Preparing for your Colonoscopy A patient friendly book for:! This booklet will help you understand and prepare for your colonoscopy. Please take your time to read it.
This document was developed by the staff of the Endoscopy Unit of the MUHC. We would like to recognize the MUHC Education Office for their support throughout the development of this booklet, the design and the layout, as well as for the creation of all the images. We would also like to thank the MUHC Patient Education Committee for their support of this project. This document is copyrighted. Reproduction in whole or in part without express written permission from patienteducation@muhc.mcgill.ca is strictly prohibited. copyright 17 March 2014, McGill University Health Centre. I IMPORTANT: PLEASE READ Information provided in this booklet is only for educational purposes. It is not intended to replace the advice or instruction of a healthcare practitioner (doctor, nurse, other), or to substitute medical care. Contact a qualified healthcare practitioner if you have any questions concerning your care. This material is also available on the websites of the and the MUHC Patient Education Office (www.muhcpatienteducation.ca)
Table of contents Introduction What is a colonoscopy? Why is a colonoscopy recommended? What happens during the test? What happens after the test? Possible complications A few weeks before your test On the day of your colonoscopy Bowel preparation When arriving at the endoscopy unit Cancellations How to reach us Hospital map Other patient education materials Notes Help us help others 4 4 4 6 6 7 8 10 11 12 14 14 14 15 15 16
Introduction In this booklet you will find information about your colonoscopy, and what you will need to prepare. Being well prepared is the key to having a successful test. What is a colonoscopy? A colonoscopy is a test in which a flexible tube, about the thickness of your index finger, with a small camera (a colonoscope) is inserted in your rectum. The camera is connected to a display monitor, which allows the doctor to see and examine the inside of your colon (large bowel). Why is a colonoscopy recommended? Cancer of the colon usually starts from a polyp. A polyp is a wart-like growth of cells. Although most polyps are benign (not cancerous), removing them is an important way of preventing colon and rectal cancer. If polyps are found during your colonoscopy, most of them should be removed. The procedure to remove polyps is called a polypectomy. Polyps are removed by burning them off or by placing a wire snare around their base and applying to it an electric current. The sample is then sent to the lab for testing. 4
Colon (Large bowel) Polyp Rectum There is a small chance that your doctor might miss a polyp or cancer. Out of 100 patients with cancer, up to 15 cases may not have been diagnosed during a previous colonoscopy (within 6-36 months prior). Alternatives to a colonoscopy are limited if you have gastro-intestinal symptoms, a positive stool test, or a personal or family history of polyp or colorectal cancer. For screening purposes, there are other tests that you can do instead of a colonoscopy but a colonoscopy has the advantage of allowing tissue samples to be taken (biopsy) and polyps to be removed. The other screening tests (presented below) do not. Discuss your options with your doctor. Other options for screening include: - stool tests: fecal occult blood test (FOBT) and fecal DNA - CT colography scan (commonly known as a virtual colonoscopy, which also requires a bowel preparation) 5
What happens during the test? During the test, you may feel some discomfort (pain, bloating or cramps), this is normal. These symptoms may last after the test and usually improve over the next few hours. You may receive a medication (sedation) to help you relax and control the pain or discomfort you may feel. This medication may make you fall asleep. 9 11 10 8 7 12 1 2 6 5 4 3 The test takes between 15 to 30 minutes to be completed, but you should expect to spend between 1 ½ hours to 3 hours at the hospital. What happens after the test? Once the test is over, you will be taken to the recovery room, where the nurses will continue to monitor you until the sedation wears off. Your recovery can take 30-45 minutes. The medication may affect your reflexes and judgement for the rest of the day. For your own safety and that of those around you, you MUST have someone to accompany you home after the test, if not your test will be cancelled. Because of the medication effects, it is important that for the next 24 hours you: Do not drive Do not drink alcohol Do not make important decisions Normally you should be able to eat your regular diet 30 minutes after the test. 6
Possible complications Complications can happen but they are rare. Perforation: there is a chance that you could get a tear or hole in the wall of your colon (called perforation). If this does happen, you would receive intravenous antibiotics and possibly have a surgery. The risk of perforation ranges from less than 1 in 5000 for screening colonoscopies to less than 1 in 1000 for nonscreening colonoscopies. The risk of perforation can be higher if a polypectomy is performed than if a polypectomy is not performed. Bleeding: bleeding may occur after a biopsy and/or a polyp is removed. It is usually minor and stops on its own or it can be controlled by special techniques during the colonoscopy. The risk of bleeding ranges from less than 1.6 in 1000 to less than 1 in 100 depending on whether a polypectomy is performed. If the bleeding is extensive, a blood transfusion may be necessary and a colonoscopy may be repeated. If you receive medication (sedation), irritation at the injection site of the vein can occur. The lump or bruise will disappear after a few days. You can apply warm or cold compresses for comfort. Adverse or allergic reactions to the medication given are possible and can be treated with appropriate medication. Other extremely rare complications can occur in predisposed patients, such as a heart attack or a stroke. Deaths have been reported but are extremely rare. 7
