To Colonoscopy or Not to Colonoscopy

This is the first of three articles that will explain what a colonoscopy is, and what the recommendations are in getting one. The following two articles will discuss the different types of common colon issues along with some unusual ones, and then the different types of preps and the reasoning behind each one. The purpose of these articles is to reinforce the necessity of doing a colonoscopy in prevention of cancer and to remind nurses of the importance of their role in educating patients about compliance with the testing and taking their preps properly. Nurses Announcements Archive Article

There are several medical tests recommended for both men and women on a regular basis to maintain optimum health. Starting as toddlers, we should get our teeth examined and cleaned annually, and as we grow, so does the list of check ups. Mammograms, pap smears, skin cancer checks, prostate exams, and a colonoscopy are among the exams considered to be routine, yet life saving.

Most people cringe when a colonoscopy is mentioned. As societal misconceptions are corrected and more data is available about the advantages of having a screening colonoscopy, more lives will be saved. First, we will discuss the anatomy of the large intestine, then what the recommendations are for getting a colonoscopy, and last, the importance of nurses being educated so they can help their patients through the process.

Anatomy of the Colon

Knowing what the colon does for us, and the five different anatomical sections will help us nurses in educating ourselves and our patients. Beginning at the ileocecal valve to the orifice, the colon is divided into areas: Ascending, Transverse, Descending, Sigmoid, and Rectum (Carpenter p163). The ileocecal valve resides in the distal end of the colon and prevents the passage of intestinal contents from the small bowel into the colon (163). This amazing flap also keeps bacteria from refluxing the other way, keeping the small bowel sterile (163).

The colon is made with complicated layers of muscle innervated with nerves and a blood supply that keep it doing its job and keep us regular and healthy. The main function of the colon is storage and movement of intestinal contents (164). Once the intestinal contents make it into the large intestine the small bowel has absorbed most of the nutritional contents, what's left is water and waste. Most of the water left is absorbed, along with some electrolytes and bile salts in the colon, leaving feces (164). Feces contains intestinal bacteria that break down the the body wastes (164)

Recommendations

A colonoscopy is a test performed by a Gastroenterology doctor, using a colon scope that is inserted into the orifice and can be pushed all the way to the ileocecal valve. The advantage of this test is the direct visualization of the colon mucosa, and the ability to diagnose and treat colon disease. Screening colonoscopies are crucial in order to prevent colon cancer.

According to SGNA, the Society of Gastroenterology Nurses and Associates, Inc., "Colorectal cancer is the most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the United States." They break patients down into two groups, Average risk - Asymptomatic people age 50 or older with no other previous family or personal history of colon cancer. High risk - people with a history of polyps, colorectal cancer or inflammatory bowel disease, and/or a family history of colorectal cancer.

Average risk patients should get their first colonoscopy at the age of 50. If no polyps are found, then the next colonoscopy needs to be in 10 years (Lieberman). If the doctor finds a small hyperplastic (an abnormal increase in the number of cells - benign) polyp, they also are recommended to have a follow up colonoscopy in 10 years. If adenomas (polyps that can turn into cancer) are found, depending on the amount and size, that will buy you a ticket to repeat a colonoscopy in 3 - 5 years.

According to the American Cancer Society, patients with a family history of colorectal cancer in any first degree relative before the age of 60 it is recommended that their first colonoscopy be at age 40 or 10 years before the youngest case of immediate family. If the first degree relative is older than 60, then age 40 for the first screening colonoscopy is advised.

Education

Nurses play a huge role in educating patients before, during and after their colonoscopy. You can make the difference between a poor prep and repeat the test next year, and a good prep where the doctor is able to see the entire mucosa and possibly save a life or prevent surgery for that patient. Most offices give written instructions regarding the prep, NPO status and a clear liquid diet the day before the prep, but these can become confusing and complicated.

Nurses can help confusion by clearly explaining why the colonoscopy is needed, and that early intervention can save their lives. Have the patient repeat their version of the prep instructions and listen for errors. Reinforce the important things, like what medicine to take the night before, and when to be NPO. Ask the patient what they are most concerned about and answer any question they have. This will help to decrease their anxiety and increase compliance.

