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Learn:
What a colonoscopy is and why
you might need to get one
The best ways to prepare for
and recover from a colonoscopy
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ISBN: 978-0-470-61661-1
Client tracking number: SAL 11/05
Not for resale
Kathleen A. Dobie
Dobie
Colonoscopy
Special Edition
1/19/11 1:30 PM
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Colonoscopy
FOR
DUMmIES
SPECIAL EDITION
by Kathleen Dobie
Carol Burke, MD, Technical Editor
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Publishers Acknowledgments
Were proud of this book and of the people who worked on it. For details on how to
create a custom For Dummies book for your business or organization, contact info@
dummies.biz. For details on licensing the For Dummies brand for products or services,
contact BrandedRights&Licenses@Wiley.com.
Some of the people who helped bring this book to market include the following:
Acquisitions, Editorial, and
Media Development
Project Editor: Jennifer Bingham
Editorial Manager: Rev Mengle
Business Development Representative:
Melody Layne
Custom Publishing Project Specialist:
Michael Sullivan
Composition Services
Project Coordinator: Kristie Rees
Layout and Graphics: SDJumper
Proofreader: Lindsay Littrell
Special Help: Hennie Hasson,
Cleveland Clinic; Jeff Driggs,
Salix Pharmaceuticals; Landy
Townsend, Salix Pharmaceuticals;
Bil Boyd, MedThink
Communications; Greg ODonnell,
MedThink Communications
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Contents at a Glance
Introduction ............................................................................................... 1
Chapter 1: Understanding What a Colonoscopy Is and
Why to Get One ................................................................................... 5
Chapter 2: Looking at Colorectal Cancer ............................................. 15
Chapter 3: Planning for Your Colonoscopy ........................................ 25
Chapter 4: Explaining the Bowel Prep Process ................................... 33
Chapter 5: Experiencing the Colonoscopy Procedure ....................... 41
Chapter 6: Getting Back to Normal after Your Colonoscopy ............. 47
Chapter 7: Ten Common Questions ..................................................... 51
Chapter 8: Ten (Okay, Seven) Uncommon Questions ........................ 59
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Table of Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
About This Book ........................................................................ 1
How to Use This Book ............................................................... 2
Icons Used in This Book ............................................................ 3
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viii
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Introduction
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Introduction
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Chapter 1
Understanding
What a Colonoscopy Is
and Why to Get One
In This Chapter
Figuring out what a colonoscopy is and why to have one
Looking into the costs
Checking out the alternative tests
Covering the colon and its function
f you have been scheduled to have a colonoscopy, congratulations on taking an important step in caring for your
health.
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Make sure that your colonoscopy will be done by an experienced digestive disease specialist who is interested in constant
improvement in the quality of colonoscopy that he or she provides. Working with a healthcare professional who is experienced in conducting colonoscopies will increase the likelihood
that your exam will be as accurate and thorough as possible.
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Understanding Some of
the Risks and Benefits
Just like other semi-invasive healthcare procedures and examinations, there are risks associated with colonoscopy and preparation for colonoscopy. The good thing is that if your health
and medication (both prescription and over-the-counter)
information is thoroughly discussed with and reviewed by your
doctor, in most people the benefits outweigh the risks.
Potential risks of colonoscopy may include bleeding, infection, intestinal perforation (poking a hole in the colon), missing polyps or cancer, and adverse reactions associated with
colonoscopy preps or sedatives. Many of these risks rarely
occur and are even less common with a colonoscopy that
doesnt involve polyp removal. You can reduce risks by ensuring that the doctor that performs the procedure is an experienced gastroenterologist or surgeon. Another great way to
reduce procedural risk and increase the detection of polyps
is to arrive at your procedure with a clean colon. This can be
done by following your healthcare providers directions for
bowel preparation. (For more on this topic, see Chapter 3.)
The most common adverse events associated with colonoscopy preps include bloating, nausea, abdominal pain, and
vomiting. Other, more serious risks have occurred as well.
Youll find further information about the risks and adverse
events associated with the prep for a colonoscopy in the literature regarding the preps supplied by their manufacturers
and from your pharmacy. As certain medications and medical
conditions may affect these events, you should fully discuss
these, as well as your prep, and how to properly take it with
your doctor. (For more on this topic, see Chapter 4.)
