This is an examination of your large bowel (colon) to ascertain the extent of any disease present. It is recommended that PSCers with Inflammatory Bowel Disease have an annual colonoscopy. Patients with ulcerative colitis have an increased risk of colorectal cancer, even more so when the patient also has PSC. Thus, patients with ulcerative colitis and PSC should undergo regular annual surveillance colonoscopy once the diagnosis of PSC is made (Chapman 2011).
Colonoscopy preparation varies from hospital to hospital and it is important to carefully read any dietary guidance you are given, and ask about anything you don’t understand well before the procedure date. You may be asked to follow a special ‘low residue’ diet for a few days before the procedure, or may be able to eat normally right up until the day before.
You will be asked to drink a special drink that is designed to completely clear out your bowels (by severe diarrhoea). It is vital to follow the instructions to the letter to ensure your bowel is clear. This is important because the doctor needs a clear view of the sides of your colon to look for any abnormal structures. Sometimes a dye is used to improve the contrast and facilitate the identification of abnormal cells.
You will be offered intravenous sedation and painkillers for the procedure and you may or may not be aware of what is going on.
You will lie on your left side while a flexible instrument called a colonscope (endoscope) is inserted through your rectum into the bowel. The scope shines light onto the lining of your bowel and pictures are taken which are transmitted to a screen; you may be able to view these. Some small tissue samples may be taken (biopsies). You can sometimes feel the biopsies being taken. It is like a small tugging sensation. Air is pumped into the colon to inflate it, to allow the doctor to view the colon walls. This can sometimes be uncomfortable.
Throughout the procedure you may be asked to move onto your back and right side. This is so the doctor can access the twists and turns in your bowel, causing you as little discomfort as possible. The nurses help you manoeuvre round as it can by quite tricky when drowsy and attached to a tube!
If you were given a colonoscopy preparation that you found difficult to take, make sure that prior to your next colonoscopy, you ask if there is an alternative preparation you could take. If you experienced any discomfort make sure you also explain this prior to further colonoscopies.
Sister Kay Greveson - 'Your colonoscopy' and 'IBD and Travel' - PSC Support London Meeting November 2015
Want to know more?
- Crohn's Disease and ulcerative colitis with PSC
- Oxford University Hospital NHS Trust leaflet on colonoscopies
- University Hospital Birmingham NHS Foundation Trust leaflet on colonoscopies