Rachel Sawyer – a patient with inflammatory bowel disease, has kindly written a blog about her experience of a recent Colonoscopy at Guy’s and St Thomas’s Hospital, London.
‘We have booked you a colonoscopy’. Cue the collective groan from a bowel-shy nation as appointment letters are opened up and down the land. Often the (quite literal) butt of medical humour, colonoscopies are, however, an essential service for the management and treatment of bowel disease. So don’t be embarrassed if you need a bowel exam – step forward and be counted!
For those of us with long-term gut conditions (eg, inflammatory bowel disease) – the ‘frequent flyers’ of colonoscopy – it means a familiar pattern of time spent prep-weary, hungry and often anxious about the result. So how best should we brace ourselves for the before, during and after of being ‘scoped?
I should start by laying my cards on the table and confessing that, to the puzzlement of many, I actually quite look forward to having a colonoscopy! It’s not quite boating on the lake, but I’m always relieved to have the results – the camera never lies, as they say. Once it’s done, it is (hopefully) done for a good while.
A bit about me… In 2000, at age 31, I was diagnosed with IBD-Unclassified, assumed to be ulcerative colitis. This was reclassified as Crohn’s disease in 2008 after I developed a perianal fistula. Suffice it to say, I have had countless bowel exams over the years. In this blog piece, I’m going to cover what to expect when you have a colonoscopy, along with some tips that I’ve picked up along the way. My most recent bowel exam was just two months ago, so it’s a report from the trenches, you might say!
Preparing For Your Colonoscopy : The Countdown
You’ve had the letter. You’ve got the date. You may have arranged to take time off work or study to attend the appointment, plus the day before for the bowel prep. And hopefully you’ve arranged a chaperone to bring you home afterwards. All good on the logistics front.
An appointment may take place with an Endoscopy Nurse either in-person or by telephone (can vary in different hospitals) to ensure you fully understand the bowel prep instructions. Colonoscopies sometimes have to be abandoned if the bowel prep hasn’t been taken correctly. Why go through all that stress and disappointment? So seize the chance to ask questions now!
Four days before your colonoscopy
You can eat and drink as normal but you should stop taking any medicines that contain iron (eg, ferrous fumarate etc).
Three before your colonoscopy
Again, food and drink is unrestricted. As well as stopping iron, you should also now stop medicines that contain codeine phosphate and loperamide (eg, anti-diarrhoeal drugs).
Two days before your colonoscopy
So far, so good. No major interruptions. But now it’s time to get into the restricted diet zone! Stop eating fibre. This means no brown carbs, no nuts/seeds, no vegetables, no fruit. And (preferably) no alcohol. You’re left with a selection of low-fibre, low-residue foods. I had potatoes (no skins), cod and cheese. But you can have beef, lamb or pork if you prefer to go crazy with a splash of colour on your plate!
TIP: Start increasing your water intake two days ahead of your colonoscopy – ideally 8 to 10 glasses on that day. This may sound extreme 48 hours before your test but it keeps things moving in your bowel. My recent colonoscopy prep was better for following this advice. No dehydration headache and an easier time with the prep.
There are more tips on bowel preparation here.
One day before your colonoscopy
Food, glorious food – or rather the lack of it pre-colonoscopy. You want me to stop eating how long before the procedure?
In truth, the lack of food is probably the biggest challenge for me when preparing for a colonoscopy. What’s one day without food, you might ask? But like all things that are withheld from us, we tend to want them all the more! Plus I’m a girl who always looks forward to her meals. The good news is that the hunger does eventually abate – or at least it becomes manageable, shall we say.
So the fasting period is about to begin. It’s the morning of the day before your colonoscopy and it’s the last time you’re going to eat until after the procedure. The temptation to pole vault your way into an all-you-can-eat-buffet may be strong… but remember, what goes in must come out. So why not make it easy on yourself? I had a very low-drama poached egg on white toast and a cup of tea.
Remember to continue drinking water. Another 8-10 glasses today. If you get H20h-so-bored, you can alternate it with fizzy drinks, strained soup or clear stock. The main thing is to stay well hydrated, particularly when you start the bowel prep.
TIP: You may find it helps to add a small amount of sugar or salt (or similar rehydration salts) to your fluids if you start to feel lightheaded throughout the day.
The bowel prep
What’s worse, the bowel prep or the colonoscopy itself? A hotly-contested question amongst people who’ve ever been ‘scoped. My view is that it depends on how inflamed your insides are and, to some degree, the skill of the endoscopist (the person doing your colonoscopy).
Let’s start with the bowel prep itself. Different hospitals often use different bowel preps, and the volume you are required to drink will vary according to which bowel prep you have. But the end result is the same – namely a large intestine that is (hopefully) as clean as a whistle to inspect.
The bowel prep used will be one your doctor feels is appropriate for you. For instance, if you have kidney problems, you will be prescribed a certain type of prep. I shan’t go into the ins and outs of this here; your healthcare team can answer any questions you may have.
At my recent colonoscopy – as with all previous ones – I took my bowel prep with a senna ‘chaser’. Senna is a laxative that’s taken an hour before you start the prep to help soften your stool. You can have it either in liquid form or, like I did, as four tablets taken together.
