My Doctor Online The Permanente Medical Group

Why It Is Done

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Screening or treatment for colorectal cancer

A colonoscopy is most often done in the clinic for two reasons:

• To screen for colorectal cancer.
• To treat or prevent colorectal cancer by removing abnormal tissue.

This procedure is one of many screening options for colorectal cancer, but it is one of the only procedures that can also prevent or treat the cancer by removing cancerous or precancerous growths in your colon. Screening for colorectal cancer typically begins at age 50, but if you are at high risk for colorectal cancer, we may recommend that screening begin at an earlier age.

Diagnosis of other bowel diseases

We also might recommend a colonoscopy to help diagnose conditions such as:

• Ulcerative colitis: An inflammatory bowel disease that causes swelling and sores (ulcers) in the lining of the large intestine, or colon.
• Crohn's disease: An inflammatory bowel disease that can affect any part of the intestinal tract from the mouth to the anus.
• Iron deficiency anemia: A condition caused by low levels of iron in the blood, which affects the body's ability to carry and use oxygen. Anemia is sometimes caused by blood loss from the intestinal tract. This is called "occult" or hidden blood loss, because in small amounts it is not detectable without a microscope or similar tool.

Hospitalization

In the hospital or emergency room the most common reasons we perform a colonoscopy are when you have blood in the stool or rectal bleeding. Sometimes we may also do the procedure if we suspect an infection or inflammation of the intestines.

How You Prepare

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A colonoscopy requires that your colon be completely empty before starting the test. This allows us to see the inside of your colon clearly and makes it easier for us to recognize and treat any abnormal tissue.

To clear your colon, we will ask you to change your diet and drink a strong laxative. The laxative will cause frequent bowel movements, which flush out your colon and prepare you for the procedure. Preparation is the most important part of the procedure. It must be done well in order for the test results to be accurate.

Your preparation instructions may differ depending on:

• The type of laxative we prescribe.
• Your overall health and any other medical conditions you may have.
• The medications you are currently taking.
• Any additional instructions we give you.

Most of our patients are prescribed a brand of laxative called Colyte. Please follow our instructions on preparing for a colonoscopy very closely.

Wear comfortable, loose-fitting clothing that's easy to change. Leave all valuables and jewelry at home. If you are having an outpatient procedure, make plans to have a friend or family member to drive you home. It's very important that you do not drive after your colonoscopy. If you do not have a driver, we will have to reschedule your procedure.

Please bring your Kaiser Permanente member ID card, a photo ID and your procedure co-pay when you come for your colonoscopy.

A word on medications

Most medications are fine to continue taking before your colonoscopy. However, there are a handful of medications that you should discuss with us before your procedure.

If we think it might be dangerous to your health to stop taking any of these medications, we may create an alternative plan for you based on your health. We may recommend that some patients avoid:

• Blood thinners: Warfarin, Coumadin, Plavix, Heparin, Lovenox.
• Ibuprofen (a few brand names are Advil, Aleve, Motrin, Nurprin, Medipren). 

How It Is Performed

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While the procedure itself does not generally cause pain or discomfort, we find patients are most comfortable with a sedative. We can discuss your options for sedation. Most patients are given an IV sedative and, though they are not completely asleep, they may not remember much or any of the procedure.

During the exam

The procedure takes about 30 minutes. You will lie on your left side on an exam table. We use a long, flexible tube to examine the inside of your colon. The tube is called a colonoscope. It has a light and a small video camera on one end, and tools that we can use to treat abnormal tissue. The tube is about the thickness of a finger, and it transmits images to a video monitor where we can see the inside of your colon clearly.

We gently insert the scope into your colon through your anus. The scope blows a puff of air into your colon, which inflates the colon and makes it easier for us to see. We will move the scope slowly along the length of your colon, stopping where your colon meets your small intestine. Then we slowly move the scope backwards and remove it. Retracing the path allows us to examine the colon walls for abnormal tissue or bleeding.

We will do our best to make this test comfortable for you. Right after the scope is inserted, some people feel an urge to go to the bathroom, but that feeling usually goes away after a few minutes. You may feel some pain or pressure as the scope moves along the colon; some people describe pressure that is similar to gas pains or bloating.

Tissue sample and removal

If we observe abnormal tissue, we use small tools inserted through the scope to take a biopsy (small sample) of tissue or to remove the abnormal tissue entirely. Sampling and removing tissue is not painful, because there are no nerve endings on the inside wall of the colon. A little bleeding is normal, and can usually be stopped with small instruments and medications during the exam.

After the exam

After the colonoscopy is finished, you’ll need time to recover from the sedative. Though you will be much more alert after an hour or so, the sedative doesn’t wear off completely for at least 12 hours. If you are having an outpatient procedure, you should not drive in these first 12 hours, which is why it is important to arrange a ride home. Hospital patients may go home the same day if the test is normal and you are otherwise stable.