A few weeks before your test On the phone: A secretary will call you to book your colonoscopy appointment. You will be given information about the date, time and location where you must go for your test. The secretary will ask you some questions about your health in general and about the medications you may be taking.the secretary will inform you about what you need to do to prepare your colon for the test. You must advise the secretary if you are a diabetic patient or if you are taking blood thinners (anticoagulants). You should also ask your referring physician if and when you should stop or continue taking these medication before your test. If you need to continue taking your medication, please inform us. In the mail, you will receive the following info: 1 2 3 4? 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 your appointment date and time instructions about your medication instructions about bowel preparation and your diet a notice of receipt of information Read the instructions carefully. A nurse may call to ask you for more information. 8
Both in the weeks before and on the day of your test, it is important that you let the nurse or doctor know: if you ever had complications or serious side effects following a previous colonoscopy. if you have a pacemaker or an implantable defibrillator. if you are allergic to sulfate. if you suffer from respiratory problems. if you have any health conditions or physical limitations or disabilities (hearing, decreased mobility, etc). if you suffer from low blood pressure (hypotension). if you are diabetic, be sure that you are given an early morning appointment. if you are breastfeeding or if there is a possibility you could be pregnant. If you have difficulty expressing yourself in either English or French you should bring a family member or friend who can help you with translation. 9
On the day of your colonoscopy: þ Bring your valid medicare and hospital cards. If your hospital card has expired, please arrive 1 hour before your scheduled appointment and go to the admissions office (room B1-121) to renew it. þ Bring your doctor s colonoscopy request and any tests you had related to the colonoscopy. þ Bring the pre-consent form regarding colonoscopy you received in the mail. þ Bring a list of your medications and allergies. þ Do not wear nailpolish. 60 55 50 þ You must arrive at least 30 minutes before your test to get ready. 5 10 45 15 40 20 35 30 25 40 45 35 30 50 55 20 25 60 5 15 10 þ You will not be able to drive for the next 24 hours after the test because of the medication that you may receive. 10 þ You should expect to be in hospital between 1.5 to 3 hours. 9 11 10 8 7 12 1 2 6 5 4 3
Bowel preparation You should buy the bowel preparation solution at your pharmacy at least 2 days before your test. You do not need a prescription from a doctor to get it. Please follow the instructions carefully on the bowel preparation sheet mailed with this booklet. Taking your bowel preparation solution and following the diet recommendations properly will clean your colon. This will allow the doctor to better see and examine the inside of your colon. This will also prevent you from having to repeat the colonoscopy in the next 2 to 12 months. The bowel preparation solution may cause some nausea and bloating, though this usually passes as you continue drinking the solution. It is important to closely follow the instructions you are given to fully prepare your colon. Reminder: It is very important to let us know if you have a pacemaker or an implantable defibrillator. Stop drinking all liquids (including water) 2 hours before your appointment. 11
When arriving at the endoscopy unit: 1. You will be greeted by the receptionist in room C7-200. If you are accompanied by someone, this person will be able to wait for you in this room. 2. You will then go to the evaluation area (D7-400) where you will be asked to change into a hospital gown. A nurse will ask you some questions and review your chart and take your blood pressure and pulse (vital signs). A needle will be inserted in your hand or arm to give you medication (sedation) during the colonoscopy, if needed. 3. When it is time for your test, a nurse will bring you to the procedure or exam room. 4. The doctor will ask you questions and may examine you. The doctor will review the procedure with you and answer your questions and then ask you to sign a consent form. By signing this form you are indicating that you understood the information given to you, that your questions were answered and that you accept to do this test. 12
5. Once the test is done, the staff will bring you to the recovery area (D7-500) where you will stay until the nurse decides that you are ready to go home. You will be given verbal and written instructions on what to watch for after the test and where to call if you need help. Your doctor will give you a written report of your test before you leave. Your doctor may also give you a copy of this report to give to your family and/ or referring doctor. If not, it will be faxed or mailed to them. You will also be instructed when to book your next appointment with the doctor who did your test, if one is needed. I Remember, you must have someone accompany you home after the test. If not your test will be cancelled. 13
Cancellations If you need to cancel your appointment, please notify us. Someone else may benefit from your cancellation! How to reach us If you have any questions, need additional information or clarification, feel free to contact us. We are located at the Montreal General Hospital: MUHC Montreal General Hospital Endoscopy Unit 1650, Cedar avenue Suite C7-200, 7th floor Montreal, QC, H3G 1A4 Contact us from 8 AM to 4 PM at the following numbers: If you are a Gastroenterology patient: (514) 934-8308 If you are a Colorectal patient: (514) 934-8486 colorectal@muhc.mcgill.ca l Hôpital général de Montréal/ Montreal General Hospital D Entrance L E A C T CEDAR AVE. COTE-DES-NEIGES Entrance B P N GUY ST. PINE AVE. P Entrée / Entrance Stationnement/ Parking Unité d endoscopie C7/ Endoscopy Unit C7 14
Other patient education materials A video, both in French and English, explaining the colonoscopy is available at this website: Notes www.cag-acg.org/posters-related-tools/110 Use this section to make notes for yourself and list any questions you may have. 15
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