Reviewing things every once in awhile is beneficial for nurses, it keeps us up to date and helps us remember details we may have forgotten. We can't remember everything, making books, pamphlets, and the internet our friend while educating our patients. Knowing how the large intestine works and what a colonoscopy entails, will help you the next time you have a patient going for one.

If you have any questions on anything discussed, please ask. The next two articles will first cover different disease processes of the colon and some therapeutic interventions that can be done while doing a colonoscopy, then a detailed discussion on the preps prescribed that clean out the colon for a colonoscopy. I recently had my 50 year colonoscopy and I will share my experience. After having worked in the GI lab for over 20 years, I learned a lot about what the patient goes through.


References

"American Cancer Society recommendations for Colorectal Cancer Early Detection". Revised 02/05/2015. American Cancer Society Recommendations for Colorectal Cancer Early Detection. 23 June, 2015. Web.

Carpenter Aquino, Amy, MS, Ed. Gastroenterology Nursing, A Core Curriculum. 4th Edition, 2008. USA. Print.

Guidelines for Performance of Flexible Sigmoidoscopy by Registered Nurses for the Purpose of Colorectal Cancer Screening". 2009. SGNA Society of Gastrointestinal Nurses and Associates, Inc. June 18, 2015. Web.

Lieberman, David A., Rex, Douglas K. et. al. "Guidelines for Colonoscopy Surveillance Polypectomy: A Consensus Update by the US Multi Society Task Force on Colorectal Cancer." 9/2012. American College of Gastroenterology. 23 June, 2015. Web.

First of all I don't believe that is the norm in most ORs. That kind of behavior would never be tolerated in the facilities where I work.

Secondly, as the wife of a stage III colon cancer survivor, refusing to have a colonoscopy because of fear of unprofessional comments won't spare you far greater hurt if you indeed are developing a precancerous polyp which goes undetected for years. Colon cancer hurts a lot worse than mean comments.

Yeah, I think that putting off a procedure because you're afraid of what might be said is ridiculous. It's as ridiculous as putting off a procedure or surgery because you're afraid of being naked while the prep you on the table. I've read those comments here too.

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
I can't imagine having a colonoscopy without sedation. I just don't like the thought of being vulnerable and not in control with versed.

Like I said, the colonoscopy itself really wasn't painful... the doc warned me when she got to "bends in the road" so I could do some deep breaths as she advanced the scope, but other than that, it wasn't really that uncomfortable at all. I think people "need" sedation more because they freak out at the idea of someone shoving something in their butt, rather than due to any actual pain caused by the procedure. The prep really is the worst part of the whole ordeal, all that time on the toilet.

It is at my center. That's one of the reasons everyone must consent to an IV, so that there is easy access to sedation (or emergency drugs) in the event that the patient decides he wants it.

In my case (no sedation colonoscopy), an IV was required in case of potential vasovagal complications that might require intervention. (I have low blood pressure and long QT interval.) Nothing was needed, but it was reassuring to know that if I did vagal out, there was quick access already in place.

brillohead - my first day in the GI lab for clinical was to watch a colonoscopy. The older gentleman wanted to watch and was awake through the whole thing. Tolerated very well.

I've since heard of other people being curious as well and have chosen not to be sedated.

I know what the inside of a colon look like so I chose sedation.

It was no big deal at all. Went out for a pasta lunch afterwards. ;)

In my case (no sedation colonoscopy), an IV was required in case of potential vasovagal complications that might require intervention. (I have low blood pressure and long QT interval.) Nothing was needed, but it was reassuring to know that if I did vagal out, there was quick access already in place.

Yes, vaso vagal reaction would be an expected potential adverse effect. Hence the prudence of requiring an IV of everyone, though I am aware of some places that won't require an IV if no sedation is requested by the patient.

Specializes in LTC, CPR instructor, First aid instructor..

