Colonoscopy
Updated on All content is checked by medical journalists.With a colonoscopy, the doctor inspects the inside of the intestine with a special optical device and can carry out small interventions or take tissue samples via special working channels. In the case of the large intestine, one speaks of a colonoscopy, the small intestine is also called enteroscopy. Read everything about the colonoscopy, its risks and what you as a patient should be aware of.
What is a colonoscopy?
The colonoscopy is a frequently performed examination in internal medicine in which the doctor examines the inside of the intestine. A distinction is made between the small intestine endoscopy (enteroscopy) and the colonoscopy (colonoscopy). Endoscopic examination of the rectum alone (rectoscopy) is also possible.
Further information: rectoscopy
You can read about how the reflection of the rectum works and when it is carried out in the article Rectoscopy.
While the large intestine can be viewed easily with a tubular instrument, an endoscope (also known as a colonoscope), the small intestine is more difficult to reach. The doctor can assess the upper small intestine behind the gastric outlet, the duodenum, as part of an extended gastroscopy (gastroduodenoscopy); for deeper sections, he now uses what is known as capsule endoscopy.
When to do a colonoscopy
The colonoscopy is a frequently used examination that serves both as a preventive measure and to clarify unclear complaints or follow-up care after surgery or, for example, tumor diseases. The following diseases can be diagnosed particularly well with the colonoscopy:
- Colon cancer and its precursors (for example, polyps)
- Protrusions of the intestinal wall (diverticulum) or inflamed diverticula (diverticulitis)
- chronic inflammatory bowel disease (for example Crohn's disease or ulcerative colitis)
- acute inflammation or circulatory disorders of the intestinal wall
A colonoscopy must not be performed in the case of an intestinal obstruction, known acute diverticulitis or peritonitis!
Colonoscopy: Prevention in Germany
The early detection of colon cancer is one of the most important indications for a colonoscopy: the earlier a tumor is discovered, the better the chances of recovery. Patients with health insurance are entitled to a screening colonoscopy from the age of 55 even if they have no symptoms. Statutory or private health insurance pays the costs for this.
Patients with an increased risk of colon cancer, for example if there are frequent colon cancer cases in the family or who have chronic inflammatory bowel disease, receive a colonoscopy earlier. The doctor can decide when a colonoscopy check-up makes sense in an individual case, taking into account the previous and family history.
Preventive colonoscopy examination: how often is it necessary?
The statutory health insurance companies recommend the first colonoscopy at the age of 50 for men and for women aged 55 and over who have no known increased risk of colon cancer. If the findings are normal, another colonoscopy is sufficient after ten years. If the doctor finds abnormalities such as polyps during the colonoscopy, closer inspection is often necessary.
What do you do with a colonoscopy?
In order for the doctor to see something during the colonoscopy, some preparations are necessary the day before. This includes cleaning the intestines, among other things. If desired, anxious patients can be given a sedative right before the procedure.
Further information: Colonoscopy: preparation
You can read about the measures the patient should take to prepare for the colonoscopy in the article Colonoscopy: Preparation.
Colonoscopy (colonoscopy)
The doctor pushes the colonoscope with a small camera over the anus into the rectum and from there further into the colon. The colonoscope is particularly flexible so that the doctor can easily use it to pass the coils of the intestine. The images transmitted by the colonoscope are displayed on a monitor. Depending on which section of the colon the doctor assesses, a distinction is made:
- Ileocolonoscopy (additional evaluation of the ileum)
- high colonoscopy (assessment of the entire colon down to the appendix)
- Sigmoidoscopy (assessment of the sigmoid colon, part of the large intestine)
- partial colonoscopy (assessment of the lower colon)
If necessary, he uses the instrument to take small samples, so-called biopsies, from the intestinal wall, which are then examined in the laboratory.
As an alternative to the classic colonoscopy with an endoscope, virtual colonoscopy, also known as CT colonoscopy, is available. During this examination, a computer tomograph takes pictures of the intestine. So that it is easy to see, it is inflated with air beforehand.
Small intestine endoscopy (capsule endoscopy and balloon endoscopy)
Due to its length and many twists, it is difficult to assess the entire small intestine with an endoscope. A relatively new procedure that solves this problem is what is known as capsule endoscopy. With this, the patient swallows a tiny video capsule, which passes through the stomach through the intestine and takes pictures of its inner workings. She transmits the images live by radio to a receiving device that the patient carries with him.
Since no tissue samples can be taken through the capsule, suspicious findings must be made. a so-called balloon endoscopy can still be performed.
Further information: Colonoscopy: Procedure
You can read exactly how the colonoscopy of the small intestine and the large intestine works in the article Colonoscopy: Procedure.
The gastroenterologist uses a special children's endoscope for colonoscopy in children. This is available in different sizes with diameters from five to thirteen millimeters, depending on the child's height. In addition, children are usually given general anesthesia or very sedative medication for the colonoscopy.
What are the risks of a colonoscopy?
Risks about which the doctor must inform the patient are bleeding and the infrequent penetration of the intestinal wall with the endoscope. The short-term anesthesia can also lead to intolerance reactions and cardiovascular problems. In general, however, it is a very safe examination method with which complications rarely occur.
Fear of a colonoscopy: what to do?
Many patients are uncomfortable about their colonoscopy. Often the reason is not only fear of the possible risks of colonoscopy, but also a certain shame about the examination. If necessary, the doctor can give a sedative. Patients should inform their doctor of their concerns at an early stage so that he can react accordingly: With a calming drug, the patient can survive the colonoscopy without any stress.
What should I watch out for after a colonoscopy?
If you were given a sedative during the examination, your ability to react is usually significantly restricted for some time after the colonoscopy. Therefore, you are no longer allowed to actively participate in road traffic on the day of the examination - neither by car, by bike or on foot.
After a colonoscopy for which you have been given sleeping pills, painkillers or sedatives, have an accompanying person or the taxi service bring you home!
As a rule, you have to indicate who will pick you up before the examination at the practice. If you are picked up by a driver service, it is best to contact your health insurance company to clarify how the costs will be covered.
Operating machines or performing similar potentially dangerous activities is also taboo. You will probably still feel a bit exhausted even after a colonoscopy without a short anesthetic. In these cases, it is best to have someone else pick you up.
Food after colonoscopy: what is allowed?
Since you as a patient have to be sober for a long time before the examination, you will probably be very hungry after the examination. The good news: right after the colonoscopy, you can eat and drink anything you want. For example, you can take a small snack with you to the doctor’s office. Sometimes doctors' offices also provide drinks and small items such as pretzel sticks.
Symptoms after colonoscopy: what should I pay attention to?
Diarrhea after a colonoscopy is a common side effect, as the laxatives previously taken can continue to work for a few days. Because a lot of air gets into the intestines during the examination, gas and air can also be lost. This is perfectly normal and not a cause for concern.
On the other hand, severe pain after colonoscopy of the large or small intestine is a warning signal that you should not ignore. If you have a fever, sweating, severe dizziness, nausea, bleeding from the intestines or abdominal pain after a colonoscopy, see your doctor so that he can react quickly.
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