What is a Colonoscopy? Why have a Colonoscopy?

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1 Endoscopy Unit Patient Information Having a Colonoscopy This leaflet will explain what a Colonoscopy is and tell you what to expect when you come to the Endoscopy Unit. What is a Colonoscopy? A Colonoscopy is a look into the large bowel. The large bowel is the last part of your digestive system. The diagram at the top of the next page shows your large bowel (also called your colon). If you need this information in large print, easy read, on audiotape or in another language please call or e- mail pals@dchft.nhs.uk If you wish to obtain a list of the sources used to develop this information leaflet please call or patient.info@dchft.nhs.uk Author: Carolyn Angel Role: Deputy Sister Publication Date: 11/15 Review Date: 11/18 The instrument used to do the examination is called a Colonoscope. It is a flexible tube with a bright light and a tiny camera at the tip. The camera transmits pictures of the inside of the bowel to a video screen. It is inserted via the rectum and manoeuvred around the colon by the Endoscopist. You are usually sedated for the procedure to keep you comfortable. This is not a general anaesthetic. The procedure usually takes minutes, although you should expect to be in the hospital for about 2 hours. Why have a Colonoscopy? The purpose of a Colonoscopy is to see if there are any abnormalities in the bowel. The pictures will show any areas of inflammation or any polyps (fleshy growths). Many examinations show a normal healthy bowel Dorset County Hospital NHS Foundation Trust 1 of 15

2 What are the benefits of having a Colonoscopy? During a Colonoscopy the lining of the bowel can be clearly seen. It is an excellent way to get a diagnosis of your complaint or to reassure you that all is well. The Colonoscope has a hollow tube inside that can be used to take samples of tissue, called biopsies. These can be examined in the laboratory under a microscope. If any polyps are seen they can normally be removed through the Colonoscope. These can be retrieved and examined by the laboratory. Side effects or risks in having a Colonoscopy It is common to get some abdominal discomfort following the procedure but this usually settles quickly. Complications following Colonoscopy are rare, but as with almost all medical procedures there are some risks of which we must make you aware. Reduced breathing rate: This is a known complication of sedation but in order to minimise any risk your dose is individually assessed and your oxygen level monitored throughout the procedure. If you are an asthmatic or have breathing difficulties please inform the nurse on your arrival and bring your inhalers with you. Bleeding: This is another rare complication that usually does not need any further treatment. A small amount of bleeding is not unusual and should not cause alarm especially following biopsy or removal of a polyp. It may occur up to several days after the procedure. Heavier bleeding may require further treatment in hospital. Perforation: This is a tear in the bowel lining and is extremely rare, occurring in about 1 in 2000 cases, but is a serious complication that may need to be repaired by means of a surgical operation. Missed Lesion: Although every attempt is made to see all the lining of the bowel, occasionally a lesion can be missed. In studies this has happened in approximately 1 in 20 cases. Failure Rate: Very occasionally it is not possible to pass the colonoscope around the entire colon. On the rare occasions this happens, a different test may be arranged. Is there an alternative to a Colonoscopy? Yes. An X-ray examination, such as Barium enema or a CT Colonogram, may show the cause of your symptoms. However it cannot treat any problems that might be found. Remember if you are unsure about this examination, please seek more information from your referring doctor Dorset County Hospital NHS Foundation Trust 2 of 15

