My 1st colonoscopy - draping & pain questions

caroladybelle, BSN, RN · Aug 17, 2004

Usually the front area is draped, but quite honestly, the last few that I have had, I have been too high on the drugs to care.

Even if you did not have polyps, it is typical to take biopsies from the walls of the GI tract, to check for nonvisible abnormalities. Usually 6-12 are standard depending on what the diagnostician suspects. For example, I have ulcerative colitis. As it stays in good remission, the disease is rarely visible to the eye on scope; However, the biopsies demonstrate the long term effects/microscopic effects of inflammation of the gut, as well as early changes that may indicate cancer developing (always a worry with UC)

In addition, you have had a large, long tube, put into a part of the body, not intended to have that done. It will have some bleeding. If people get bleeding from mild cases of constipation, something like a scope will definitely produce some bleeding. But it should not be a great deal.

As far as pain, if there is inflammation (from whatever caused the positive occult test), passing the tube may cause some sharp pain. Also, ocasionally, the scope trying to pass around corners (descending colon to transverse or transverse to ascending colon) will cause some sharp pain. Hopefully, the diagnostician added some more drugs then. Since the area of initial UC disease started at the descending to transverse corner, I routinely get some sharp pain there. You also get "inflated" with a great deal of air, to open you up and pass the tube. That, to me, has always been quite uncomfortable.

Just like the irritation of throat that occurs from passing an ET tube, post op, people will have a few days of discomfort following a scope. If in doubt, call the diagnostician and report thesee issues.

Traveler · Aug 19, 2004

I had my first colonoscopy done yesterday. I am sorry that you had a bad experience. The worst part of mine was the prep: clear liquid diet the day before, citrate of mag. at 10am, NuLiltely beginning 3pm, and 2 enemas the morning of. After being given the Versed and Demerol, I don't remember a thing until I woke up wanting to just go home. I felt dopey the rest of the day and did have some cramping. They took a biopsy because 2 lesions were found- maybe early Crohn's. It sounds like not enough meds were given to you.

janjoy52 · Aug 19, 2004

Patients are repositioned during a colonoscopy to facilitate scope advancement. Sometimes a scope comes to an impass and is unable to proceed and moving the patient creates a new configuration to the turns that makes it easier to maneuver around. In our GI lab the staff is always concerned about protecting the patient's privacy and dignity. We redrape the patient to provide maximal coverage while keeping the work area clear. I'm sorry you felt so exposed and embarrased. It would be helpful if the GI staff heard this feedback. In these days with so much emphasis on patient privacy and confidentiality these types of incidences need to be brought to the forefront and addressed.

Pain with scope advancement is not necessarily inevitible. The colon has no nerve awareness to touch. A biopsy or polypectomy are conducted with no sensations occuring. The digestive tract, however, is wired for stretch reception. If there is no stretching there is no sensation. The straighter the colon the less stretching occurs and the easier it is to have a scope advance through the colon. I have been doing flexible sigmoidoscopies for 17+ years and have gotten to the cecum with 65-75cm Olympus and Pentax scopes many times WITHOUT SEDATION. Men seem to be plumbed with straighter colons and I have successfully examined the entire colon on more men then women for that reason. Women tend to be more curvatious inside and out and advancing around the sigmoid and splenic flexure can be intolerable. This is especially true for post hysterectomy females because the organs drop into the pelvis to take up the space vacated by the uterus. Aren't we women so special?! There is a down side to sedation. If the doctor is concerned that your blood pressure or respirations will be compromised with additional sedation you might be asked to bear with the pain until the scope has passed the difficult area. That happened during my colonoscopy. I have a high, tortuous splenic flexure and you bet I felt that turn. It wasn't fun but I know I was safe and appreciate the doctor working with me to complete the test without incident.

In our GI lab biopsies are not routinely taken when the patient is asymptomatic and no abnomalities are found. There are lots of reasons for OB+ stool. Bleeding hemorrhoids, if tested in the office with a digital rectal exam the examining finger might have caused trauma and created a false positive. If red meat was eaten in the previous 2 days the blood from the meat might have been detected. Or there could be an upper gi bleed. Anyway, unless there is reason to suspect microscopic colitis or there is a history of colitis there is no need to "routinely biopsy".

