About Bowel Tests
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Colonoscopy
Colonoscopy
What is a colonoscopy?
A colonoscopy is a test to check for disease inside your colon and rectum. Your colon and rectum make up the lower half of your gut and are often called your bowel.
During a colonoscopy, a doctor puts a tube with a camera on the end (a colonoscope) into your bottom (anus) and passes it up through your rectum and colon. This allows your doctor to look for problems such as cancer, inflammation (red, swollen patches) or polyps (small lumps, like cherries, on the inside wall of your bowel).
If your doctor sees anything unusual during the test, he or she can take samples of tissue to look at more closely. This is called a biopsy.
Why do I need this test?
You might need a colonoscopy if you have symptoms that could be caused by cancer of the colon or rectum (bowel cancer). These symptoms are:
* Blood in your stool when you go to the toilet (you might notice blood in the toilet bowl, on the toilet paper, or covering the stool)
* A change in your bowel habits, such as having bowel movements more often each day or diarrhoea.
But most people with these symptoms don't need a colonoscopy and don't have cancer. The National Institute for Health and Clinical Excellence (NICE), the organisation that advises doctors about which treatments should be available on the NHS, says that you may need a colonoscopy if any of the following happen:1
* You are over 40 and you've had both of the main symptoms (blood in your stools and a change in bowel habits) for at least six weeks
* You are over 60 and you've had one or both of these symptoms for at least six weeks. This is because older people have a higher risk of cancer. If you have bleeding, your doctor will check you don't have any itching around your anus. Itching or soreness around your anus is more likely to be caused by piles than cancer. Piles are swollen veins just inside your anus
* You or your doctor can feel a lump in your abdomen, or your doctor can feel a lump in your rectum when he or she examines you internally
* You've had polyps before, or have a family history of bowel cancer
* A blood test shows that you have anaemia. Anaemia means you have a shortage of iron in your blood. It makes you feel tired. It can be a sign that you are slowly losing blood from your bowel, but not enough to see in your stools
* You've had another test, such as a barium enema, that shows you have a problem in your bowel.
NICE says that, if you have these symptoms, you can expect to have a colonoscopy within two weeks of seeing your doctor.
If you've had treatment for bowel cancer, you may have a colonoscopy to check it hasn't come back.
What happens during a colonoscopy?
You have a colonoscopy in hospital, but you can usually go home the same day. The test is done in an operating theatre, usually by a doctor trained in problems of the digestive system (a gastroenterologist). But it's not an operation and you won't have a scar or stitches afterwards.
Preparing for a colonoscopy
Your bowel has to be cleared out before a colonoscopy. You do this at home, usually the day before. The doctor or nurse will write down a list of instructions for you. There are several different ways to clear out your bowel. The most common methods are:
* Taking a strong laxative tablet (you may need more than one dose)
* Drinking a large amount of a special drink
* Stopping eating solids one or two days before the colonoscopy
* Stopping eating and drinking (apart from sips of water) from midnight the night before.
Some people also need to have their bowels washed out an hour or so before their colonoscopy to make sure the bowel is empty.2
Clearing out your bowel can be unpleasant. But it's important to do it properly. If your bowel isn't clear, your doctor won't be able to see the inside of your bowel, and you may not be able to have the colonoscopy.
During the test
You'll need to take off most of your clothes, and you'll be given a hospital gown to put on. You can have a drug (a sedative) to make you relaxed and sleepy during the test. Sedatives are usually given straight into your bloodstream through a small plastic tube in your arm. If you have a sedative, you'll have extra oxygen to breathe through a small mask on your face during the test.
You'll lie on your left side with your knees pulled up to your chest. The doctor puts a long bendy tube into your bowel by feeding it up through your anus. The tube is called a colonoscope. It has a light and a camera on the end. The camera sends pictures of the inside of your bowel to a screen. While feeding the colonoscope through your bowel, the doctor watches the screen and checks for anything unusual.
If you have a polyp, you can have it removed during the colonoscopy. The doctor can also take small samples of tissue to look at later.3 This called a biopsy. It's done by passing an instrument down a hollow tube built into the side of the colonoscope. The instrument has tiny pinchers or clippers on the end that the doctor uses to cut away a small piece of tissue. The tissue is brought back through the hollow tube and sent to a laboratory to be examined under a microscope.
You won't usually feel anything while the tissue is being removed. But if you're in any pain, let someone know.
A colonoscopy can be uncomfortable and embarrassing, but it shouldn't hurt. If you do feel pain, it's important to tell the doctor or nurse. Some people find that they can't control their bowels during the test. This is normal. It's your bowel reacting to the tube inside it.
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