3 Preparing for your Colonoscopy It is really important that the bowel is empty of faeces for the procedure to be successfully performed. In order to do this you need to follow the special diet (on page 7) for 5 days before your appointment. This is very important; failure to follow the diet will result in your colonoscopy being unsuccessful or cancelled. You will need to take all the Sodium Picosulfate (Picolax) powders that we have sent you. This medication does cause diarrhoea. You will need to drink plenty of fluids during the preparation up until one hour before your examination. Instructions follow about the diet and about taking the medicine. Please read these carefully. Medication If you take iron tablets please stop taking these 7 days before the procedure. Do not take any other laxatives except the medication provided for this test. Take all other medication as normal but please read the information on page 6 in case further arrangements are needed. What happens when you get to the Endoscopy Unit You should expect to be at the Endoscopy Unit for about 3 hours. It is not unusual to feel anxious or embarrassed about having a Colonoscopy. The nurses and doctors understand this and will do their best to reassure you. When you come to the Endoscopy Unit please give your name to the receptionist. A nurse will come to meet you and take you through to a private office. You will be asked some questions about the arrangements you have made to get home and about your health. Please tell the nurse if you are allergic to any medicines. You can ask any questions that you have or tell the nurse of any worries. The nurse will take your pulse and blood pressure and ask you to get changed into a hospital gown ready for the test. Although there are likely to be male and female patients in the Endoscopy Unit, your privacy and dignity will be respected at all times. Please bring with you: A list of your medications A dressing gown and slippers for your comfort and dignity 2015 Dorset County Hospital NHS Foundation Trust 3 of 15

4 Why have you sent the consent form to me? The consent form gives the hospital and the Endoscopist a formal indication, required by law, that you are agreeing to have the test. We have sent you a consent form with this booklet. Please read the consent form to familiarise yourself with it, and bring it with you to the Endoscopy Department on the day of your test. You do not need to fill it in; a nurse or doctor will complete the form with you and witness your signature as part of your admission process. Please do not sign the form before then. Before you sign the form you should understand what you are consenting to. The information about your test is included in this booklet. The Endoscopy staff will also be happy to answer any questions you may have. Entonox This test is usually carried out using a sedative injection; however we can now offer another form of sedation/analgesia for colonoscopy procedures called Entonox. You may already know that it is widely used by many Endoscopy Units nationwide to make colonoscopy a more comfortable experience. It is a mixture of Nitrous Oxide Gas and Oxygen that is breathed in through a mouthpiece. You control the amount you breathe in. The lungs clear it from the system through the breath, so after you stop breathing it in the Entonox gas disappears rapidly from your body. If Entonox is used alone; you will not need to be accompanied home and could drive yourself home afterwards. There are rarely any side effects and the overall majority of patients can use Entonox unless: You have had a recent ear infection or surgery to the ear You have been scuba diving or flying in the past 48 hours You believe that you may be pregnant You have chronic breathing problems We can provide more information when you attend your appointment. Sedation If you decide to have the sedative injection, you will need to have a responsible adult to come into the Endoscopy Unit to collect you, drive you home and look after you for 24 hours. This is for your own safety as the sedative injection can make you feel drowsy after the procedure If you have not made these arrangements we will not be able to proceed with the investigation. The Colonoscopy You will be taken to a treatment room for the procedure, and be asked to lie on your left side on a trolley. You will be covered with a blanket Dorset County Hospital NHS Foundation Trust 4 of 15

5 If you have chosen Entonox the nurse will show you how to use the canister and valve. It will make you feel relaxed, but can give you a dry mouth. If you have chosen the sedative injection the medication will be given via an intravenous canula (small plastic tube that is put into your vein). This is usually a combination of an analgesic (pain killer) and a sedative. These two drugs together make most people feel drowsy and relaxed. Some extra oxygen will be given to you through a small tube placed in your nose. Your pulse, breathing and blood pressure will be monitored throughout the procedure. You should feel comfortable for most of the procedure but it is not unusual to experience short periods of discomfort as the Colonoscope goes round a bend in your bowel. Your bowel will be inflated with a little air, so that good views are seen. This can sometimes be uncomfortable. Please tell the nurse if you have any pain. You can watch the procedure on the screen if you feel awake enough. After the Colonoscopy When the procedure is over you will be wheeled back to the recovery area on a trolley for a rest. During this time the nursing staff will continue to monitor your pulse and blood pressure. It s not unusual to have some windy discomfort in your abdomen; this should soon start to disperse. You may feel a bit light-headed. The nurses in the recovery area will be making regular checks on you to see that all is well. It doesn t take long before you feel more awake and are ready for a drink. Once you are ready for discharge the nurse will talk to you about the procedure and explain your discharge information. If you have had sedation you must have a responsible adult with you to listen because the medicines that you had will make you forgetful. A report of the procedure will be sent to your G.P. Going Home Remember: If you have chosen the sedative injection you must have someone to come into the Endoscopy Unit to collect you, drive you home and look after you for 24 hours. Travelling on public transport (train or bus) is inappropriate. You can travel by taxi but must have a responsible adult with you. For the 24 hours after the procedure you must not: Drink any alcohol Drive a car Operate machinery 2015 Dorset County Hospital NHS Foundation Trust 5 of 15

