What is a Colonoscopy?
A Colonoscopy is a test, which allows the Endoscopist to look directly at the whole of the large bowel (Colon). In order to do this, a flexible tube the thickness of a finger, is carefully passed through the anus into the rectum and into the large bowel. This can be uncomfortable as bends in the colon are negotiated and air is used to inflate the colon. The Colonoscope has a small camera attached which is connected to a monitor system where images can be seen. In order for the test to be successful, it is important that you take the Citramag® bowel preparation as directed. This will assist in cleaning your bowel, enabling us to make a correct diagnosis.
Benefits
By examining your bowel the cause of your symptoms may be found. Images and biopsies (samples) may be taken and sometimes polyps (small growths in the bowel) can be removed or other treatments performed.
Risks
A Colonoscopy is a safe examination but rarely, a complication such as bleeding or perforation may occur (1 in 1500, or if polyps removed 1 in 200). Other risks are discomfort, bloating and pain. Entonox® (gas and air) may cause nausea, dizziness and euphoria. Sedation may cause nausea and vomiting, and rarely you may become over sedated which can reduce your breathing rate.
Alternative treatments
There may be alternatives to this procedure and sometimes a dedicated bowel CT scan is done instead. Your referring clinician has advised that this is the most appropriate test for you. If you would like to discuss alternatives further please speak to your referring clinician.
Please make sure you follow the instructions in this leaflet and on your appointment letter. If you are unable to make your appointment or need to change your appointment time, please telephone using the numbers listed on the back page of this leaflet.
Your appointment time takes into account the time required to admit you onto the unit. You should therefore not expect to immediately go through for the test when called. You will be assigned to a Morning or Afternoon Endoscopy session and will be in the department for up to 4 hours. Please note we usually have 6 different lists running consecutively, which may mean some people will have to wait longer than others, even with the same appointment time.
Please note that the time of day that you will need to start taking the Citramag® solution differs between a morning and an afternoon appointment. Please follow the instructions carefully.
Please be aware we are a Teaching Hospital and may have trainees in any areas of your pathway. They will always be supervised and they will always be working at an appropriate level for their training stage. If you would rather not have a trainee involved in your care please let the staff know your wishes. This will not affect your care.
Please bring a list of all your medications on the day.
Please leave valuables and jewellery at home where possible as we unfortunately are unable to look after these.
What to expect on the day
Before the procedure a nurse will take you into a room and explain the test and ask you some health questions. You will be asked to sign a consent form and change your underwear to some procedural dignity shorts that we supply.
A cannula will be inserted in preparation for your procedure (a small plastic tube).
We will transfer you to the waiting area and from here you will be called into the procedure room for your test.
If you are having Entonox® (gas and air) instructions will be given on how to self administer this before your Colonoscopy starts.
Entonox® is inhaled through a mouthpiece to relieve pain.
A cannula (small plastic tube) will be inserted just in case any medication is needed during your Colonoscopy.
After the procedure you will be transferred to our recovery area for about 30 minutes where you will be given a drink and some biscuits. The nurse will prepare your results and discharge advice.
Recovery from the effects of Entonox® is rapid and you will be able to drive 30 minutes after stopping Entonox®, providing you have had a straightforward Colonoscopy.
You may feel bloated with wind-like discomfort. This is normal and usually settles quickly. If you have a biopsy taken or a polyp removed it is common to pass small spots of blood from your bottom for a day or two following the procedure.
Details of your results and discharge advice will be given before leaving the unit. Biopsy results will be communicated by the referring clinician at a later date.
You will need a cannula (small plastic tube) in your hand or arm through which a mild sedation and analgesia (pain relief) is given.
This should relax you but will not put you to sleep. It is not a general anaesthetic.
You will be awake and aware during the procedure with sedation.
Sedation may cause loss of memory and judgement for 24 hours after the test. You must not:
• Drive
• Drink alcohol
• Operate machinery
• Sign legal documents
If your job involves any of the above you will need to take the day off work following the sedation.
After your procedure you will be transferred to our recovery area for approximately 30 minutes where you will be given a drink and some biscuits. The nurse will prepare your results and discharge advice.
You may feel bloated with wind-like discomfort. This is normal and usually settles quickly. If you have a biopsy taken or a polyp removed it is common to pass small spots of blood from your bottom for a day or two following the procedure.
You will need a responsible adult to accompany you from the unit because of the effects of the sedation and also have someone at home overnight after having sedation.
Details of your results and discharge advice will be given before leaving the unit. Biopsy results will be communicated by the referring clinician at a later date.
In order to examine the whole of the bowel it must be clear of all waste materials. This is achieved by using a combination of changing what you eat and taking laxative medicines.
Citramag® works by loosening your stools. This is unpleasant but necessary and may last up until the time of your appointment.
Easy access to your toilet will be required for most of the day.
You might like to use a barrier cream to prevent a ‘sore bottom’. A product such as petroleum jelly can be effective.
