Having a Colonoscopy – Information for Individuals with Spinal Cord Injury (SCI)

You have been advised by your GP, hospital doctor or clinical nurse specialist to have an investigation known as a Colonoscopy.

Please read this patient information leaflet carefully. It provides information on the procedure, the risks and the preparation involved, as well as after-care guidance. Following the preparation instructions below will contribute to the effectiveness of the colonoscopy.

Appointment

If your appointment is not convenient, please phone the Endoscopy Department at Stoke Mandeville Hospital at the earliest opportunity on 01296 315175 so that we can reschedule it.

Consent

All procedures undertaken in hospital require the patient’s consent. This is a legal requirement.

Some procedures require tissue samples to be taken for analysis. Rather than destroying the samples after this examination we ask your permission to use these tissue samples for teaching and research purposes. All specimens are treated anonymously.

This information sheet enables you to make an informed decision before agreeing to the procedure.

What is a Colonoscopy?

A colonoscopy is an investigation using a flexible, telescopic

tube to look accurately at the lining of the entire large bowel (colon). This long tube, called a colonoscope, is inserted at the anus and manoeuvred around to the appendix.

The colonoscope has within it an illumination channel which enables light to be directed onto the lining of your bowel, and relays pictures back to a television screen. This helps the Endoscopist to have a clear view to check whether your bowel is abnormal.

Why do you need to have a Colonoscopy?

Your symptoms may suggest that you have a problem with the large bowel (the colon), which requires investigation.

You may have been seen by the NSIC colorectal team who have requested this to rule out any other issues that they couldn’t see in clinic or prior to planned surgery
You may be having the procedure as part of the Bowel Cancer Screening Programme to determine whether you require

What are the benefits of having a Colonoscopy?

If there is any abnormality in the colon then it should be possible to see it during the procedure, which is relatively quick (30mins). It does not require a general anaesthetic but depending on your level of injury, it may be necessary for you to have a short acting sedative drug while the procedure is being carried out. The doctor may need to take samples (biopsies) of tissue so they can be examined under a microscope. Polyps, if found, may also be removed at the same time.

Polyps

A polyp is a lumpy growth from the lining of the bowel. Some polyps are on a stalk, and some are flat. Polyps can usually be removed or sampled (biopsied) as they may grow and cause problems.

Polyps are usually removed by placing a snare (a wire loop) around the polyp. A high frequency current is then applied, and the polyp removed. Smaller polyps are sometimes removed by forceps that cut the polyp off. Polyp removal should not be painful.

Is there an alternative to having a Colonoscopy?

There are alternatives such as CT Pneumocolon, which is an X-ray procedure, but these do not allow the doctor to take samples and may not be suitable for all Spinal Cord Injury (SCI) levels. You may have already had one of these investigations which did not pick up the problem or showed an abnormality which now requires a biopsy to be taken.

Are there any risks?

A colonoscopy is a skilled procedure performed by a trained endoscopist who takes every care to reduce any risks. However, as it involves inserting a miniature camera into your bowel, by its nature it carries the risk of complications. Although these complications arise very rarely, we need to make you aware of them.

Risks associated with the procedure:

Perforation or tear of the lining in the bowel whilst rare, approximate incidence 1 in every 1,000 procedures, requires hospital admission for observation and possible surgery to repair the perforation. The risk of perforation is higher with polyp removal; approximate incidence 1 in every 500
Bleeding – at the site of polyp removal or biopsy has a risk of 1 in 200 but the bleeding is normally minor and usually stops on its own; however, in the event this isn’t the case, it can be controlled by cauterisation, or injection

Will you need sedation?

Some colonoscopies are done under sedation, and this depends on your level of spinal cord injury. Sedation is given through an intravenous cannula (small plastic tube put into your vein). It is a sedative, not an anaesthetic and will make most people feel drowsy and relaxed.

Risks associated with having sedation:

Sedation in a small number of patients may cause problems with slower breathing, low blood pressure and a slow heart rate. Careful monitoring of these vital signs during the procedure by your nurse will detect any changes early and these can be treated rapidly.

Incomplete procedure

In a small number of patients, the colonoscope cannot be manoeuvred all the way around the to the far side of the bowel. In this case it is possible to miss small abnormalities particularly if the bowel preparation and enema used to empty the bowel has not worked well. You may then need another test such as a CT scan or a repeat procedure after longer bowel preparation.

How long will you need to be at the hospital?

This is usually performed as a day procedure but is not always practical or advised for people with SCI due to the extended bowel preparation required. It may therefore be requested that you are admitted to the NSIC, which will involve a stay of between 2 – 4 days. You will be admitted to a ward at the spinal unit 2 days prior to the procedure (possibly earlier if longer preparation is deemed necessary), so that we can assist you with the preparation.

Preparing for the examination

The bowel must be completely cleared of all waste matter. This involves a low residue diet and oral and rectal medications. The medicine you will be given over 2 days is designed to give you diarrhoea, so it is advisable to stay on the ward or on your bed where the nursing staff are available to assist you as required. You may have a short period of bed rest as you may feel tired.

The bowel preparation medication will be prescribed by your doctor and the instructions should be followed carefully. You are asked to start a low residue diet at home 2 days before your admission and if not admitted to a Spinal ward, to drink Moviprep as outlined in the “Preparation for Spinal Cord Injury (SCI) Patients” charts on page 5 of the pdf download.

Note: If you have a colostomy the medicine will work in the same way. You are advised to put on a drainable appliance before taking the medicine until after the examination. If you do not have any drainable appliances (pouches), please contact your stoma care nurse.

What is a Low Residue (low fibre) Diet?

A well-balanced diet contains fibre that helps with digestion and absorption of nutrients and water. However, it also helps bulking in stool and this diet can leave behind residue. The residue makes seeing and performing the colonoscopy harder. A low-residue diet cuts out all high fibre foods to reduce the volume of stool in the bowel. Some examples are listed below. This is a very important part of the preparation for the colonoscopy, as it helps to make sure the bowel is clean for the procedure and that the colonoscope can see everything clearly.

Clear fluids include still water, fruit juice without bits, tea or coffee (no milk), squash (not blackcurrant), jelly or clear soups. It is important to drink enough to satisfy your thirst. This will help to avoid dehydration and headaches.