6 Sign any legally binding documents Be responsible for small children Lock the bathroom door You no longer need to follow the low residue diet and can go back to your normal eating. We do advise, however, to start with something light. It may take a few days for your bowels to get back to normal. Symptoms to Watch Out For It is not unusual to get some discomfort from wind. It should not be severe or unbearable but please follow the instructions in the discharge advice that you will be given. It is not unusual to get some slight bleeding following this procedure, especially if you have had a biopsy taken or a polyp removed. If the bleeding continues and is of concern please follow the instructions in the discharge advice that you will be given. Eating Plan for the Week before your Appointment For the examination to be successful it is necessary for the bowel to be empty, otherwise the examination may have to be repeated. Please follow the instructions for the special diet and the Sodium Picosulfate (Picolax) Powder (a laxative). People with Diabetes If you have diabetes and are on tablets or insulin, please contact us and we will send you an information leaflet on diet and medication. Medication - One Week before Appointment Please note: Contraceptive Pill If you are using the contraceptive pill, a loose bowel may make this ineffective. It is thus recommended that other contraceptive measures, e.g. sheath/cap are also used for a period of 14 days following the examination. Do not stop using the Pill. Continue to take prescribed medication including medication for Inflammatory Bowel Disease (ulcerative colitis or crohn s disease, if you are unsure please contact you IBD nurse for advice). If you take iron tablets or other bowel medication, please stop taking them one week before your appointment. Diet - 5 Days before Appointment For the 5 days before your appointment, you can only eat what is listed in the low residue diet (overleaf) Dorset County Hospital NHS Foundation Trust 6 of 15

7 The Low Residue Diet Foods allowed: Tender lean meat, poultry, ham, liver, kidney, fish Eggs, cheese, milk, natural yoghurt Fruit flavoured or set yoghurt Potatoes boiled (no skins), mashed, roast or chips Well-cooked cauliflower florets (no stalks), carrots, turnip or swede Consommé or strained soup or tomato puree Oxo, Bovril, Marmite Soft tinned fruit, except those with pips - tinned pears or peaches are suitable White bread (this can be toasted), white flour White rice and pasta Water biscuits, cream crackers, Rich Tea, Marie or Morning Coffee biscuits Plain sponge cake, e.g. Madeira Plain scone (no fruit), cheese scone Butter, margarine, fats and oils Jelly jam, rindless marmalade, honey, syrup, ice cream. Not red or blackcurrant. Rice Krispies, Cornflakes, Readybrek, Special K Herbs and spices Tea, coffee (sugar allowed), fruit and herbal teas Tomato juice, strained fruit juices, any flavoured fruit squash, fizzy drinks. Not blackcurrent. A small amount of alcohol is allowed Vegetarians may have plain Tofu Foods not allowed: Tough fibrous meat, hamburgers, beef burgers, sausages, faggots Sausage rolls, pasties, pies and pastries Whole fruit yoghurt, muesli yoghurt All salads All fresh fruit Pulses and beans including baked beans Thick vegetable soup, e.g. Scotch Broth, Lentil Wholemeal and granary bread Wholemeal flour Brown rice, wholewheat pasta High fibre crispbreads, Digestives, Hob-Nobs Cakes containing dried fruit, nuts or coconut All nuts and dried fruit Jam or marmalade with skin or pips, peanut butter, jelly All high fibre breakfast cereals, porridge, bran Chutney, pickles All vegetables (except those detailed above) 2015 Dorset County Hospital NHS Foundation Trust 7 of 15