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10
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11
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12
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Small intestine
Ascending colon
Transverse colon
Descending colon
Cecum
Rectum
Anus
Sigmoid colon
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14
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Chapter 2
Looking at
Colorectal Cancer
In This Chapter
Looking at the disease and its stages
Understanding risk factors
Trying for prevention, then treatment
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Pedunculated polyp
Sessile polyp
Flat polyp
Depressed polyp
Figure 2-1: Types of polyps.
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17
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Race
African Americans have a higher risk and death rate from
colon cancer than any other ethnic group. The exact reason
isnt known. African Americans should begin screening colonoscopy at the age of 45 rather than the age of 50.
Age
Yes, 50 is still fabulous. Its also the age at which you need
to schedule your first colonoscopy if you havent had one
already. Youre more likely to start developing adenomatous
polyps that can lead to colon cancer after 50 than you are
before that age. A lot of things start developing after you turn
50, but while you can ignore that little paunch or those fine
laugh lines, you cant ignore the possibility of colon cancer.
Although colon cancer can strike at any age, 91 percent of
new cases are in people older than 50 years.
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19
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21
Lifestyle factors
Your mothers colon cancer is a risk factor you cant avoid,
but you can change your own unhealthy behavior.
Poor diet: A diet high in fat (including red meat, fried
foods, and high-fat dairy products) and low in fruits,
grains, and vegetables may increase the risk of colon
cancer.
Smoking: Maybe the strongest associated risk factor,
smoking may double the risk of developing colon cancer.
Excess alcohol use: In addition to potentially damaging
your liver, pancreas, cardiovascular system, and more,
excessive alcohol use increases the risk of developing CRC.
Sedentary lifestyle: Add lowering CRC risk to the list of
benefits associated with an active lifestyle.
Obesity: Like smoking, obesity may increase the risk up
to twofold.
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22
American
Society
for
Gastrointestinal Endoscopy:
www.asge.org
American
College
of
Gastroenterology: www.acg.
gi.org
American Gastroenterological
Association: www.gastro.
org
By the time a person begins experiencing symptoms associated with colon cancer, the polyp may have turned cancerous.
If you experience the symptoms in the following list, you dont
necessarily have colon cancer; theyre simply common symptoms that may also occur with colon cancer:
Abdominal pain
Anemia
Blood in the stool
Change in bowel habits (diarrhea, constipation, or other)
Rectal bleeding or low blood count
Weakness
Weight loss
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Chapter 3
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26
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27
Read through the complete instructions and information concerning your colonoscopy and the bowel prep selected by your
doctors at least two weeks before your colonoscopy. Make
sure you fully understand all such information and instructions before you start your bowel preparation. Contact your
healthcare providers if you have any concerns or questions.
Also advise your providers if there has been any change in your
health status or medications (prescription or over-the-counter)
in the time between your last visit and your colonoscopy.
Schedule a ride
If youre planning to have sedation at the time of your colonoscopy (as the overwhelming majority of individuals who
undergo colonoscopy do), you will be required to have someone accompany you and drive you from the colonoscopy
facility. The facility rules (and liability laws) dont allow you
to leave or drive yourself home, and you cant even take any
transportation by yourself. Ideally, you should have someone
who can spend the rest of the day with you at home as well.
It may be an inconvenience, but for your own safety you
need a friend or family member there with you in order to be
discharged.
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Stock up on supplies
After you start taking the colonoscopy prep medication, you
wont want to leave the house (the next chapter explains
why, but youve probably gathered that you wont want to be
far from a bathroom). So stock up on what you need before
you ever begin taking the medication. While youre at the
pharmacy, you can also check out the magazine section, hard
candies, and other supplies that you may want during the
preparation process!
