Colonoscopy in Baku: who needs it, how to prepare and what to expect

A colonoscope is a flexible tube thinner than a finger, with a light source and a video camera at its tip. Starting from the anus, the instrument is advanced along the entire colon — about 1.5 meters — up to the cecum. A little air or carbon dioxide is pumped in to widen the bowel slightly so that its wall can be seen clearly.

A colonoscopy is more than just a look. During the procedure:

• a small tissue sample (biopsy) can be taken from a suspicious area;
• polyps are cut off and removed with a thin wire loop — more on this: colon polyps;
• a small source of bleeding can be stopped on the spot.

Unlike a fecal occult blood test, a colonoscopy both finds the problem and often deals with it right on the spot.

If you have symptoms. A colonoscopy is usually recommended in these cases:

• blood or mucus in the stool, especially after the age of 40 — more on this: blood on toilet paper;
• a change in bowel habits that lasts for weeks: new constipation, diarrhea or alternating between the two;
• stools that become pencil-thin, a feeling that the bowel has not emptied completely;
• unexplained weight loss, iron deficiency anemia with no clear cause;
• abdominal pain that does not go away, diarrhea at night.

Without symptoms — screening. Polyps and early cancer cause no symptoms for a long time. That is why colonoscopy is recommended for people at average risk from the age of 45–50. If the result is normal, the next examination is usually not needed for many years.

People who should start earlier or be checked more often:

• those with colorectal cancer or a large polyp in the family (parent, sibling, child) — usually from age 40 or 10 years before the age at which the relative was diagnosed, whichever comes first;
• those who have had polyps removed before;
• those who have had Crohn's disease or ulcerative colitis for a long time;
• members of families with an inherited polyposis syndrome.

Colonoscopy is often needed in proctology, too. We recommend a colonoscopy for patients aged 40 and over who suffer from constipation and are found to have hemorrhoids (piles) on examination, because hemorrhoids may not be the only cause of bleeding. With an anal abscess or anal fistula, a colonoscopy is also sometimes needed to rule out inflammatory bowel disease.

Not every complaint requires a full colonoscopy. Proctology also has two shorter and simpler examinations:

Anoscopy is usually done right at the first visit, and in younger patients it is often enough to diagnose hemorrhoids. Rectoscopy is recommended for patients who come in with bleeding from the rectum. Age, family history and other symptoms determine whether a full colonoscopy is needed. We decide together at your appointment which examination you need.

The quality of the examination depends on how clean the bowel is: leftover stool can hide small polyps, and sometimes the procedure has to be repeated. You will receive written instructions for the preparation. The steps below are general information; what counts are the instructions you are given.

1. Discuss your medications about a week in advance. Blood thinners (warfarin, aspirin, clopidogrel and others), iron supplements, diabetes medications and insulin need special attention. Iron supplements are usually stopped a few days beforehand, because they darken the stool and make the view harder. The doctor decides about blood thinners and diabetes medications — do not stop any medication on your own. If you have constipation, mention it too: your preparation may need to be extended.
2. 2–3 days before — a low-fiber (“low-residue”) diet. Avoid fruit and vegetables with seeds (tomatoes, cucumbers, grapes, kiwi), raw vegetables and leafy greens, nuts and seeds, legumes, and bran bread or dark bread. You can eat white bread, rice, pasta, peeled boiled potatoes, lean chicken and fish, eggs and cheese.
3. The day before — clear liquids. Usually, from the afternoon on, you drink only clear liquids: water, clear broth, tea without milk, and light-colored juice without pulp. Avoid red and purple drinks, because in the bowel they can look like blood.
4. Bowel-cleansing solution. Drink the solution according to the instructions. Often, part of the dose is taken the evening before and the rest on the morning of the procedure. A chilled solution is easier to drink. If the preparation has worked well, the liquid coming out at the end is clear and yellowish.
5. On the day of the procedure. If sedation (a light, medication-induced sleep) is planned, do not eat or drink anything after the time you are given. Bring someone with you, and take a list of your medications and the results of any previous examinations.

1. Before the procedure, you sign a consent form and your questions are answered. If sedation is planned, a thin catheter is placed in a vein in your arm.
2. Wearing a special examination gown, you lie on your left side with your knees drawn up toward your stomach. Your body stays covered, and only the necessary medical staff are in the room.
3. The sedative is given through the vein, and you drift into a light sleep. Your pulse, blood pressure and blood oxygen level are monitored throughout the procedure.
4. The colonoscope is inserted through the anus and slowly advanced up to the cecum.
5. The most important stage is withdrawing the instrument: this is when the bowel wall is examined carefully, without rushing. Any polyp is removed, and a biopsy is taken from any suspicious area.
6. The procedure usually takes 20–40 minutes. It may take longer if polyps are removed or if the bowel is long and has many bends; the exact time depends on the findings.

These are the two questions we hear most often. Many people put off the procedure for years precisely because of these fears.

Pain. A colonoscopy is usually done under sedation — people often call this a “sleep colonoscopy”. In that case, patients feel no discomfort or very little, and often do not remember the procedure. Without sedation, you may feel bloating, pressure or brief cramping. The inner lining of the bowel does not respond to cutting with pain, so polyp removal usually cannot be felt either.

Gut flora. The cleansing solution temporarily changes the gut flora. Once you return to your normal diet, the flora usually recovers on its own within a few weeks, so no special treatment is needed. The colonoscope itself does not harm the flora.

Embarrassment. The procedure is done in private, and your body stays covered. Health is nothing to be ashamed of, and a timely colonoscopy can save lives.

Colonoscopy is a widely performed and generally safe procedure, but like any medical intervention, it has rare complications:

• bleeding — mostly after polyp removal, sometimes starting a few days later; it often stops on its own or is stopped endoscopically;
• perforation — a hole in the bowel wall; very rare, but a serious complication that sometimes requires surgery;
• reaction to sedation — a drop in blood pressure, shallow breathing; this is why your vital signs are monitored continuously;
• related to the preparation — dehydration and weakness; older adults and people with heart or kidney disease should agree on the preparation plan and fluid intake with their doctor separately.

No examination is perfect: very small or flat polyps can sometimes be missed. Good preparation reduces this risk.

• After sedation, you usually stay under observation for 30–60 minutes and then go home with the person accompanying you.
• You may have bloating, gas and mild cramping for a few hours; walking around helps the gas pass.
• Unless you are told otherwise, you can start eating light meals the same day.
• For the rest of the day after sedation, do not drive, make important decisions or sign documents.
• If a polyp was removed, there may be small traces of blood in your stool. The doctor will tell you when to restart any blood thinners.
• The colonoscopy report is usually ready the same day, while biopsy results can take from a few days to two weeks. The timing of your next examination is based on these results.

If you have severe or worsening abdominal pain, a hard, tense abdomen, fever, chills, heavy or repeated bleeding, or vomiting, do not wait — seek urgent care.