8 Sodium Picosulfate (Picolax) Instructions You have been prescribed an oral bowel cleansing agent (sometimes also called a bowel prep ). Its role is to clear out your bowels. This is important to ensure the safety and effectiveness of the planned procedure. There is a risk of developing dehydration, low blood pressure or kidney problems with this medication. The doctor prescribing the oral bowel cleansing agent will have assessed your risk and identified the most appropriate medication for you. If you have any long term renal conditions please contact us before taking this medication. You should refer to the manufacturer s instructions when taking your preparation. However the following rules apply in all cases unless you have been advised by the referring doctor or nurse: The prescribed dose of oral bowel cleansing agent should not be exceeded The oral bowel cleansing agent should not be taken over a period longer than 24 hours Oral bowel cleansing agents will cause diarrhoea and consequently dehydration. You should drink at least 3 litres a day whilst taking these medications. Symptoms of dehydration include: dizziness or light-headedness (particularly on standing up) thirst a reduced urine production. If you have these symptoms and are unable to take extra fluids please seek medical attention. If you have not received specific advice regarding your regular medication then you should continue to take them as normal. However, you may need to amend the timing as it is preferable to avoid taking them less than one hour either sided of any dose of oral bowel cleansing agent. Patients taking immunosuppressant medication for transplanted organs should seek the advice of their doctor before taking an oral bowel cleansing agent. Patients taking the oral contraceptive pill should take alternative precautions during the week following taking the oral bowel cleansing agent. In some cases it may mean you will need to take a day off work Dorset County Hospital NHS Foundation Trust 8 of 15

9 Preparing for your Colonoscopy Please follow these instructions carefully If you have any questions please contact The Endoscopy Unit on or Morning Appointment (8.30am to 1pm) If your appointment falls between the above times, please follow these instructions very carefully; The Day before your Appointment Before breakfast (not to be eaten any later than 8am) Mix the contents of one sachet of Sodium Picosulfate in a cup of cold tap water (approximately 150 mls). Stir for 2 3 minutes and drink the solution. If the solution becomes hot, allow it to cool sufficiently to drink. Be prepared for frequent bowel movements starting within a few hours of the first dose of Sodium Picosulfate (Picolax) being taken. You need to keep hydrated throughout this preparation period. Try to drink at least one glass full of clear fluids every hour. CLEAR FLUID includes: tea or coffee without milk, herbal or fruit teas, clear soup, meat extract drinks (e.g. Oxo, Marmite), plain water, clear fizzy drinks (e.g. water, lemonade NOT cola). Breakfast (7am - 8am, after the first Sodium Picosulfate (Picolax) Powder has been taken) One boiled egg, not more than one slice of white bread with honey (no jam or marmalade), one cup of tea or coffee without milk but sweetened if wanted. Lunch (12noon 1.30pm) A small portion of grilled or poached (not fried) fish or chicken, cheese, egg or plain Tofu with a little cooked white rice, followed by plain yoghurt or junket. No potatoes, vegetables or fruit are allowed. A cup of tea or coffee without milk but sweetened if wanted. The contents of the second sachet should be prepared as above and taken about two hours after lunch but no later than 4pm Dorset County Hospital NHS Foundation Trust 9 of 15

10 Supper (7pm 9pm) Clear soup or meat extract drinks may be taken, but no solid food. Please have no more food until after your appointment, although it is important that you drink plenty of clear fluids. The Day of your Appointment Drink clear fluids only, up until one hour before your appointment Dorset County Hospital NHS Foundation Trust 10 of 15

