” Will colonoscopy be painful” is the most concerned issue for many patients before colonoscopy, and many patients delay the best treatment time because they are afraid of pain, however, Prof. Chuangangang Fu tells you that it is actually easy to be painless as long as the examination method is mastered correctly and the related work is done before the examination. Colonoscopy is the most important method for early detection of colorectal cancer. It inserts the colonoscope into the intestinal cavity through the anus, which can observe whether there are lesions in the whole intestinal cavity, and can take small pieces of lesions for pathological examination, which can help to make a clear diagnosis and judge the severity of the disease, and then guide the treatment. At the same time, colorectal polyps can be removed under colonoscopy, and bleeding can also be stopped under colonoscopy.
What preparations need to be made before colonoscopy?
1, psychological preparation colonoscopy has a certain pain and discomfort, especially to hear some unscientific anecdotal evidence, the first time in the patient will often have a certain sense of fear with colonoscopy. Therefore, many patients are still afraid of colonoscopy and have a lot of concerns. In fact, most of the patients’ colonoscopy is relatively smooth, generally 10-20 minutes to complete the examination, the pain level is less. It is only when the colonoscope passes through several bends of the colon that there is some swelling and pain, at this time, just hold on a little for 1-2 minutes, and after the colonoscope passes through this bend, the swelling and pain will be gone. So when colonoscopy, you must relax, eliminate doubts and tension, so that you can quickly and successfully complete the colonoscopy.
2, diet preparation 1-3 days before the examination do not eat vegetables and fruits, because vegetables and fruits are rich in fiber, will produce more feces, colonoscopy before the examination is not easy to clean. Patients should eat some easily digestible slag-free or low slag diet, such as thin rice, rotten noodles, eggs, fish and meat food. Fasting on the day of the examination (can consume sugar or chocolate for energy, or drink sugar water for hunger, do not drink milk and other dairy products)
3.Intestinal preparation What is intestinal preparation? Bowel preparation means that the bowel is emptied of feces through dietary modification and medication, so that the colon can be completely cleaned in order to detect lesions during colonoscopy.
Why is bowel preparation necessary? Bowel preparation is an important part of colonoscopy that cannot be ignored. If there is still a lot of stool during the examination, it will affect the access and observation, and even the whole colon examination cannot be completed, or the diagnosis may be missed due to the stool cover.
How to prepare the intestine?
Laxatives are usually started 4 hours before the examination. Remember not to take laxatives too early, usually about 4 hours after taking laxatives the colon can reach a most clean state, after 4 hours, the fecal residue in the small intestine will gradually enter the colon, the colon is covered with fecal water again and becomes unclean again.
If the patient is examined in the afternoon, the patient may eat liquid for breakfast and start taking the laxative at 8-9 a.m. Lunch is prohibited, and sugar, chocolate or sugar water may be consumed for energy midway.
Patients may feel nausea and a feeling of fullness after taking the medication. Rarely, there are transient gastrointestinal reactions such as abdominal pain, vomiting and anal discomfort. If there is severe abdominal distension and discomfort, slow down or suspend the dose and continue to take it until the symptoms are eliminated and the stool is clear and watery. If the stool is still not clear, a cleansing enema should be given before the examination.
What are the common laxatives used before colonoscopy?
1.Compound polyethylene glycol electrolyte dispersion (Hengkang Zhengqing, He Shuang, etc.)
Colonoscopy bowel preparation commonly used laxatives A: the outer package of Hengkang Zhengqing. B, the inner package of Hengkang Zhengqing, visible A packet, B packet, C packet a total of three small packets of drugs. C: the outer package of and cool. D: magnesium sulfate solution (will be described in detail later).
For most people, 2 boxes of compound polyethylene glycol electrolyte dispersion are sufficient; however, for patients with persistent constipation, 3-4 boxes are needed.
Usage】 Dissolve two boxes of medication (each box contains 3 sachets of packet A, packet B and packet C) with 2000 ml of warm boiled water, and measure the volume of water with a measuring cup, 500 ml mineral water bottle or a large 2-liter Coke bottle. Take 600-1000 ml for the first time, and 250 ml every 15 minutes thereafter, to be taken within 2 hours. Until the excrement becomes clear water-like. If the excrement contains a large amount of fecal residue, you can continue to drink water and drink a total of up to 3,000-4,000 ml of water.