7 days before
your Colonoscopy appointment please stop taking iron tablets. Please also stop taking any laxatives that will cause bulk in your bowels (such as Fybogel®).
4 days before
your Colonoscopy appointment please stop taking medication that might constipate you for example Codeine, Co-phenotrope (Lomotil®), Loperamide (Imodium®) or Kaolin and Morphine mixture, Cholestyramine or Colesevelam.
Taking other medication
If you are taking other medication, please take it at least one hour before or at least one hour after taking Citramag®, otherwise they may be flushed through your digestive system and not work so well.
Take any medication you are on up to 2 hours before your appointment with water. If you are taking medication for DIABETES please refer to the specific diabetic instructions towards the end of this leaflet.
Oral Contraception
If you are taking an oral contraceptive pill, diarrhoea can make it less effective. Continue taking the pill but use other precautions for the rest of that cycle.
Important: No alcohol should be consumed on the day before and on the day of the procedure.
Important notes on Citramag®
DO NOT TAKE CITRAMAG® IF:
• You are allergic to any of the ingredients.
• You are pregnant.
• You are on dialysis.
• You are taking medication for an organ transplant.
• You have not passed wind or opened your bowels in the last five days leading up to your bowel preparation time.
Please contact us via the phone numbers on the back of this leaflet if any of the above cautions apply to you.
Some Possible side effects of Citramag®
Abdominal pain, abdominal distension, sleep disturbances, dehydration, dizziness, tiredness, feeling generally unwell, soreness of the anus, nausea, vomiting, headache and indigestion. If you experience any of these symptoms try taking the Citramag® more slowly. There is a small possibility that the medication can cause low blood pressure or kidney problems. Rarely are people allergic to Citramag®. They may experience a rash or itching, swelling of the face or ankles, palpitations or shortness of breath. If any of the side effects become serious, stop taking Citramag® and seek medical advice.
Three days before your test please follow a low residue diet, which consists of the following:
• Fats (use sparingly) – Butter or margarine.
• Rice – Plain boiled white rice.
• Eggs – Boiled or poached.
• Meat / Fish – Chicken (skinless) or whitefish.
• Cheese – Cream, cottage cheese, tofu or cheese sauce.
• Bread – White bread or toast.
• Cereals – Crisped rice cereal, cornflakes (no bran).
• Pasta – Plain macaroni, spaghetti, noodles.
• Potatoes – Boiled, creamed, mashed or baked (no skins).
• Dessert – Clear jelly (not red jelly) natural plain yogurt, ice cream or custard.
Foods to avoid:
Red meat, sausage, pies, any fruit or salads, most vegetables, potato skins, chips, wholemeal or brown bread, nuts, pulses, baked beans, wholemeal pasta, brown rice, puddings containing fruit and nuts, cakes, biscuits and yoghurts.
The Day before your Colonoscopy
Eat your breakfast before 9am. Do not eat anything after 9am.
Do not eat food again until after your examination even if you feel hungry. Your bowel must be completely empty for the examination to be successful.
You may drink clear soup, Oxo, Bovril, soft drinks (not red coloured), black tea or coffee (no milk). You may add sugar if you like. You may drink as much as you like of these fluids.
Senna tablets and two sachets of Citramag® are provided. Please follow the instructions carefully to make sure your bowel is empty. This is essential for a proper examination.
2pm
Take 10 Senna 7.5mg tablets with plenty of water.
During the day drink at least a glass of water (about 250ml) or other clear fluid every hour whilst the effects of the medication persist.
5pm
Dissolve the contents of one sachet of Citramag® powder in 200mls of hot water in a large wide mouthed measuring jug, as the mixture may fizz over when water is added.
Allow to cool for at least a 30 minutes before pouring into a suitable glass and then drink this solution.
During the day you must drink at least one and a half litres of water or clear fluids. This will prevent you from becoming dehydrated.
When you start taking Citramag® it is important that you stay close to a toilet. At some point you will start having very watery bowel movements. This is normal and indicates that the Citramag® is working.
7pm
Dissolve the contents of one sachet of Citramag® powder in 200mls of hot water in a large wide mouthed measuring jug, as the mixture may fizz over when water is added.
Allow to cool for at least a 30 minutes before pouring into a suitable glass and then drink this solution.
During the rest of the evening you must drink at least one and a half litres of water or clear fluids. This will prevent you from becoming dehydrated.
When you start taking Citramag® solution it is important that you stay close to a toilet. At some point you will start to experience watery bowel movements. This is normal and indicates that the Citramag® solution is working.
You can go to bed when you have stopped going to the toilet. If you follow these instructions your bowel should be clear to enable a successful examination.
You may continue to drink water up to 2 hours before your procedure.
The Day before your Colonoscopy
Eat your lunch before 12 Noon (midday). Do not eat anything after 12 Noon.
Have a light lunch of foods permitted within the low residue diet.
