• You are on anticoagulants (blood thinners) or aspirin-containing products.
• You have been told to take antibiotics prior to dental visits or diagnostic tests.
• You have bleeding tendencies.
• You are diabetic.

Please contact the doctor who ordered these medications for you for any changes that may be required before your procedure.

Please make arrangements for someone to drive you home after the procedure. A companion must accompany you because you will be given medication to help you relax. Even though you may not feel tired, your judgment may be impaired and your may be reflexes slower. You will not be allowed to drive or take a taxi alone after the procedure.

Please bring with you a list of your current medications and dosages. Please bring your colon x-rays with you if requested to do so.

What Should I Do to Prepare?
Call our office at 610.375.6001 if you have questions.

How Is Colonoscopy Performed?

When you arrive in the endoscopy suite, a nurse will take your vital signs (blood pressure, temperature and pulse) and insert an intravenous catheter into a vein in your hand. Your doctor may then prescribe medicine to relax you and help ease abdominal cramping. You will be lying on your left side. The colonoscope (a long flexible tube about the width of a finger) is inserted into the rectum and gradually advanced through the colon. The doctor will insert air into the colon. The air may cause pressure or a bloating feeling but will enable the doctor to see your colon more clearly. The colonoscope is then slowly withdrawn while the lining of the colon is carefully examined. Your doctor will remove polyps or take biopsies as necessary. Following your examination, there may be some discomfort, which quickly improves with the passing of gas. The entire procedure usually takes less than an hour. Your nurse will transport you back to the recovery area and continue monitoring you until you go home. You will be observed in the endoscopy suite for a period of time. You will be given written instructions at the time of discharge.

What Do I Do After the Procedure?

You may resume your regular diet and activities according to the instructions below:

Colonoscopy alone

1. Return to your regular diet on the same day.
2. Avoid strenuous exercise or driving for 24 hours after the procedure.
3. Resume taking aspirin-containing medication or blood thinners on the same day.

Colonoscopy with polypectomy or biopsy

1. Return to your regular diet on the same day unless instructed otherwise by your doctor.
2. Avoid strenuous exercise or driving for 24 hours after the procedure.
3. Avoid aspirin-containing medications for an additional seven days.
4. If you normally take anti-coagulants (blood thinners), your doctor will give you instructions about when to resume taking them.

Results
All polyps (pieces of tissue) removed at the time of colonoscopy will be examined under the microscope by a pathologist. It will take up to one week for us to get the results. We will call you with the results as soon as we get them. If you need follow up, you will receive a letter reminding you to call and schedule an appointment.

Are There Any Complications from Colonsocopy and Polypectomy?

Colonoscopy and polypectomy are associated with very low risk when performed by doctors with special training and experience in these endoscopic procedures. One possible complication is perforation, which is a tear through the wall of the bowel that may allow leakage of intestinal fluids. Another complication is bleeding that may occur from the site of biopsy or polyp removal. It is usually minor and stops on its own, or it can be controlled by cauterization (application of electrical current) through the colonoscope. Rarely, surgery is necessary. A third complication is a localized irritation of the vein in your hand that may occur at the site of medication injection. A tender lump could develop and may remain for several weeks to several months. Elevation of the arm and hand on several pillows and local application of heat speeds recovery.

Causes for Concern

Call your doctor if you have any of the following problems:

• Rectal bleeding greater than one cupful or lasting longer than one to two days
• Increasing abdominal pain lasting longer than 30 minutes
• Nausea or vomiting
• Fever or chills

If your doctor is not available, a doctor on call is available 24 hours a day, every day of the year, including holidays. After hours call any of our offices and the answering service will locate one of our doctors on call. In an emergency try to contact us for advice before you go to the hospital. A telephone call may save you a lot of time, money, and discomfort.

When to call your doctor

The most common post-operative “problems” associated with small bowel, colonic or rectal resections relate to:

• Wound or incisional problems (increased pain, discolorations or concerns regarding infection).
• Control of bowel function — after removal of a small or extended portion of the bowel, regaining of normal bowel function varies with the individual. We try to control functions and prevent either constipation or diarrhea.
• Dietary considerations (“What can I eat?,” is a very common post-discharge question.) Normalization of the diet and bowel movements may take up to several weeks postoperatively. As necessary, dietary restrictions will be discussed by your doctor prior to your discharge from the hospital.
• Abdominal distress (nausea, vomiting, bloating, gas cramps and hiccoughs) Increase in any of these symptoms to the point of pain, particularly if it is worsening as time goes on, is cause for concern, and your colon and rectal surgeon should be consulted.
• What medications will I take home from the hospital? When may I resume my “regular” medicines? Medications and supplies upon discharge generally center around pain control, bowel function regulation (anti-diarrheal agents or stool softeners), prednisone where applicable, antacids, antibiotics, supplies concerned with wound care, gauze dressings, occasional drainage tubes or irrigating supplies.
• Activity constraints such as walking, climbing stairs, driving a car, sexual activities, running, golfing, and “When can I go back to work?,” where applicable.
• Unusual bleeding from wound, rectum, stoma or other.
• When to see you back in the office: Any further follow-up tests anticipated in near or distant future such as scans or endoscopy procedures, blood tests or x-rays. Your physician should cover all of these areas with you prior to your discharge. If this has not been done or you are uncertain about any of these items, call your physician to get updated information soon after you are discharged to home. If you are concerned about any possible complications, please call your physician immediately. If your own doctor is unavailable, the on call doctor is available 24 hours a day, every day of the year, including holidays. If after hours, you may reach any of our physicians by calling any of our offices. The answering service will locate our doctors on call. In an emergency try to contact your colon and rectal surgeon for advice before you go to the hospital. A telephone call may save you a lot of time, discomfort and expense.