Then it’s time for the headline act – Citrafleet, in my case. The powder behind the purge. Or the ‘jollop’, as my dad calls it… You mix Citrafleet with 150ml of water (two doses at 12 hours or so apart). Much easier than some of the 2 x 1-litre bowel preps that are prescribed.
And then it’s the waiting game... How long does it take for the bowel prep to work? Anything from one to three hours tends to be usual. Not much else to do than look at your watch and wait, so it’s a good time to get on with all of those boring tasks you’re forever putting off… Paperwork, phone calls, ironing, whatever… You’re confined to barracks now so you may as well make good use of the time!
Some crampy pains or mild discomfort are to be expected as your bowel sizes up this potent liquid you’ve sent its way! Don’t be too worried about this, but if you do have any major concerns, remember you can call the Endoscopy Unit for advice (the number is on the information leaflet you are given).
Once you have started to go to the toilet, you can expect back-and-forth trips until you are passing clear liquid. For me, this was between 10 and 12 trips per dose, but it varies on the individual.
TIP: Whether or not I can class this is a true ‘tip’ I don’t know, but a doctor on Twitter told me that drinking a can of Coke Zero may help improve the bowel washout (don’t ask me why the type of Coke had to be so specific!) I have to say that my bowel exam did indeed appear to be the clearest yet, so I’ll give it the benefit of the doubt and point you to the research (If nothing else, the Coke Zero broke up the tedium of drinking water!),
TIP: If you have a detachable shower head in your bathroom, you may find it easier to use this to clean yourself after each bowel movement. It avoids soreness from repeated rubbing with toilet tissue. You may also find it useful to use a barrier cream or Vaseline to protect the skin around your anus from getting too sore from the frequent bowel movements.
Split-dose bowel prep
Most hospitals favour a split-dose bowel prep these days. This means taking the first dose of bowel prep towards the evening (eg, 5pm) on the day before your colonoscopy and the second dose on the morning (eg, 9am) of your procedure. It is felt this gives a better cleanse and hence better visibility of your colon during the exam.
A word of advice on this. The bowel prep instructions ask you to take the second dose of bowel prep about four hours before your procedure. However, you may find this is not long enough. Bearing in mind it can take a good few hours before you stop going to the toilet – and particularly if you have to factor in long travel to your appointment – it may be wise to add a couple of extra hours as a buffer. With my 2pm colonoscopy, I took my second dose of bowel prep at 7am, I stopped going to toilet around 11am and I left the house at midday. I felt much more relaxed having started the second dose earlier.
The day of your colonoscopy
The day is here. Congratulations, you’ve done the hard bit. You have made it through the first dose of bowel prep and you will make it through the second dose as well.
Assuming your bowel has resumed near obedience after your second dose of prep, you should now find yourself arriving at the Endoscopy Unit to check in. It’s always at this point that I have a slight, irrational panic that I’ve gone through the motions with the bowel prep (the many, many motions, you might say!), only to find I’ve got the wrong day! I am sure it must have happened to people before. Fortunately, so far, so good for me!
The Endoscopy Nurse will take your blood pressure and ask you some brief questions: when did you last eat and drink; what medication do you take; do you have any allergies; are you having sedation? And if you are having sedation, who is your chaperone? Your chaperone is there to ensure you get home safely. Make it someone you like so they stop you doing any crazy stuff like signing over your house deeds while you’ve still got the Fentanyl coursing through your veins!
Next you’ll be handed a very fetching hospital gown with various impossible-to-fathom-out ties to do it up. If you’re lucky the nurse will do a few no-nonsense sailors’ knots for you to make sure your dignity is safely strapped in! Oh, and there are elasticated paper knickers too! (can vary in different hospitals). The nurse laughed hard when I asked “do I wear these or use them as a hairnet?”. She assumed I was joking and I didn’t like to disappoint…
Time to enter the inner sanctum of the colonoscopy suite itself. Your endoscopist and their assistants will probably already be there as you make your theatrical gowned entrance and assume your position (lie on left-side, bring your knees towards your chest) If you have chosen to have sedation and/or pain relief, it will be administered now. And if you’re lucky, they might even ask you what music you want to listen to. Perhaps they’ll even sing along, as mine did. Surprisingly tuneful, I must say… no pain relief needed for that!
It’s completely natural to feel self-conscious before and during your bowel exam. It is, after all, less of an everyday occurrence for the patient than it is for the doctor doing the exam. But there really is no need to feel embarrassed. For your doctor this is all in a day’s work; their focus is solely on scrutinising every inch of your bowel lining, with medical matters in mind. They are not after anecdotes for the pub that evening!
If you are finding the procedure particularly uncomfortable, do let your endoscopist know – don’t suffer in silence. The air that is passed into your colon may cause a degree of discomfort but this should pass as the scope moves around.
And then you’re done! The endoscopist doing your exam will tell you their findings and make any follow-up appointments as appropriate. You will be taken to the recovery area where the Discharge Nurse will review you and give you a copy of your Endoscopy report.
You’re ready to go home. But not before the nursing team have reunited you with food and drink! “White, no sugar, please. And two biscuits, if I may…”
You can hear more from Rachel by following her on Twitter @bottomline_ibd