Do not eat food again until after your examination even if you feel hungry. Your bowel must be completely empty for your examination to be successful.
You may drink clear soup, Oxo, Bovril, Soft drinks (not red coloured), black tea or coffee (no milk). You may add sugar if you like. You may drink as much as you like of these fluids.
Senna tablets and two sachets of Citramag® are provided. Please follow the instructions carefully to make sure your bowel is empty. This is essential for a proper examination.
2pm
Take 10 Senna 7.5mg tablets with plenty of water.
During the day drink at least a glass of water (about 250ml) or other clear fluid every hour whilst the effects of the medication persist.
5pm
Dissolve the contents of one sachet of Citramag® powder in 200mls of hot water in a large wide mouthed measuring jug, as the mixture may fizz over when water is added. Allow to cool for at least a 30 minutes before pouring into a suitable glass and then drink this solution.
During the day you must drink at least one and a half litres of water or clear fluids. This will prevent you from becoming dehydrated.
When you start taking Citramag® it is important that you stay close to a toilet. At some point you will start having very watery bowel movements. This is normal and indicates that the Citramag® is working.
7pm
Dissolve the contents of half of the second sachet of Citramag® powder in 100mls of hot water in a large wide mouthed measuring jug, as the mixture may fizz over when water is added.
Allow to cool for at least a 30 minutes before pouring into a suitable glass and then drink this solution.
During the rest of the evening you must drink at least one and a half litres of water or clear fluids. This will prevent you from becoming dehydrated.
When you start taking Citramag® solution it is important that you stay close to a toilet. At some point you will start to experience watery bowel movements. This is normal and indicates that the Citramag® solution is working.
You can go to bed when you have stopped going to the toilet.
On the Day of your Colonoscopy
9am
Remember do not eat anything.
Dissolve the contents of the other half of the second sachet of Citramag® powder in 100mls of hot water in a large wide mouthed measuring jug, as the mixture may fizz over when water is added.
Allow to cool for at least a 30 minutes before pouring into a suitable glass and then drink this solution.
If you follow these instructions your bowel should be clear to enable a successful examination.
You may continue to drink water up to 2 hours before your procedure.
If you have diabetes, please read the ‘extra’ leaflet sent alongside this leaflet.
This leaflet is specific to controlling your diabetes through the various procedures available within our unit and you will have been sent the one that corresponds with your specific procedure:
• Guidance for Managing Diabetes for Sigmoidoscopy / Colonoscopy
This will give you clear instructions on what to do with your medication (including insulin) during the preparation for your test.
If you have not received a copy of this leaflet, please contact the Gastroenterology & Endoscopy Unit, via the phone numbers listed on the back of this leaflet and request a copy.
How long does the procedure take?
A Colonoscopy lasts between 30 to 60 minutes depending on the position of your colon and the procedures that need to be done (for example removal of polyps will take longer). You will be in the department for up to 4 hours.
Does it hurt?
Sometimes patients find the test painful but gas and air (Entonox®) or sedation is available to use for pain relief if needed.
Do I have to have the test?
No. The choice is yours, please refer to page 3 for alternatives and the reason why this test is appropriate.
Can I take my tablets as normal?
Yes unless instructed otherwise. Please take the tablets at least one hour before or at least one hour after taking Citramag®. Diabetic patients please read page 14 for diabetic medication instructions.
Will I be asleep for this procedure?
No. Gas and air (Entonox®) or sedation is available (if your circumstances permit), but you will be awake throughout the procedure.
How can I make the Citramag® more palatable?
It is important to sip the Citramag® and not gulp it down to reduce nausea. A straw is sometimes helpful to drink the Citramag® with and you can add cordial (not blackcurrant) to taste if you prefer.
What shall I wear to attend the procedure?
Please wear loose comfortable clothing. You will be asked to wear dignity shorts under your own clothing before the procedure. On entering the procedure room you will be asked to remove your lower clothing (keeping your dignity shorts and your top clothes on).
Details of your results and discharge advice will be given before leaving the unit. Biopsy results will be communicated by the referring clinician at a later date.
If you have any issues or need advice after your procedure please contact the Gastroenterology & Endoscopy Unit within working hours (7.45am to 6pm) and ask to speak to the nurse in charge. See contact phone numbers on the back of this leaflet.
If urgent out of hours advice is required please contact Ward 2 on 01253 953402.
Gastroenterology & Endoscopy Unit Location Map
Access from the main hospital multistorey car park
We are located in Area 6 - Gastroenterology & Endoscopy Unit, highlighted in orange on the main hospital map. Follow the signs for the Main Hospital up the escalator/lift towards Area 6, second corridor on the left. Follow the signs down the link corridor, exit to the right via the side door (external) which is signposted for Patient Entrance to Reception.
Access for drop off/collection only & disability parking
Enter via East Park Drive and follow the road up the hill, take the second left signposted for Gastroenterology & Endoscopy Unit Drop Off Only, follow the road round to the right.