11 Afternoon Appointment (1.30pm 5pm) If your appointment falls between the above times please follow these instructions very carefully; The day before your Appointment Breakfast (8 am 9 am) as per Low Residue diet Lunch (12 noon 1.30 pm) as per Low Residue diet Sodium Picosulfate preparation - 4pm Mix the contents of one sachet of Sodium Picosulfate in a cup of cold tap water (approximately 150 mls). Stir for 2 3 minutes and drink the solution. If the solution becomes hot, allow it to cool sufficiently to drink. Be prepared for frequent bowel movements starting within a few hours of the first dose of Sodium Picosulfate (Picolax) being taken. You need to keep hydrated throughout this preparation period. Try to drink at least one glass full of clear fluids every hour. CLEAR FLUID includes: tea or coffee without milk, herbal or fruit teas, clear soup, meat extract drinks (e.g. Oxo, Marmite), plain water, clear fizzy drinks (e.g. water, lemonade NOT cola). Supper (7 pm 9 pm) A small portion of grilled or poached (not fried) fish or chicken, cheese, egg or tofu with a little cooked white rice, followed by plain yoghurt, or junket. No potatoes, vegetable or fruit are allowed. A cup of tea or coffee without milk but sweetened if wanted. Drink plenty of clear fluids during the afternoon. 8am on the day of your Appointment Mix the contents of one sachet of Sodium Picosulfate in a cup of cold tap water (approximately 150 mls). Stir for 2 3 minutes and drink the solution. If the solution becomes hot, allow it to cool sufficiently to drink. Please have no more food until after your appointment, although it is important that you drink plenty of clear fluids. The Day of your Appointment Drink clear fluids only, up until one hour before your appointment Dorset County Hospital NHS Foundation Trust 11 of 15

12 For your information The hospital car park is pay and display. You will need to pay for the first 2 hours. When you enter the hospital grounds, follow the signs for North Wing Entrance 1. The Endoscopy Unit will be signposted as you enter the main entrance. We aim to give a reasonable appointment time to avoid patients waiting unnecessarily. Unfortunately due to the nature of the investigations and individual needs of each patient it is not always possible to run to time. The staff at the Endoscopy Unit will endeavour to keep you informed of any delays. A selection of magazines is available but you may like to bring your own book to read whilst waiting. During busy periods any relatives may be asked to return to the Endoscopy Unit once you are recovered to escort you home Dorset County Hospital NHS Foundation Trust 12 of 15

13 Other Medical Conditions and Medications Please answer the following question Yes or No: DO YOU HAVE: YES NO A Steroid Deficiency e.g. Addisons? Diabetes? A cardiac pacemaker or ICD fitted? DO YOU TAKE: Warfarin? Clopidogrel? Any other blood thinning medication? If you have any medical queries or answered yes to one or more of these questions, you must contact the Deputy Sisters in the Endoscopy Unit on This is because there may be a need for additional arrangements to be made for your appointment. For any appointment queries please phone Please leave a message with: your name and telephone number what procedure you are having the date and time of your appointment your hospital number or date of birth Someone will return your call as soon as possible to discuss the situation further. If you take: Anti-hypertensives to lower your blood pressure (such as Ramipril or Candesartan); Diuretics (water tablets) such as Furosemide; NSAID s (non-steroidal anti-inflammatory drugs, such as Ibuprofen or Meloxicam) Please stop these tablets the day before and the day of your procedure. Please note under present guidelines Aspirin does not need to be stopped before endoscopy unless specifically recommended by the referrer. If you have a severe heart condition please discuss with your GP before stopping any medication 2015 Dorset County Hospital NHS Foundation Trust 13 of 15

14 Patient s Property You are advised not to bring expensive items of jewellery or clothing with you when you visit the Endoscopy Unit. You will be given a patient property bag to place your clothes in if changing for your procedure. You will be asked to keep your property with you at all times. The Endoscopy Unit and Dorset County Hospital NHS Foundation Trust cannot accept responsibility for the safeguarding your property Dorset County Hospital NHS Foundation Trust 14 of 15

15 Information Booklet for Colonoscopy We wish to seek your views on how helpful you found the information provided in this booklet. Please would you kindly take a few minutes to complete the following form, and write any comments you wish to make below. Thank you your time is much appreciated. Did you find this booklet helpful? Yes No Did it contain the type of information you wanted? Yes No Would you have liked more information? Yes No If yes, please tell us Is there anything else you would like to know? Yes No If yes, please tell us Did you experience any unexpected discomfort following this procedure that required you to visit your GP? Your Comments Please cut along the dotted line and return this sheet to: Endoscopy Unit Dorset County Hospital Williams Avenue Dorchester Dorset, DT1 2JY 2015 Dorset County Hospital NHS Foundation Trust 15 of 15