Go over your prep instructions and ensure you fully understand how to take the prep and have everything you need
to complete the prepping process. The prep process may
include some or all of the following items:
A variety of clear liquids check out the Just what is a
clear liquid? sidebar for choices
Soft toilet paper
Wet wipes
Lotions/creams to ease anal irritation
Reading materials, movies, and other ways to help pass
the time
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Contact your
doctor if there
are any changes
in your medical
condition or
medications
(prescription or
over-the-counter)
Schedule
transportation
to and from
procedure
Read prep
instructions
Stock up on
necessities
including clear
liquids, toilet
paper, wet
wipes, lotion
Adjust
medications
according to
doctors orders
A Week or
More Before
Pick up
the prep
Two Weeks
Before
Follow
instructions
for prep
medication
One Day
Before
Stay near
a toilet
Drink plenty of
clear liquids
Three Days
Before
Arrive at the
facility at the
designated time
Stay near
a toilet
Drink plenty of
clear liquids,
but not anything
after the
specied time
If splitting the
dose, see
instructions for
completing your
bowel prep as
provided by your
doctor
The Day of
Drink plenty
of clear liquids
and stay near
a toilet
Follow doctors
directions
this part is
pretty much out
of your hands!
Return to
your normal
diet unless
otherwise
instructed by
your doctor
Follow doctors
directions, and
call your doctor
if you experience
any other
conditions
or problems
after your
colonoscopy
is completed
After the
Exam
During the
Exam
31
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Chapter 4
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34
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Staying hydrated
A huge component of how well you
tolerate the prep process has to do
with how well hydrated you stay.
The prepping process pulls a lot of
water from your body, so you need to
replace that water by drinking clear
liquids. Hydration is essential for an
effective and safe colonoscopy prep.
Colon cleansing causes the body to
lose fluids quickly, which can lead to
dehydration regardless of the specific prep that you take. Even mild
dehydration will give you a dull, sick
feeling and if you feel bad, you wont
be motivated to complete your prep.
If you become dehydrated, you may
experience extreme thirst, dizziness,
headaches, chill, and nausea. If you
have ever experienced these symptoms you know that drinking more
bowel prep is probably not in your
top ten list of things you would like to
do next. In fact, calling your doctor
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Paying Attention to
Potential Problems
Cleansing your bowel over the course of a few hours doesnt
make for a comfortable experience. Talk to your doctor about
what are normal occurrences during the prepping process
and if you have any questions as to how to properly complete
the process.
Some minor side effects are common during the prep; some
nausea, bloating, and abdominal distention. If you chilled the
prep prior to drinking it, you could experience some shaking
chills from consuming so much cold liquid in a short time
period. These minor types of side effects call for holding off
on the prep for a bit, then trying to restart after the symptoms
pass. If you cant restart, call the doctor for recommendations. Although no fun to experience, these side effects are
very common. They unfortunately go hand-in-hand with
ingesting 2 to 4 liters of fluid in a short period of time. But
its a problem if these side effects become severe or continue
after completing the prep.
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40
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Chapter 5
Experiencing the
Colonoscopy Procedure
In This Chapter
Expecting the best
Zipping through the procedure itself
Resting up afterward
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Large intestine
Small intestine
Rectum
Anus
Colonoscope
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Forceps
Snare
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Chapter 6
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Following Up on Polyps
When a polyp is removed from the colorectal lining, a small
ulcer or sore remains at the removal site, which can be prone
to bleeding, either immediately or within two weeks. If you had
polyps removed during your colonoscopy, your doctor may
make special recommendations about your use of medications,
including over-the-counter medications, herbs, or supplements
to minimize the risk of bleeding from the polyp removal site.
Make sure you and your doctor develop a plan for resuming
any medications.
Immediately after the procedure, your doctor will be able to reassure you or advise you whether there was something serious
or concerning detected on the examination, even without the
results of biopsies. The majority of individuals undergoing colonoscopy get reassuring news that the exam was normal or that
nothing found on the exam is life threatening. If your doctor is
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Chapter 7
n this short chapter, I try to answer some common questions you may have about getting a colonoscopy. Knowing
the answers to some of the questions can reduce your anxiety
about having the procedure I hope. Please read the questions, absorb the answers, and pass the message on to people
who are still not convinced of the importance of a colonoscopy. Heck, tear out these pages and give it to them in a
card . . . or just give them this book.
I tried to identify the questions most often asked, but I cant
address every concern you may have. Your healthcare professionals can be a good resource when you have questions
about this critical procedure. Do your best to get your questions answered and get screened today.
