Colonoscopy

As a Consultant General and Colorectal Surgeon, I spend a lot of my time talking with and treating people who have bowel problems.

The bowels are an area of the body many people feel uncomfortable talking about. I cannot emphasise enough how important it is to see a doctor if you notice a change in your regular bowel movements, blood in the stools or any other significant condition. If you do notice a problem, early diagnosis and treatment is always preferable and often more effective.

A colonoscopy is a way of investigating the part of your bowel known as the large bowel or the colon.

What is a colonoscopy?

Many diagnostic tests, such as CT and MRI scans, play a valuable role in assessing, diagnosing and monitoring many conditions and diseases of the body. They can certainly be helpful in diagnosing and assessing many bowel conditions.

However, there are some things scans like this cannot do as well as a colonoscopy. A colonoscopy is the only test that allows a consultant like me to directly view the lining of the bowel. It is an extremely helpful investigation to help assess the likely cause of any symptoms you have been experiencing.

During a colonoscopy, I can also remove a small sample of tissue for analysis; this is known as a biopsy. The tissue is removed painlessly through the colonoscope using tiny forceps and sent to be analysed.

A colonoscopy is also the only test where it is possible to remove polyps should any be found in the bowel. Polyps are raised fleshy areas on the lining of the bowel caused by an abnormal multiplication of cells. Over time, they may develop into cancerous growth, so removal and analysis of a polyp is a good way of reducing the risk of bowel cancer.

Do we do enough of them?

A colonoscopy is really the 'gold standard' in investigative tests for the bowel and for helping to prevent disease (or to detect it at an early stage). Despite this, I have to say that we are not doing nearly enough of them in the UK. There is no national colonoscopy screening programme in this country which will identify polyps and allow removal.

There is a partial-colonoscopy screening programme currently being piloted. Although it is better than nothing, it only checks up to half the bowel and is only done for people who are aged 55. The other national bowel cancer screening program is based upon a stool test for invisible blood, but this will miss most polyps and even some cancers and is only for people between 60 and 75 years of age.

Most people in the UK are referred for a colonoscopy because they have certain symptoms and want to exclude cancer or other diseases. They may also have a strong family history of cancer.

How is a colonoscopy done?

With any procedure I carry out, or treatment I provide, my ethos is to always focus on the patient. Everyone I see is an individual, not just a hospital number, and I always make sure that people fully understand and are comfortable with what to expect from a colonoscopy.

A colonoscopy involves inserting a narrow, flexible tube (colonoscope) through the anus and into the large bowel. The tube has a camera at one end, allowing me to see the lining of your bowel in excellent detail.

The day before the colonoscopy, you will need to take a special drink to help clear out your bowels. Without this, the colonoscopy wouldn't be very good at showing the lining of the bowel, so a clean bowel is extremely important. Most people tell me that the drink (and the effect it had on their bowels) was the worst part of the investigation - the colonoscopy was the "easier" bit. I always tell people they should expect to be spending quite a bit of time on the toilet the day before their colonoscopy.

The colonoscopy itself usually takes between 15 - 25 minutes and it can be a bit uncomfortable for some patients. The risk of discomfort can be reduced using Entonox (laughing gas) or, better still, by intravenous cannula and sedation with a morphine-type drug and a Valium-type drug, although you will still be awake.

Everybody has a different tolerance to pain and discomfort, and so I let my patients make the decision about whether they have sedation or not. If they do have sedation, they will need to have a relative with them to take them home, but that is the only difference.

Can I help?

You may have seen your GP who has advised you to have a colonoscopy. Possibly you've been doing some research online about symptoms you've been getting. Whatever the reason, if you are having any problems in your bowel, expert help can be invaluable.

When you visit with me, we will spend time talking about you, your symptoms and your concerns. If I believe that a colonoscopy would be helpful in assessing and diagnosing the cause of your symptoms, I can arrange that for you here at Sulis Hospital Bath.

If you think you may need a colonoscopy, it's easy to book a consultation with me. Please contact my private secretary who will be delighted to get things arranged for you at a time that is best for you.