Post colonoscopy pain is likely a sign of air trapped in the folds. A very tortuous colon will be harder to eliminate the gas. A colon with extensive diverticular disease has thickened, tortuous folds that trap the air and can be very painful. A patient should keep moving to promote peristalsis and expelling the air. Even turning the patient from side to side and encouraging a good "fart" is helpful. Air trapped inside triggers vasovagal responses resulting in drop in BP and Pulse rate, dizziness, diaphoresis, nausea. Its not a pretty picture. We always stress the need for our patients to push out the air. It is "music to our ears!"

mrsred · Jul 12, 2007

I just had my first colonoscopy last week as well. I had researched the procedure and the meds used. My husband had his 2 year screening done in March and while sitting in the recovery area with him, I had heard 2 people scream. One was a woman who cried and hollered just like I remember myself doing at the start of the procedure.

I was uncontrollably crying as they wheeled me into the procedure room. I had a death grip on my husbands hand and was told that when the Dr told him he had to leave the procedure room I would not let go of his hand. He had to literally pry my fingers off of his hand to leave and this was after the sedative.

My blood pressure was 142/102 just after I saw the colonoscope on the nurses arm and I did not do very well in the beginning. I was so upset that the Dr. had a difficult time sedating me and ended up giving me 7 mcg of Versed and 200 mcg of Fentanyl plus oxygen.

I really feel stupid for getting that upset and my husband says that I made more of it than it was. That was a traumatic experience for me because #1 I work on the med/surg floor and see things, and #2 I know too much about what can happen and what can go wrong. I think that maybe he should be a little more understanding of my fear because they are real.

I was talking to a coworker who has been an RN for many years and she told me that she still thinks about her breast biopsy and colonoscopies and still gets scared and cries. She says that that is a normal thing and that I should not let anyone tell me that I am a baby!

I know that I felt pain when they started the colonoscopy, becaue I felt a burning/pain sensation going up my left side and I remember crying and whining Owe, Owe, Owe, and then it stopped and I don't remember anything else until I woke up in recovery and told both the Dr and my husband that they had lied to me, that the procedure hurt!

Thanks for listening and allowing me to vent

psalm, RN · Jul 13, 2007

My first one I was oblivious to. My second one I remember "dreaming" that I was yelling "I can feel it, it hurts". With my second one my prep wasn't as good as the first one...and the Dr. insinuated I didn't do my prep properly (at home). I had told them when I went in that morning I didn't think I was cleaned out enuff but they didn't do anything to remedy it.

ItsyBitsySpider, BSN, RN · Jul 15, 2007

psalm said:
My first one I was oblivious to. My second one I remember "dreaming" that I was yelling "I can feel it, it hurts". With my second one my prep wasn't as good as the first one...and the Dr. insinuated I didn't do my prep properly (at home). I had told them when I went in that morning I didn't think I was cleaned out enuff but they didn't do anything to remedy it.

What would they have done to remedy it? If you didn't take your prep properly there is really nothing that they can do but give it a shot and see if it works.

As far as the people that have had trouble with sedation, I find the more anxious people are, the more difficult they will be to sedate. If someone has convinced themselves that it is going to hurt than it probably will and vice versa. The medications given are conscious sedation and not anesthesia and minor discomfort does sometimes occur.

I'm not trying to be insensitive to anyone who has had a difficult experience with endoscopy but it is difficult to be called a liar, as stated by the previous poster, day in and day out, by patients who are upset that they were not unconscious during the procedure. I never, ever make promises that anyone won't feel anything. Tortuous colons are difficult to manuver and we absolutely do our best to medicate and keep everyone as comfortable as possible.

psalm, RN · Jul 15, 2007

ItsyBitsySpider said:
What would they have done to remedy it? If you didn't take your prep properly there is really nothing that they can do but give it a shot and see if it works.
As far as the people that have had trouble with sedation, I find the more anxious people are, the more difficult they will be to sedate. If someone has convinced themselves that it is going to hurt than it probably will and vice versa. The medications given are conscious sedation and not anesthesia and minor discomfort does sometimes occur.
I'm not trying to be insensitive to anyone who has had a difficult experience with endoscopy but it is difficult to be called a liar, as stated by the previous poster, day in and day out, by patients who are upset that they were not unconscious during the procedure. I never, ever make promises that anyone won't feel anything. Tortuous colons are difficult to manuver and we absolutely do our best to medicate and keep everyone as comfortable as possible.

