapy can be used to treat abnormal blood vessels or bleeding sites.

What is the role of colonoscopy in treating/removing foreign bodies?

Rectal and colonic foreign bodies are uncommon problems which may require colonoscopy for management. Sometimes the foreign body is ingested while at other times it is inserted through the anal canal. Small foreign bodies are often easily retrieved with a colonoscope while larger lesions cannot always be removed and sometimes require removal in an Operating Room while the patient is under general anesthesia.

What are the possible complications of colonoscopy?

Colonoscopy has an extremely safe track-record, especially when performed by competent well trained physicians. Our surgeons and their support staff are trained to avoid complications but are prepared to recognize and treat them during or after the procedure. The rate of severe complications in colonoscopy approximate 0.1% to 0.5%. The main complications include breathing difficulties, bleeding, perforation or infection. Less common complications include missed lesions, release of bacteria into the blood stream, abnormal heart rhythms and trauma to the spleen. Colonic preparations can result in dehydration, vomiting, cramps and anal irritations are possible. Local skin reactions can occur at the IV or injection site including redness, streaking, itching or swelling.

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