What is a colonoscopy?

A colonoscopy is a procedure where a gastroenterologist (a specialist doctor) looks at the inside of the large bowel (colon) using a long, flexible tube with a light and a camera on the end. This tube is known as a colonoscope.

The colonoscope is inserted into the bottom (anus) and then slowly pushed through the large bowel. The bowel is carefully examined and small samples of bowel tissue (biopsies) are taken and collected for further tests. 

A child may need a colonoscopy to find a cause for gastrointestinal symptoms such as abdominal pain, diarrhoea and bleeding from the bowel.

A polypectomy is the removal of a polyp. A polyp is an overgrowth of tissue, shaped like a mushroom which can cause bleeding. A polypectomy may be carried out at the same time as the colonoscopy, if required.

Preparing for a colonoscopy

Before having a colonoscopy, the bowel needs to be completely empty. This can be achieved by changing your child's diet and by your child having a bowel washout. 

One week before procedure:

• Stop taking medications that have iron in them.

Four days before procedure:

• Stop eating food that has small seeds or pips in them such as wholegrain breads, wholegrain cereals, tomato, cucumber and nuts.

One day before procedure:

• All solid food must be finished by 2PM
• Your child can drink anything they like until 4PM. That includes milk or juice.
• After 4PM, your child may only drink clear fluids. Clear fluids are drinks you can easily see through including: water, apple juice, lemonade, jelly (except red and green), lemonade icy poles,weak black tea or coffee. Clear fluids DO NOT include juice and milk.

Bowel washout

To ensure your child's bowel is completely empty before having a colonoscopy, a bowel washout must be carried out. A bowel washout is a drink that your child must have which helps the bowel to be emptied. This will help the gastroenterologist to see more clearly during the procedure.

If your child cannot drink the bowel washout at home, they may need to stay in hospital the night before the colonoscopy so that the bowel washout can be administered through a nasogastric tube. A nasogastric tube is a small, thin tube which is placed in through the nose and then passed down into the stomach.

The bowel washout is then given through this tube for four to six hours.

On the day of the procedure

• You must make sure that your child has followed the hospital fasting guidelines correctly or your child's colonsoscopy may be postponed and booked at a later date. Your doctor or nurse should give you these fasting guidelines or you can get them from the RCH  anaesthetic web page.
  
• Most medications can be taken as usual, however if you are unsure please speak to your child's gastroenterologist before the colonoscopy.
  
• The colonoscopy is performed under an anaesthetic, so your child will be asleep during the whole procedure. A local anaesthetic cream is applied on the back of your child's hands before the procedure to make their skin feel numb. This is done so your child will not feel the injection while they are going off to sleep.

Care after a colonoscopy

Eating and drinking

After the colonoscopy, your child can start eating a light diet such as sandwiches, pasta, soup or jelly. Your child may return to their usual diet when they feel well enough. Babies can start breastfeeding, drink formula or water as soon as they are awake from the procedure.

Activity

Children can usually go home on the same day as the colonoscopy where there should be a responsible adult (over 18 years if age) to care for them. Your child should rest for the remainder of the day following a colonoscopy, but should be able to return to their normal activities the day after the procedure. Young adults must not drive a car, operate machinery or make important decisions on the day of the colonoscopy because of the anaesthetic.

Side effects

After having a colonoscopy, your child may have one or more of the following side effects, which usually get better without any special treatment.

Nausea and vomiting

• Nausea and/or vomiting: if your child feels sick, stop them from eating and drinking for half an hour. After this, they can start having sips of clear fluids. You can slowly increase what they eat and drink as they start feeling better.
  
• Abdominal (tummy) pain and bloating: if your child suffers from abdominal pain and/or bloating, allow them to rest and encourage them to have sips of clear fluids until they feel better.

You may give your child some pain relief such as paracetamol every four to six hours for one to two days if needed. Read the bottle for the correct dose for your child according to their age.
Ask someone if you need help.

Do not give any medicine with paracetamol in it more than four times in 24 hours.

For moderate pain we recommend Painstop Daytime (a codeine and paracetamol mixture). You can buy this over the counter at the chemist.

For more severe pain call your child's surgeon or see your family doctor.

• Sore throat: if you child is old enough, allow them to suck on throat lozenges or sipping warm fluids can help soothe a sore throat.
  
• Bleeding: a small amount of blood might be seen in your child's bowel actions (poo) after a colonoscopy. This is usually caused by the small samples of bowel tissue (biopsies) taken during the procedure for testing. 

When to come back

Call the RCH switchboard on (03) 9345 5522 and ask them to page the gastroenterology registrar, or the on-call gastroenterologist, or your child's gastroenterologist if your child has:

• vomited more than 2 to 3 times.
• vomit with more that 2 to 3ml (½ teaspoon) of bright red blood in it.
• bowel actions (poo) with more than an expected amount of blood.
• severe tummy pain or bloating.
• a high temperature (above 38 degrees Celsius)
• difficulty swallowing

If you have any other significant concerns after the procedure, you can also contact: 

• a high your family doctor
• the RCH Emergency Department
  

Follow-up appointments

• Your child's Gastroenterologist will normally discuss the follow-up plan with you on the day of the colonoscopy or before you leave the hospital.
• If you have trouble understanding the follow-up plan, speak to your nurse in the Day of Surgery Centre before you leave.
  
  

For more information

Other sources of information about your child's colonoscopy include:

• Having a Colonoscopy pamphlet, which you can get from the Gastroenterology Department.
• I'm going to have an Anaesthetic information booklet, which you can get from the anaesthetic department.
• RCH Anaesthesia and Pain Management website
• Contact the RCH Gastroenterology Nurse Coordinator on (03) 9345 5082
• Preadmission Resource Centre (PARC) on (03) 9345 4115 
  
  
  The name of your child's Gastroenterologist is:
  
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Surgery Centre
Monday to Friday (7am - 7pm)
Phone: (03) 9345 6570