Go-lytly type stuff or more of the Fleets soda and holding the surgery for a couple of hours? Is that possible? The pt. has already endured the prep at home and taken time off work for the procedure...and made transportation arrangements. With an IV to hydrate and being on-site, are these possible? Probably a scheduling nightmare, but that's life, eh?

I am not calling anyone a liar and am distressed that anyone would conclude that from my post. I was trying to say that sometimes you are oblivious and sometimes you aren't.

psalm, RN · Jul 15, 2007

Oh, and I did my prep exactly as instructed.

ItsyBitsySpider, BSN, RN · Jul 15, 2007

psalm said:
Go-lytly type stuff or more of the Fleets soda and holding the surgery for a couple of hours? Is that possible? The pt. has already endured the prep at home and taken time off work for the procedure...and made transportation arrangements. With an IV to hydrate and being on-site, are these possible? Probably a scheduling nightmare, but that's life, eh?
I am not calling anyone a liar and am distressed that anyone would conclude that from my post. I was trying to say that sometimes you are oblivious and sometimes you aren't.

It's really not possible. There would be nowhere for that patient to stay for the duration of their prep, there is only one bathroom for the entire unit, and there is no guarantee that after X amount of hours the prep would be satisfactory. Not to mention it would hold up an MD for however the length of time it would take for the patient to finish their prep. Many of our MD's work at several hospitals and have only limited blocks of time per day to spend in our unit. Usually the patient is scheduled for the following day and if that's not possible then they are rescheduled at their convenience, depending on their circumstances of course.

Please don't be distressed at my comment. I didn't think you actually believed the nurse was a liar you were probably just more disappointed that you had some pain or discomfort. I can understand that. I guess I just wish MD's would take a little extra time to explain the sedation to patients so that they may have realistic expectations.

sharann, BSN, RN · Jul 23, 2007

psalm said:
Oh, and I did my prep exactly as instructed.

I just had a Colonoscopy and EGD last week and the doctor told my husband that I had a poor prep. Husband told the doc, no way, my wife followed your prep to the LETTER.

I did, and it upset me that I was "accused" of not complying". Then the GI mumbled something about poor intestinal transit or something, he isn't sure what he was talking about.

I have IBD(Crohn's) and I never run clear after a prep. Even with enemas I always seem to have stuff left up somewhere. After Golytely and Dulcolax 4 pills and a liquid diet, clears... What can you do?

I also want to add I had SEVERE pain after the scope in my abdomen, distendened firm belly, I was in tears. I am not a sissy by the way(live with CD one can't be and work as a PACU RN). I was under anesthesia w. propofol(wonderful drug)and didn't feel a thing until after.

It was trapped air of course but it took alot of Demerol and alot of moving around to get it better. Thank goodness I had a very nice compassionate nurse caring for me in recovery area. It was 3 hours from start to finish!

Thanks for being there GI nurses and techs.:)

chewchabuckala · Aug 5, 2007

Had my first colonoscopy and endoscopy last month. Several months ago I had been scheduled but the prep put me in the hospital. This new doc I saw did my prep differantly. No laxative pills, and drank the mix with orange drink.....McDonald's! I drank it in small doses over a 12 hour period, and if I was to start vomiting (thank goodness I didn't), I was told to take a fleets before leaving home.

I was sedated to the max. Saw nothing, felt nothing.

Has anyone in cyber space been diagnosed with diverticulitis?

I'd sure appreciate to hear what your S&S are, I'd like as much info as anyone is willing to share. :balloons: