The Colon & Rectal Clinic

Instructions for Colonoscopy

A colonoscopy is a procedure to examine the entire colon or large intestine. It is performed with a colonoscope which is a flexible tube with a light and a camera that allows the doctor to inspect the colon lining, and if necessary, remove small samples of tissue for examination under a microscope (biopsy) or remove small growths or polyps (polypectomy).

Be sure to let your doctor know if:

You are on anticoagulants (blood thinners) or aspirin-containing products.
You have been told to take antibiotics prior to dental visits or diagnostic tests.
You have bleeding tendencies.
You are diabetic.

Please contact the doctor who ordered these medications for you for any changes that may be required before your procedure.

Please bring with you a list of your current medications and dosages. Please bring your colon x-rays with you if requested to do so.

Here are some answers to some common questions:

Indications:

Screening guidelines indicated in the American Gastroenterology Association, (Gastro. 2003; 124:544-560)
Patients with anemia with complete UGI and SBFT studies
History of colon polyps or cancer
Familial history of colorectal cancers or polyps who are 10 yrs younger than the affected relatives
Persistent blood per rectum without identifiable source, or despite management of hemorrhoids

What Should I Do to Prepare?

Stop all aspirin products or anticoagulation meds (i.e. Coumadin or warfarin) for 5 days prior to procedure. Consult your physician if stopping these drugs is considered unsafe. We sometime use a “bridge therapy” for those on anticoagulation with Lovenox injection two times per day. This is started 36-48 hrs after stopping the anticoagulation med and the injection of Lovenox is continued until the evening of the colonoscopy procedure, and then stopped until 12-18 hrs after the procedure.
Avoid seeds, corn, berries the week prior to the procedure.
Fill your prescription for your bowel prep two days prior to the procedure.
Clear liquid diet (juices without pulp, Gatorade, coffee, tea, ice pops, broth, and Jell-O) starting the day before and continued until AM of the procedure. We recommend no red Jell-O, because it may look like blood.
Various cleansing regimen will be given by your doctor, we tend to use Golitely, or NuLytely 1 gallon take at least 12 hour before the schedule exam. These may be substituted with a smaller volume prep such as the Fleet Phospho-soda Accu-Prep if you have no kidney or heart disease. Read all instructions before use. You may store the solutions in the refrigerator because it will taste better chilled.
You may apply Vaseline or A & D ointment to the anus at the start of the preparation in order to prevent irritation.
Do not eat or drink after midnight. You may take your regular meds with sips of water or clear juice in the morning of the procedure.
Use two Fleets enemas at least two hours prior to the procedure.
Be sure to be at the procedure unit at least one hour before the schedule procedure. An intravenous (IV) will be inserted to administer fluids and medications that will make you sleepy and reduce discomfort.
Please make arrangements for someone to drive you home after the procedure. A companion must accompany you because you will be given medication to help you relax. Even though you may not feel tired, your judgment may be impaired and your may be reflexes slower. You will not be allowed to drive or take a taxi alone after the procedure.

Call our office at 503-222-1615 if you have questions.

How Is Colonoscopy Performed?

When you arrive in the endoscopy suite, a nurse will take your vital signs (blood pressure, temperature and pulse) and insert an intravenous catheter into a vein in your hand. Your doctor may then prescribe medicine to relax you and help ease abdominal cramping. You will be lying on your left side. The colonoscope (a long flexible tube about the width of a finger) is inserted into the rectum and gradually advanced through the colon. The doctor will insert air into the colon. The air may cause pressure or a bloating feeling but will enable the doctor to see your colon more clearly. The colonoscope is then slowly withdrawn while the lining of the colon is carefully examined. Your doctor will remove polyps or take biopsies as necessary. Following your examination, there may be some discomfort, which quickly improves with the passing of gas. The entire procedure usually takes less than an hour. Your nurse will transport you back to the recovery area and continue monitoring you until you go home. You will be observed in the endoscopy suite for a period of time. You will be given written instructions at the time of discharge.

What Do I Do After the Procedure?

May resume aspirin after 24 hrs, for those on anticoagulation (i.e. Coumadin) resume the Lovenox injection and anticoagulation meds 12-18 hrs after the procedure. Stop the Lovenox injection when INR is therapeutic. This usually takes 3-5 days, we usually recommend a check of your INR on day 4 after the procedure.
You may experience small amount of rectal bleeding, drowsiness and bloating, these should pass over the next 12-24 hrs. Try to expel the gas.
Resume a diet, starting with a liquid diet, until all discomfort is resolved. Then resume your regular diet.
You may resume your normal activities 24 hours after your colonoscopy.
If the vomiting, rectal bleeding, increasing abdominal pain persist call us (503) 222-1615, or your regular doctor.
Results of your procedure will be discussed by your regular doctor. Your doctor will call you in 7-10 days with the results. Contact your doctor if you have not received your results within 14 days.
Your doctor will tell you when you need to have a repeat colonoscopy.

Colonoscopy alone

Return to your regular diet on the same day.
Avoid strenuous exercise or driving for 12 hours after the procedure.
Resume taking aspirin-containing medication or blood thinners on the same day.

Colonoscopy with polypectomy or biopsy

Return to your regular diet on the same day unless instructed otherwise by your doctor. Do not eat nuts or popcorn for 72 hours.
Avoid strenuous exercise or driving for 12 hours after the procedure.
Avoid aspirin-containing medications for an additional seven days.
If you normally take anti-coagulants (blood thinners), your doctor will give you instructions about when to resume taking them.

Are There Any Complications from Colonsocopy and Polypectomy?

Colonoscopy and polypectomy are associated with very low risk when performed by doctors with special training and experience in these endoscopic procedures. One possible complication is perforation, which is a tear through the wall of the bowel that may allow leakage of intestinal fluids. Another complication is bleeding that may occur from the site of biopsy or polyp removal. It is usually minor and stops on its own, or it can be controlled by cauterization (application of electrical current) through the colonoscope. Rarely, surgery is necessary. A third complication is a localized irritation of the vein in your hand that may occur at the site of medication injection. A tender lump could develop and may remain for several weeks to several months. Elevation of the arm and hand on several pillows and local application of heat speeds recovery.

Causes for Concern

Contact Your Doctor
Call your doctor if you have any of the following problems:

Rectal bleeding greater than one cupful or lasting longer than one to two days
Increasing abdominal pain lasting longer than 30 minutes
Nausea or vomiting
Fever or chills

The Colon and Rectal Clinic
511 SW 10th Ave. Suite 714
Portland, OR 97205
Phone:(503) 222-1615
Exchange: 503-294-1927(after hours emergencies)

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