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Colonoscopy

Colon cancer - colonoscopy; Colorectal cancer - colonoscopy; Colonoscopy - screening; Colon polyps - colonoscopy; Ulcerative colitis - colonoscopy; Crohn disease - colonoscopy; Diverticulitis - colonoscopy; Diarrhea - colonoscopy; Anemia - colonoscopy; Blood in stool - colonoscopy

A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope.

The colonoscope has a small camera attached to a flexible tube that can reach the length of the colon.

How the Test is Performed

Colonoscopy is done most often in a procedure room at your doctor's office. It can also be done in the outpatient department of a hospital or medical center.

  • You will be asked to change out of your street clothes and wear a hospital gown for the procedure.
  • You will likely be given medicine into a vein (IV) to help you relax. You should not feel any pain. You may be awake during the test and may even be able to speak. You will probably not remember anything.
  • You lie on your left side with your knees drawn up toward your chest.
  • The scope is gently inserted through the anus. It is carefully moved into the beginning of the large intestine. The scope is slowly advanced as far as the lowest part of the small intestine.
  • Air is inserted through the scope to provide a better view. Suction may be used to remove fluid or stool.
  • The doctor gets a better view as the scope is moved back out. So, a more careful exam is done while the scope is being pulled back.
  • Tissue samples (biopsy) or polyps may be removed using tiny tools inserted through the scope. Photos may be taken using the camera at the end of the scope. If needed, procedures, such as laser therapy, are also done.

How to Prepare for the Test

Your bowel needs to be completely empty and clean for the exam. A problem in your large intestine that needs to be treated may be missed if your intestines are not cleaned out.

Your health care provider will give you the steps for cleansing your bowel. This is called bowel preparation. Steps may include:

  • Using enemas
  • Not eating solid foods for 1 to 3 days before the test
  • Taking laxatives

You need to drink plenty of clear liquids for 1 to 3 days before the test. Examples of clear liquids are:

  • Clear coffee or tea
  • Fat-free bouillon or broth
  • Gelatin
  • Sports drinks without added color
  • Strained fruit juices
  • Water

You will likely be told to stop taking aspirin, ibuprofen, naproxen, or other blood-thinning medicines for several days before the test. Keep taking your other medicines unless your doctor tells you otherwise.

You will need to stop taking iron pills or liquids a few days before the test, unless your provider tells you it is OK to continue. Iron can make your stool dark black. This makes it harder for the doctor to view inside your bowel.

How the Test will Feel

The medicines will make you sleepy so that you may not feel any discomfort or have any memory of the test.

You may feel pressure as the scope moves inside. You may feel brief cramping and gas pains as air is inserted or the scope advances. Passing gas is necessary and should be expected.

After the exam, you may have mild abdominal cramping and pass a lot of gas. You may also feel bloated and sick to your stomach. These feelings will soon go away.

You should be able to go home about one hour after the test. You must plan to have someone take you home after the test because you will be woozy and unable to drive. The providers will not let you leave until someone arrives to help you.

When you are home, follow instructions on recovering from the procedure. These may include:

  • Drink plenty of liquids. Eat a healthy meal to restore your energy.
  • You should be able to return to your regular activities the next day.
  • Avoid driving, operating machinery, drinking alcohol, and making important decisions for at least 24 hours after the test.

Why the Test is Performed

Colonoscopy may be done for the following reasons:

Normal Results

Normal findings are healthy intestinal tissues.

What Abnormal Results Mean

Abnormal test results may mean any of the following:

Risks

Risks of colonoscopy may include any of the following:

  • Heavy or ongoing bleeding from biopsy or removal of polyps
  • Hole or tear in the wall of the colon that requires surgery to repair
  • Infection needing antibiotic therapy (very rare)
  • Reaction to the medicine you are given to relax, causing breathing problems or low blood pressure
Open References

References

Garber JJ, Chung DC, eds. Colonic polyps and polyposis syndromes. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 126.

Lawler M, Johnson B, Van Schaeybroeck S, et al. Colorectal cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 74.

National Cancer Institute. Colorectal Cancer Prevention (PDQ) - Health Professional Version. www.cancer.gov/types/colorectal/hp/colorectal-prevention-pdq. Updated April 21, 2022. Accessed May 27, 2022.

Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112(7):1016-1030. PMID: 28555630 pubmed.ncbi.nlm.nih.gov/28555630/.

US Preventive Services Task Force website. Final recommendation statement. Colorectal cancer: screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Published May 18, 2021. Accessed May 27, 2022.

Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281. PMID: 29846947 pubmed.ncbi.nlm.nih.gov/29846947/.

  • Colonoscopy

    Colonoscopy - illustration

    There are 3 basic tests for colon cancer; a stool test (to check for blood), sigmoidoscopy (inspection of the lower colon), and colonoscopy (inspection of the entire colon). All 3 are effective in catching cancers in the early stages, when treatment is most beneficial.

    Colonoscopy

    illustration

  • Colonoscopy

    Colonoscopy - illustration

    A sample of colon tissue is obtained during a colonoscopy procedure using special instruments. The specimen is sent to the laboratory and fixed with special stains. The specimen is examined under the microscope for abnormal findings, such as cancer or inflammation.

    Colonoscopy

    illustration

  • Large intestine (colon)

    Large intestine (colon) - illustration

    The large intestine is the portion of the digestive system most responsible for absorption of water from the indigestible residue of food. The ileocecal valve of the ileum (small intestine) passes material into the large intestine at the cecum. Material passes through the ascending, transverse, descending and sigmoid portions of the colon, and finally into the rectum. From the rectum, the waste is expelled from the body.

    Large intestine (colon)

    illustration

    • Colonoscopy

      Colonoscopy - illustration

      There are 3 basic tests for colon cancer; a stool test (to check for blood), sigmoidoscopy (inspection of the lower colon), and colonoscopy (inspection of the entire colon). All 3 are effective in catching cancers in the early stages, when treatment is most beneficial.

      Colonoscopy

      illustration

    • Colonoscopy

      Colonoscopy - illustration

      A sample of colon tissue is obtained during a colonoscopy procedure using special instruments. The specimen is sent to the laboratory and fixed with special stains. The specimen is examined under the microscope for abnormal findings, such as cancer or inflammation.

      Colonoscopy

      illustration

    • Large intestine (colon)

      Large intestine (colon) - illustration

      The large intestine is the portion of the digestive system most responsible for absorption of water from the indigestible residue of food. The ileocecal valve of the ileum (small intestine) passes material into the large intestine at the cecum. Material passes through the ascending, transverse, descending and sigmoid portions of the colon, and finally into the rectum. From the rectum, the waste is expelled from the body.

      Large intestine (colon)

      illustration

    Tests for Colonoscopy

     
     

    Review Date: 2/7/2022

    Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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