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In a Colonoscopy treatment, an endoscope is inserted through the anus to observe the large intestine (colon and rectum) and part of the small intestine, and polyps, cancer, and inflammation that occur in these areas are diagnosed. A part of the tissue is taken (biopsy), and polyps and early colorectal cancer are examined endoscopically by polypectomy (polypectomy), endoscopic mucosal resection (EMR), and endoscopic submucosal layer and can also be excised by ablation (ESD).

It is a very important test for both detection and prevention of colorectal cancer and should be done once after the age of 40. After cleaning the large intestine with a laxative, an endoscope with a thickness of 10 to 13 mm is inserted through the anus to directly observe the entire large intestine for polyps, tumors, inflammation, and other abnormalities. The inspection time varies depending on the purpose of the inspection and the number and size of polyps found. It is about 10 to 30 minutes.

Colonoscopy procedure

A colonoscopy procedure usually takes 20-30 minutes. However, patients should set aside time for the preparation of the procedure and recovery. Prior to the procedure, the patient will get a sedative. The patient will normally wear a hospital gown and lie on their left side on a patient examination table during the procedure. Then, the doctor will insert the colonoscope into the rectum.

After the procedure

Once the doctor has finished the examination, the patient will stay in a special recovery room until the sedative effect ends.It is necessary to take the rest of the day off after the Colonoscopy procedure. It is unhealthy to drive or work after a colonoscopy.

  • Typically, a patient can start eating and drinking as soon as the procedure is concluded. They may resume their normal lifestyle the day after the procedure.
  • If the doctor performs a biopsy, they will inform you when the results will be available and whether any extra testing is necessary. If the doctor removes abnormal tissue, they will prescribe any temporary dietary changes that may be necessary.
  • Some mild discomfort, such as gas, bloating, or very mild cramping, is normal after a colonoscopy. These symptoms should go away within 24 hours. Passing gas or walking around may aid reduce discomfort.
  • Small amounts of blood in the first bowel movement after the procedure are also expected by the doctors. However, it is necessary to consult a doctor if the bleeding in bowel movement continues or the stool contains large amounts of blood or blood clots.

Colonoscopy preparation

Cleansing the bowel is a crucial and necessary step for a high-quality colonoscopy. Your doctor will give specific instructions on how to do this.

They may recommend:

  • Dietary changes: The day before the Colonoscopy procedure, it is essential to take a clear liquid diet. You will not be able to eat solid food or dairy products.
  • Clear liquids only: The doctor will prescribe the patient to drink only water, broth, and tea, and coffee without milk the day before the procedure of colonoscopy.
  • Laxatives: It is necessary to take laxatives the day before Colonoscopy. Usually, a patient may also have to take them on the morning of the colonoscopy as well.

Patients who are on medications or supplements should discuss these with their doctor. The doctor may advise them to stop taking certain medications for some time or to change the dose.

It is better to make the doctor aware of medications that:

  • thin the blood (such as aspirin or warfarin)
  • are for diabetes, hypertension (high blood pressure), or heart problems
  • contain iron

When is a colonoscopy necessary?

A colonoscopy allows the doctor to investigate lower gastrointestinal symptoms of patients, such as:

  • bleeding from the rectum
  • chronic constipation
  • chronic diarrhea
  • abdominal  pain

The Gastrointestinal community also considers colonoscopy the gold standard for screening and diagnosis for colorectal cancer.

A colonoscopy can diagnose early-stage colorectal cancer before symptoms of cancer develop. It also allows doctors to remove polyps, which are precursors to cancer. Early detection can enhance treatment outcomes.

A doctor may recommend a colonoscopy for those who:

  • have a first degree relative with a history of colon polyps or colon cancer
  • are at higher risk because of their personal medical history
  • are aged 45 or older, even if no other risk factors are present

Colonoscopy risks

The American Society for Gastrointestinal Endoscopy describes possible complications that may occur in approximately 2.8 out of every 1,000 procedures (0.28%) in people at average risk.

The risks linked with a colonoscopy may increase if a biopsy or abnormal tissue removal occurs, including bleeding and tears in the lining of the colon or rectum (perforation).

Sedation also carries risks, including:

  • a decrease in respiratory rate of the patient
  • changes in heart rate of the patient
  • patient may experience nausea and vomiting

Is it painful?