:writing:Unfortunately the medical professionals I see won't perform one on me.i have never had one. They think i'm too risky of a patient.:unsure:

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
brillohead - my first day in the GI lab for clinical was to watch a colonoscopy. The older gentleman wanted to watch and was awake through the whole thing. Tolerated very well.

I've since heard of other people being curious as well and have chosen not to be sedated.

I wish more people heard these stories, of it not really "requiring" sedation to be tolerated.

I think a lot of people don't get their screening done b/c of a lack of a ride home... no spouse / relative / friend who can take a whole day off work in order to accompany them.

In my area, they won't give you sedation without your ride being there when you check in and staying there the whole time -- I guess they had too many people who would say that their ride was picking them up afterward and then the ride never showed, etc. They also won't let you take a cab home b/c you're still "under the influence" a little when discharged, and you're supposed to have a competent adult to watch over you -- not some random cab driver.

If you don't have a ride and can't take a cab, you tend to just put off the procedure indefinitely. In addition to the fact that I'm curious as heck to watch the procedure, not needing a ride home was another compelling reason for me to forego sedation. After the procedure, I removed my cardiac leads, put on my clothes, and walked out the door -- no "recovery" time needed.

I know what the inside of a colon look like so I chose sedation.

It was no big deal at all. Went out for a pasta lunch afterwards. ;)

Oh, that first real meal after a few days of nothing but clear liquids is PURE HEAVEN!!!! :inlove:

I think a lot of people don't get their screening done b/c of a lack of a ride home... no spouse / relative / friend who can take a whole day off work in order to accompany them.

In my area, they won't give you sedation without your ride being there when you check in and staying there the whole time -- I guess they had too many people who would say that their ride was picking them up afterward and then the ride never showed, etc. They also won't let you take a cab home b/c you're still "under the influence" a little when discharged, and you're supposed to have a competent adult to watch over you -- not some random cab driver.

Some of our doctors will okay a cab ride home, but the patient has to recover 30 mins to 1 hour longer than the patient who has a ride home.

Specializes in Geriatrics, Home Health.

I had a colonoscopy about 6 years ago. I got through the prep by playing my first ever drinking game. I haven't been able to drink Gatorade since. The procedure and recovery were fine.

Specializes in Gastrointestinal Nursing.
I'm a 35 year old female LPN. I personally think colonoscopies should be done sooner, before age 45. I was having some digestive issues last year and made an appt. with a GI doctor. He recommended a colonoscopy. During the colonoscopy he found a 1.2 cm adenoma polyp in my colon (type of polyp that can become cancer), it was benign fortunately. The GI doctor said had it been left there, it could've become cancer in several years. I now have to have more frequent colonoscopies, about every 2-3 years. I have no family hx of colon cancer that I know of. I am glad I had symptoms, otherwise I wouldn't have sought treatment. My point being it isn't always an "over age 50" cancer. Just my two cents...

Thank you for sharing, and I am so glad you found the polyp sooner rather than later. I do believe you are the exception rather than the rule.

Specializes in Gastrointestinal Nursing.
Why are there societal misconceptions about colonoscopies, OP? (I apologize if I should know this already- lol.)

Not sure who Op is, but I do misconceptions in the article regarding colonoscopies because people have hang ups about scopes going up their but, or discussing their bowel habits. For many it is an uncomfortable conversation

Specializes in Gastrointestinal Nursing.
I'm surprised nobody has mentioned the recent $500,000 malpractice/defamation award against an anesthesiologist whose vile comments were recorded by a patient during his colonoscopy. I wonder how common this situation really is when patients are undergoing surgery or procedures. It makes me more reluctant to have a colonoscopy done. I'm sure I'm not the only one.

What happened in that situation was totally disgusting and unprofessional. I have worked in the GI lab for over 20 years and never have I experienced this kind of comments. In fact, the people I have worked with are the upmost professionals. Be reluctant if you want , but it's not worth losing your life to colon cancer is it?

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Not sure who Op is, but I do misconceptions in the article regarding colonoscopies because people have hang ups about scopes going up their but, or discussing their bowel habits. For many it is an uncomfortable conversation

"OP" is shorthand for Original Poster... in other words, YOU! ;)