A Q&A with Sister Corné Bloemhoff, Practice Nurse at Dr Maré du Plessis’ practice, Mediclinic Milnerton, Cape Town.
A colonoscopy is one of the most effective ways to detect bowel cancer early, investigate symptoms and remove potentially pre-cancerous polyps before they become a problem. While many patients are understandably anxious about the procedure, most of the questions they have relate not to the examination itself, but to the preparation beforehand.
Colonoscopy can be performed in-hospital or in the comfort of Dr Du Plessis’ Endoscopy suite as an outpatient. We spoke to Sister Corné Bloemhoff, Practice Nurse at the practice, about what patients can expect and how to make the experience as straightforward as possible.
Why is the bowel preparation so important?
The bowel preparation is one of the most important parts of the entire procedure. The purpose is to completely clean the colon so that Dr Du Plessis has a clear view of the bowel lining.
Even very small polyps or early cancers can be difficult to detect if there is any remaining stool in the bowel. A well-prepared bowel gives the best chance of identifying abnormalities accurately and, where appropriate, removing polyps during the same procedure.
What does the preparation involve?
The day before the procedure, patients may have breakfast as their only solid meal. After breakfast, they should have clear fluids only for the rest of the day.
Patients are prescribed a bowel preparation solution, available from most pharmacies, which is mixed with water and taken according to the practice’s instructions.
Just as important is drinking at least four litres of water during the preparation period. This is essential to replace fluids lost during the bowel cleansing process and to help the preparation work effectively. Other clear fluids may be enjoyed in addition to the water, but they do not replace the required water intake.
The preparation doesn’t sound very pleasant. Are there any tips?
The preparation has a strong lemon flavour, which some people find intense.
I usually recommend mixing it with warm water and drinking it slowly, almost like a herbal tea. If you drink it too quickly, it’s like swallowing concentrated lemon juice, which can make you feel nauseous. Taking your time and sipping it steadily usually makes it much easier to tolerate.
What can I drink during the preparation?
There is actually more variety than people expect. Patients may drink clear fluids such as water, apple juice, electrolyte drinks like Energade, clear soft drinks such as Coke, Sprite or Sprite Zero.
Clear jelly is also an excellent option. It provides something that feels more like food and can help reduce feelings of hunger, while still being suitable for the preparation.
Why must I drink so much water?
The bowel preparation works by emptying the bowel completely, which also causes significant fluid loss. Without enough water, patients can become dehydrated. Early signs of dehydration include headache, nausea and vomiting. Drinking the recommended amount of water helps prevent dehydration and ensures the preparation works properly.
What if I feel nauseous while taking the preparation?
Nausea is usually caused by drinking the preparation too quickly or by not drinking enough water. If patients begin to feel unwell, we advise them to drink additional water, pause for a short while and then continue more slowly. In most cases, they feel much better afterwards.
Serious reactions to the bowel preparation itself are uncommon.
Will someone explain everything before the procedure?
Absolutely. On the morning that patients begin their preparation, I telephone them to review the instructions, answer any questions, confirm their arrival time for the next day, and explain exactly when they need to stop eating, and drinking clear fluids, before the procedure.
Then, immediately before the colonoscopy, Dr Du Plessis personally meets with every patient, explains the procedure, answers any remaining questions and obtains informed consent.
What if I take regular medication?
It is important that patients tell us about all their medications before the procedure. Most regular medications, such as blood pressure medication, are continued, although we will advise exactly when they should be taken.
Blood-thinning medication requires special planning because it may need to be stopped several days beforehand if biopsies or polyp removal are anticipated. This should always be discussed with the practice in advance.
Is the colonoscopy painful?
Patients receive sedation, so they are comfortable during the procedure and often remember very little afterwards. Following the examination, some patients experience mild bloating or wind because the bowel is gently inflated with air during the procedure to allow the bowel lining to be examined thoroughly. Most of this gas is removed before the procedure ends, and any remaining gas usually passes naturally once patients begin moving around, eating and drinking.
How long does recovery take?
Recovery is generally very quick. Patients spend a short time in recovery before enjoying tea or coffee and a rusk. Once they are fully awake, they return to Dr Du Plessis’ consulting room, where he discusses the findings, reviews photographs taken during the procedure, and explains whether any biopsies were taken or polyps removed. Most people return to their usual daily activities the following day.
Can I drive myself home afterwards?
No. Because sedation is used during the procedure, patients must arrange for someone to drive them home afterwards. They should not drive, operate machinery, drink alcohol or make important legal or financial decisions for the remainder of the day.
When will I receive my results?
Dr Du Plessis discusses the initial findings immediately after the procedure. If biopsies have been taken, they are sent to the laboratory for analysis. Results are usually available later that week or early the following week, and the practice contacts patients once these have been received.
How common are polyps?
It varies considerably. Some weeks we remove polyps from several patients, while at other times none are found. Risk depends on individual factors, including age, family history and previous bowel disease. The good news is that most polyps can be removed safely during the colonoscopy, often preventing them from developing into bowel cancer in the future.
Are younger people needing colonoscopies more often?
Yes, we are seeing more younger adults requiring investigation than we did in the past. While bowel cancer remains more common in older people, there has been an increase in diagnoses among younger adults internationally. The reasons are still being studied, but lifestyle and environmental factors are thought to play a role.
Anyone with persistent bowel symptoms or a strong family history should seek medical advice rather than assuming they are too young to have a significant bowel condition, and everyone over the age of 45 should undergo a screening colonoscopy.
How safe is a colonoscopy?
Colonoscopy is considered a very safe procedure, particularly when performed by an experienced specialist. Like all medical procedures, there are amall risks. One of these is a perforation, or small tear, in the wall of the bowel, which occurs in approximately one in every 1,000 procedures.
If a perforation is suspected, patients are admitted for prompt assessment and treatment. Depending on the size and severity, some small perforations can be managed without surgery, while others require an operation. Fortunately, this complication is extremely uncommon.
What symptoms should I watch for after I go home?
Most patients feel well within a few hours. However, patients should contact the practice or seek urgent medical attention if they develop severe abdominal pain, persistent vomiting, heavy rectal bleeding, fever or feel generally unwell after returning home. This is highly unlikely.
As part of our routine care, we also follow up with patients after their procedure to ensure they are recovering well and to address any concerns promptly.
Download our guide to the preparation and the procedure.
Are you over 45 and have not yet had your first screening colonoscopy? Contact Sister Corné on milnerton@drduplessis.com to ask questions, or to book the procedure.