A colonoscopy is not usually painful because patients have the procedure under sedation, making them very sleepy, forgetful, and relaxed. However, due to the expected side effects of sedation, a person should not drive home, as they would not be alert enough to drive safely.

After the Colonoscopy, patients may suffer mild discomfort for up to 24 hours. After that, they may experience mild abdominal cramping, gas pains, and bloating.

In addition to moderate discomfort, bleeding may occur if the doctor takes a biopsy or removes abnormal tissue.

At what age do people have a colonoscopy?

Patients of any age can undergo a colonoscopy. Adults with ages ranging from45–85 undergo colorectal cancer screening, such as a colonoscopy, at least once every 10 years.

Incidents associated with colonoscopy

  • Occurrences of colonoscopy include intestinal perforation (holes in the intestine.
  • The complications of colonoscopy treatment are mainly bleeding (melena) and intestinal perforation.

Bleeding

The colonoscopy treatment site becomes an ulcer, and bleeding may occur for about a week. The frequency is about 1% (about 1 in 100). Post-treatment bleeding is not enough to get blood on the stool, but the toilet bowl turns red with blood.

If bleeding continues, you will need to stop bleeding with an endoscope.

Injection of analgesics and sedatives

Our center uses injections of sedatives and analgesics to relieve anxiety and tension during examinations. Disadvantages of sedatives and analgesics include drowsiness and poor judgment on test day. If you are elderly, please be accompanied by your family. The amount of sedatives/analgesics used may be reduced or discontinued at the doctor’s discretion. 

Prohibition of driving after colonoscopy

  • Do not drive a car, motorcycle, bicycle, etc., all day after the inspection. It may lead to an accident due to impaired judgment due to sedatives and painkillers.
  • If you receive colonoscopy treatment, you will not drive a car for 3 days and a motorcycle/bicycle for 7 days from the day of treatment. This is because anemia due to bleeding can lead to an accident. It also has the purpose of keeping you at rest and preventing bleeding.

Bleeding tendency drugs

  • If you are taking medicine that makes it difficult for blood to clot on the day of the test, you may not perform the treatment.
  • If your doctor has instructed you to stop taking medicine, please follow the instructions.

Cause of pain in colonoscopy

Most of the cases of colonoscopy (colonoscope) pain occur in the sigmoid and transverse colons.

The reason is that the sigmoid colon and the transverse colon are not fixed and are bent in a squishy state. The place and shape are constantly changing. If you proceed, unnecessary pressure will be applied to the intestinal tract, and pain will occur.

To avoid pain, it is necessary to advance the scope while straightening the meandering intestine.

  • If you try to pass a wire through a bent sprinkler hose, you will not be able to proceed due to resistance, but if you hold both ends of the hose and straighten it, you can imagine that it will move without resistance. When “resistance” occurs in the large intestine, it causes pain.
  • The second point is that the large intestine swells excessively, causing pain.
  • To advance the colonoscope to the back. We will check the direction of travel while injecting air and perform an inspection. If you do so, excessive pressure will be applied to the intestinal tract and cause pain.
  • If you inflate the balloon too much, you’ll get a bang. if the same thing happens in your stomach, you can imagine it hurt.
  • Pain in which the air stretches the intestinal tract. When air enters (puts) into the large intestine, it swells and becomes like a balloon about to burst, causing pain.
  • Thin people have a small body or have constipation (pain that passes through the bent intestines). Thin people with a small body or constipation have more continuous S-shaped curves because the large intestine is densely folded in the abdomen compared to normal people.
  • Forcibly pushing the endoscope at the bend (sharp curve) will apply unnecessary tension to the intestine, causing pain in that part.

People with sensitive intestinal nerves

It may be found in patients with irritable bowel syndrome or inflammatory bowel disease (ulcerative colitis / Crohn’s disease). Still, intestinal hypersensitivity is higher than in normal patients, and it is easier to feel pain.

  Persons with a history of abdominal surgery (adhesion) such as cesarean section and gastric surgery
  • During surgery to open the abdomen, such as a Caesarean section, adhesions occur, and part of the large intestine adheres to surrounding tissues, causing the intestines to deform.Even if you try to move the endoscope straight, the endoscope will bend at the adhesion part, and a force that does not initially occur at the adhesion part will be applied. There will be a pain.