After Discharge

Medicines

You will take home

1. 1. A prescription for pain medication with instructions. If you need additional medication, call your doctor during normal business hours. (After hours, if the doctor on call does not know you personally, he or she may not renew narcotic pain medication by telephone.) 2. Bulk-forming stool softeners (for example, Konsyl®, Metamucil®, or Citrucel®) to be taken in a glass of water two or three times a day. 3. Anal ointment, such as Americaine®, Tronothane®, or Xylocaine®. Apply these ointments to the anal area with your finger; then cover with cotton or gauze.

Bowel Function
Bowel movements after anorectal surgery are usually associated with moderate to severe discomfort. Constipation and diarrhea make the pain much worse and must be avoided. The trauma to the anal wounds caused by hard bowel movements will slow down the healing process.

Constipation
You should be sure to have a bowel movement at least every other day. If two days pass without one, take an ounce of milk of magnesia; if there is no result, repeat this dose in six hours. You can also use an over-the-counter phosphate enema or tap water enema.

Diarrhea
Diarrhea, usually caused by overuse of laxatives, is also a concern if you have more than three watery bowel movements during a 24-hour period. If diarrhea occurs, stop taking milk of magnesia or other laxatives. Continue the bulk-forming agents. If the diarrhea persists, call your physician.

Bathing
After bowel movements, use a wet wash cloth, toilet paper, cotton, or perianal pads (Tucks, Preparation H pads) to clean yourself. If possible, take a sitz bath or tub bath immediately. Baths should last at least 10 to 15 minutes with the water as warm as you can comfortably tolerate. Try to take at least three baths (or showers with a hand-held sprayer) a day.

Discharge/Infection
Some bloody discharge after bowel movements is normal for at least two to four weeks after rectal surgery. If you have profuse, continuing bleeding, call your doctor immediately. Postoperative infection around the rectal opening is surprisingly uncommon despite the obvious contamination by stool. This is probably because of the very excellent blood supply to the area.

Urination
If you have trouble urinating, do so while sitting in a warm tub of water, or run the water faucet while sitting on the toilet. If the problem is severe or persistent, your doctor may prescribe oral bladder stimulants.

Diet
Eat a high-fiber general diet, including plenty of fruits and vegetables. Try to drink at least six to eight glasses of water or juice per day to help keep the stool soft.
Activity
On discharge there are generally no restrictions on walking, climbing stairs, or riding in a car. After some procedures you will be asked to avoid strenuous activity or heavy lifting for 7 to 14 days.

Causes for Concern

If any of the following occur, please call our office and speak with the nurse. She will help you with your problem or have the doctor call you.

• Problems with the incision(s), including increasing pain, swelling, redness, or drainage
• Severe constipation (no bowel movement for three days)
• Diarrhea (more than three watery stools within 24 hours)
• Difficulty urinating
• Fever greater than 101 degrees
• Severe bleeding
• Nausea or vomiting
• Chills

If your doctor is not available, a doctor on call is available 24 hours a day, every day of the year. After hours, call any of our offices and the answering service will locate one of our doctors on call. In an emergency, try to contact us for advice before you go to the hospital. A telephone call may save you a lot of time, discomfort, and expense.

Day of Surgery

On the day of surgery, report to the admitting area to register. A nurse will take your vital signs (blood pressure, pulse and temperature) and go through a list of questions to ensure you are ready for surgery. If your doctor or anesthesiologist requires a chest x-ray or EKG and these were not done as part of your preoperative examination, you may have them done at the hospital. Blood will be drawn and sent to the laboratory for current test results. You may also be asked to give a urine specimen.
Then your family will be directed to the surgical waiting room and you will go to a preop room. The anesthesiologist will talk with you about options for anesthesia

In the Operating Room

You will be escorted into the operating room. An IV will be started. You will receive medication to relax you and then the anesthesia chosen by you and your doctors will be given. You will be positioned on your stomach over a roll. The length of surgery varies from patient to patient and is determined by the general health of the patient and how complicated the surgery is.

After Surgery

Following surgery you will be taken to the recovery room where specially trained nurses will care for you. Your doctor will meet your family after surgery to discuss your condition.