The air that we used to inflate your colon may cause some discomfort in the first few hours after the procedure. You will feel better as you pass gas, which happens often in the first few hours after the exam.

You can go home a few hours after the exam is finished. You will still need time to recover, so we recommend that you rest and relax for a day or even two. You may continue to have cramps, feel bloated and pass gas: this is all normal. Drink liquids and eat if you are hungry, but avoid caffeine as it can cause cramps.

It will take about a week for your colon to recover completely. You may find that your bowel movements are not completely normal during this recovery period. You may notice a little bit of blood in your stool at first, but it should stop after a day or two.

Any pain or bleeding that you experience should stop in the first few days. However, you should let us know if you:

• Have a fever of 101 degrees Fahrenheit or higher.
• Experience persistent, severe pain.
• You have heavy rectal bleeding, with or without stool.
• Your belly is tender, firm, or swollen.

Risks

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Most people experience little or no pain during the exam. Recovery time from a colonoscopy is usually complete following a day or two of rest. But like any procedure, there are some risks which include:

Damage to your colon

There is a small risk that the procedure can tear or puncture the colon wall. This is rare, but if it happens, we may need to operate to repair the tear in your colon.

Should damage to your colon occur, we may see the damage during your procedure. In rare cases, you may not know about damage to your colon until a day or two after the procedure. Because of this, it's important to let us know immediately if you have:

• A fever of 101 degrees Fahrenheit or higher.
• Significant rectal bleeding (more than a few drops in the first 1 or 2 bowel movements).
• Persistent stomach pain.

Bleeding

If we remove or treat abnormal tissue during your colonoscopy there is a possibility that you will experience bleeding during or after the procedure. Bleeding may occur as often as 1 in every 200 times a polyp is removed. We will observe you carefully as you recover from the colonoscopy in the hospital. In rare cases, bleeding does not happen until after you have left the hospital. If the bleeding doesn’t stop or becomes worse, we may need to perform surgery or another colonoscopy.

Need to repeat the colonoscopy

There are a few reasons why we may recommend that you have another colonoscopy. For example, if your colon was not completely cleaned out before the procedure it can be difficult for us to see your colon or to move the colonoscope to the beginning of your small intestine.

Additionally, if there is blockage or obstruction in the colon, it might be difficult to observe the entire colon. Blockages can be caused by scar tissue from a previous abdominal surgery, severe diverticular disease, severe colitis, or another inflammation of the colon.

Finally, if a large amount of tissue was removed, a follow-up colonoscopy will help us confirm the success of the procedure.

Alternatives

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There are several alternative procedures to a colonoscopy. We can discuss the options and decide together which is best for you.

With all of these alternatives, if we observe or see evidence of abnormal tissue in your colon, you will probably still need a colonoscopy to sample, remove, or treat those areas.

Fecal occult blood test (FOBT or FIT)

A fecal occult blood test, or stool test, is a very quick test with no known side effects. It is sometimes abbreviated as FOBT test, or FIT test. There are no preparations for this test or special changes to your diet. We will provide all the supplies you need to do this test at home. This test is done with a sample of your stool that you collect using a home test kit and send to us by mail to be tested.

Flexible sigmoidscopy

A flexible sigmoidoscopy is similar to a colonoscopy, but only part of the colon is examined. The entire colon is 4 to 5 feet long, but a flexible sigmoidoscopy only examines the lowest 2 feet of the colon, called the sigmoid and descending colon. Because this test examines a shorter part of the colon, it is usually done in our offices instead of in the hospital. This procedure does not require any sedation.

There is less preparation needed for a flexible sigmoidoscopy than for a colonoscopy. You will need to take several enemas or an oral laxative two hours before the exam to clear your lower colon and rectum. We’ll also ask you to change your diet the day or two before the exam.

Barium enema

A barium enema is an X-ray of your colon. During the exam, we insert a thin tube into your colon through your anus. With this tube, we fill your colon with barium, a liquid that shows contrast during an X-ray. Then we take a standard X-ray of your abdomen. This allows us to see any abnormal tissue or growths in your colon wall.

You will need to prepare for this exam just as you would for a flexible sigmoidoscopy. We may recommend laxatives or enemas to clear the colon in preparation for the exam, and changes to your diet in the day or two before the test.

Your Care with Me

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Your personal physician may recommend that you have a colonoscopy for screening or treatment of colorectal cancer, or as a diagnostic test for various bowel diseases.
If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department – either by sending a referral or if appropriate, calling me or one of my colleagues while you are in the office so we can all discuss your care together.

My staff will contact you to make an appointment for either telephone advice or an office visit, and may schedule you for a colonoscopy at that time or later. In some cases we may ask you to attend a class or review an online educational program called “Preparing for Your Procedure (Emmi) for Colonoscopy,” instead of an office or telephone advice visit.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. After your colonoscopy,  I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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