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What Do I Have to
Do to Get Ready?
Its not you, so much as your bowels, that need preparation
for a colonoscopy. For the physician to get a good view of your
colon lining, your bowel needs to be as empty and as clean as
possible. To achieve this, your doctor will give you a prescription for a bowel prep, based on a discussion of your medical
history and other medications youre taking, that will make you
and your bathroom wallpaper good friends. (I talk about the
prep process in Chapter 4.) Another very important issue prior
to colonoscopy is following your doctors instructions to adjust
any medications that may make the procedure more hazardous
or increase the risk for you if polyps need to be removed.
A helpful patient
A nurse tells a story about a patient
who wanted to be more helpful than
most. When she lifted the sheet to
get him situated, there was a sign
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55
of folds, the doctor instills air to inflate it for a good view. The
air may cause you to feel a little bloated or full during or after
the procedure, but dont be ashamed to let it pass.
Your physician will provide you with a list of written discharge instructions including what symptoms may be normal
after colonoscopy and what symptoms should prompt you to
call them or seek urgent medical attention. If you experience
severe abdominal pain, excessive rectal bleeding, fever, or
anything unanticipated following the procedure, contact your
healthcare provider as soon as possible. (For more on this
topic, see Chapter 6.)
Colonoscopy bingo!
A nurse had a conversation with
an acquaintance several days after
his procedure. The acquaintance
thought his polyp was b-9 (like playing bingo), and was so proud to know
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Chapter 8
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Notes
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Notes
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64
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Your Goal:
A CLEAN COLON
What is
split
dosing?
Good prep
Fair prep
Poor prep
A fair or poor prep can leave the colon dirty, making it difficult for your doctor to spot abnormal growths.
Following your doctors directions may ensure a cleaner colon and a more accurate colonoscopy.
References: 1. Khan MA, Wasiuddin N, Brown M. Patient acceptance, convenience, and efficacy of one-day
versus two-day colonoscopy bowel preparations. Poster presented at: Digestive Disease Week: May 20, 2008:
San Diego, CA. 2. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of
Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009;104:739-750.
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2286-CFD insertsREV-M1.2.indd 1
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HYDRATION
is essential for an
effective colonoscopy prep
Taking a colonoscopy prep will cause you to lose
fluids quicklyleading to dehydration
Your fluids and minerals need to be replenished
It is important to drink plenty of clear liquids before, during,
and after the colonoscopy-prep process
Follow your doctors colonoscopy-prep directions very carefully
Colonoscopy
Prep Tip
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WATCH WHAT YOU EAT. FoIIow your doctors recommendations about what you can and cannot eat before a colonoscopy
COMPLETE THE PREP. Be sure to read all prep instructions,
follow the recommendations for a precolonoscopy diet, and complete each step when instructed
STAY HYDRATED. Be sure to drink all required liquids dur-
SPREAD THE WORD. Make sure to tell those you know about
the importance of getting screenedit could save a life
NOTE: No brochure can ever replace the advice of your healthcare team.
Please carefully follow your doctors instructions.
1/17/11 12:15 PM
PASS ON
the importance of
colon cancer screening
Colon cancer can affect you and your loved ones
Colorectal cancer is the second leading cause of cancer-related
death in the United States,1 but it is preventable if the early
warning signs are detected
Because 90% of colorectal cancer cases occur in those aged
50 and older, 2 its very important to take the preventative step
of getting screened
A CALL
FOR
IMMEDIATE
ACTION
FREE INFORMATION
These materials are the copyright of Wiley Publishing, Inc. and any
dissemination, distribution, or unauthorized use is strictly prohibited.
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1/17/11 12:15 PM
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Compliments of
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y
p
o
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Colo
Learn:
What a colonoscopy is and why
you might need to get one
The best ways to prepare for
and recover from a colonoscopy
Go to Dummies.com
for videos, step-by-step examples,
how-to articles, or to shop!
ISBN: 978-0-470-61661-1
Client tracking number: SAL 11/05
Not for resale
Kathleen A. Dobie
Dobie
Colonoscopy
Special Edition
1/19/11 1:30 PM