Getting Ready for Surgery

To prepare for your surgery—
Do not eat or drink anything after midnight the night before your surgery; this includes water and chewing gum.
Continue to take medication as prescribed, but with only a sip of water. Do not take ibuprofen, aspirin or any medication containing aspirin for one week before your surgery.
Do not smoke after midnight the night before your surgery.
Do not wear any make-up, especially eye make-up.
Do not bring large sums of money, jewelry, or credit cards.
If you wear contact lenses, bring the case.
Do not wear artificial nails or nail polish. Your nails are monitored during surgery to identify oxygen and blood circulation.
Bring a list with you of all medications and their dosages.
Bring your insurance identification cards.

Commonly Asked Questions

How long will I be in the hospital? Most likely you will be discharged on the same day. In some situations you may stay in the hospital one or two nights.
Will I have stitches? The use of stitches depends on the procedure. However, if they are used, they will dissolve in a few weeks. There may be some bleeding at that time.

How much pain will I have and how is it managed? The incision does cause pain. You will be given pain medication to take at home. If you need a refill for a pain medication, you must call your pharmacy during normal business hours.

What kind of diet will I be on at home? You will be on a regular diet.

Will it hurt to move my bowels? Yes, there will be pain. Avoid constipation by eating a high-fiber diet, drinking plenty of water (8-10 glasses of liquid per day), and taking natural fiber products. Taking baths will also help to relieve the pain. Do not take laxatives unless directed by your doctor. Passing loose stools is painful.

Will I have bleeding? It is normal to have bleeding with your bowel movements for up to two weeks. If you pass more than a cupful of blood, you should call your doctor.

How soon can I exercise? You can do whatever you are comfortable doing and what you can tolerate. You may increase your activity as you tolerate it.

What medications will I need at home? You will be given pain medication. You should resume your usual medications if directed to do so by your doctor.

How soon can I drive? You can drive when you are comfortable enough to do so and are no longer taking pain medication.

When can I go back to work? Return to work varies depending on your procedure. Discuss this with your doctor.

What will I have to do at home? You will be able to care for yourself, but you may need some assistance with cooking, housekeeping, and grocery shopping.

Do I need someone to stay with me at home? It would be preferable to have someone stay with you.

When can I have sex? This varies with the procedure. Discuss this with your doctor.

Can I swim in a pool or lake? Yes, you can swim in either one.

If your doctor is not available, a doctor on call is available 24 hours a day, every day of the year, including holidays. After hours call any of our offices and the answering service will locate one of our doctors on call. In an emergency try to contact us for advice before you to the hospital. A telephone call may save you a lot of time, money, and discomfort.

After Surgery
Following surgery you will be taken to the recovery room. Your physician will meet your family after surgery to discuss your condition.
Getting Ready for Surgery
To prepare for your surgery—
Do not eat or drink anything after midnight the night before your surgery; this includes water and chewing gum.
Continue to take medication as prescribed, but with only a sip of water. Do not take ibuprofen, aspirin or any medication containing aspirin for one week before your surgery.
Do not smoke after midnight the night before your surgery.
Do not wear any make-up, especially eye make-up.
Do not bring large sums of money, jewelry, or credit cards.
If you wear contact lenses, bring the case.
Do not wear artificial nails or nail polish. Your nails are monitored during surgery to identify oxygen and blood circulation.
Bring a list with you of all medications and their dosages.
Bring your insurance identification cards.
Commonly Asked Questions
How long will I be in the hospital? You will be in hospital for approximately seven days.
How much pain will I have and how is it managed? The incision does cause pain. There are several alternatives to manage the pain: an injection (hypodermic); PCA (patient-controlled analgesic, where the patient controls his/her own pain medication through the IV); and epidural catheter (analgesic is administered through a catheter placed into the epidural space of the spinal column).

What can I eat? You will start taking liquids when the intestinal tract is functioning (you pass gas). If you tolerate liquids for one to two days, you will get solid food. Before then, you may be allowed ice chips.

What kind of diet will I be on at home? You will be on a fairly regular diet.

Will it hurt to move my bowels? There should be no pain.

How soon can I exercise? You can walk, bike, and swim as soon as you want to, but there should be no upper body exertion for one month.

What medications will I need at home? You may require pain medication. You should resume your usual medications if directed to do so by your doctor.

How soon can I drive? You can usually drive one week to ten days after you leave the hospital.; You should not get behind the drivers wheel until you are pain free and off pain medication.

When can I go back to work? You can usually go back to work three to four weeks after surgery.

What will I have to do at home? You will be able to care for yourself, but you may need some assistance with cooking, housekeeping, and grocery shopping.

Do I need someone to stay with me at home? It would be preferable to have someone stay with you.

When can I have sex? In most cases you can resume sex after a few weeks.

Can I swim in a pool or lake? Yes, you can swim in either one.

If your doctor is not available, a doctor on call is available 24 hours a day, every day of the year, including holidays. After hours call any of our offices and the answering service will locate one of our doctors on call. In an emergency try to contact us for advice before you to the hospital. A telephone call may save you a lot of time, money, and discomfort.