Note] Try to move as much as possible during and after taking the medicine until the fecal matter becomes clear water-like. Polyethylene glycol is an isotonic isotonic solution, which is not easily absorbed after oral administration, does not undergo ion exchange, does not stimulate the intestinal tract, does not undergo enzymolysis, and is considered to be the standard drug for intestinal cleansing in Europe because of its non-permeability, non-absorbability and non-explosive properties. In layman’s terms, compound polyethylene glycol electrolyte dispersion taste good, not easy to cause dehydration, the elderly and frail people can also take, colonoscopy with an electric knife for operation will not cause an explosion, is recognized as the best intestinal preparation method before colonoscopy.
2, magnesium sulfate (magnesium sulfate solution or magnesium sulfate powder)
For most people, need to take magnesium sulfate powder 50g or 50% magnesium sulfate 100ml.
【Use】 Generally 4 hours before the colonoscopy with 300ml of warm water to dilute the drug flush, and then continue to drink water, in the subsequent 2 hours after the oral intake of 2000ml-3000ml of warm water, roughly 2-3 hours can complete the intestinal preparation. If the stool is still not clear water-like, then you can continue to drink water to 4000ml.
【Note】 with magnesium sulfate intestinal preparation, the benefits are prepared quickly, high cleanliness, but poor taste, sometimes also produce severe abdominal pain, individual patients will appear vomiting, poor physical condition of patients may cause dehydration and electrolyte disorders in the body, especially elderly patients use caution.
3, sodium phosphate oral solution (Pfizer) sodium phosphate oral solution (Pfizer)
The main components of Pfizer are disodium hydrogen phosphate and sodium dihydrogen phosphate, which is a highly effective, high-safety hypertonic laxative that is more commonly used in the United States. It is characterized by good cleansing effect; ginger – lemon flavor, comfortable taste; small amount of water taken by patients, good tolerance; high safety, easy to take, etc.
The first dose is taken at 7:00 p.m. the day before the examination, diluted with 750 ml of warm water. The second dose is taken 4 hours before the examination, and the usage is the same as the first.
4, other drugs (such as mannitol, senna, etc.)
Mannitol can easily lead to dehydration and loss of electrolytes, and can be fermented to produce explosive gas, which can be used for simple examination, but may cause an explosion once the polyp electrocautery and other operations.
Senna is a traditional Chinese medicine, long-term use can cause colonic melanosis.
What should I do if I can’t pass stool even after taking laxatives?
Bowel preparation is usually advisable to start taking it 4 hours before the examination and emptying it about 3 hours. If you do not have much bowel movement after taking laxatives for 3 hours, the discharge still contains more fecal residue. Then you may continue to drink 1000-2000ml of water, or take 1-2 boxes of Hengkang Zhengqing, or you may perform a cleansing enema to cleanse your intestines. If you are a constipated patient or have a history of inadequate bowel preparation before colonoscopy, please refer to the bowel preparation for constipated patients and take precautions in advance.
How should I prepare my bowel for constipation?
Constipated patients have slow bowel movements and poor responsiveness to various laxatives for bowel preparation due to long-term use of various laxatives. If the conventional bowel preparation method is followed, often the bowel preparation is poor and a large amount of fecal residue remains in the intestinal cavity after drinking laxatives, resulting in unclear examination or inability to complete colonoscopy. Patients with constipation can try the following methods of bowel preparation.
1. Take an additional dose of laxatives the night before the colonoscopy. Then take another dose of the laxative 4 hours before the colonoscopy as described above.
2.Take cisapride 20mg orally while taking laxatives. cisapride is a gastrointestinal motility drug given to constipated patients because of weak intestinal peristalsis and slow excretion of intestinal contents, which enhances intestinal peristalsis and promotes intestinal evacuation by promoting the postganglionic fibers of the intermuscular plexus and intramural plexus of the intestine.3 Take 10ml of lactulose oral solution 3 times/day two days before the examination while performing a slag-free diet, and then take laxatives as described above for laxatives. Lactulose oral solution has the osmotic activity of disaccharide, which can produce a hypertonic effect by retaining water and electrolytes in the intestinal lumen and has a laxative effect. The combination of medications allows you to prepare your intestines more adequately, enabling a smooth colonoscopy to visualize the mucosa.