The thought of having a tube pushed up your nether regions and pooping your insides out are not appealing, but if you’re over 50, have been having gastrointestinal symptoms, or have a family history of colon or prostate cancer, then it’s time to go for a colonoscopy.
Chief Executive Officer of Victoria Hospital Dr Melvin Moodley, Victoria Hospital’s CEO, wants to stress the importance of colonoscopy screening for patients with bowel problems.
“Most patients over 40 will have this test at some point in their lives. It’s a useful test that can help detect cancer early, increasing the possibility of cure,” said Dr Moodley.
Dr Mark Hampton, a general surgeon at Victoria Hospital, who has an interest in colorectal surgery, emphasises that symptoms, including bleeding from the rectum, abdominal pain or cramps, symptoms of anaemia, weight loss or a change in bowel habit could warrant a colonoscopic evaluation of the large bowel.
“It’s then possible to examine the colonic mucosa (lining) and common problems can be diagnosed and managed, such as polyps, small growths or abnormal cells,” said Dr Hampton.
He said certain types of Some polyps can develop into cancers over time, usually between five and 10 years. Removing them can reduce the risk of colon cancer. Polyps detected during colonoscopy are removed with a snare which is passed through the working channel of the colonoscope.
Dr Moodley said colonscopies require a skilled operator and highly specialised equipment.
The large bowel has many angulations bends to get the end of the scope around.
“Imagine negotiating a hosepipe around the garden, but you are aiming it from the tap. We have skilled staff who can do the procedure and we also train doctors to perform it,” he said.
Sometimes, it is necessary to reposition the patient during the procedure to allow the tip of the scope to progress through the bowel.
“This is why the patient is under a light sedation, because negotiating these turns can be uncomfortable. It helps to communicate with the patient to allow for progress of the scope for optimal patient comfort.
“Most patients don’t remember much of the procedure once it’s finished,” he said.
The main challenge is that the endoscopist is unable to localise his scope’s position within the colon until he has reached the caecum – the first part of the large intestine. Only then, can he confidently report that all of the colon has been examined.
“In patients who have had previous abdominal or pelvic surgery, the procedure can be more difficult, as the scar tissue that forms around the large bowel from prior operations can make the bowel relatively non-compliant and difficult to traverse with the scope,” said Dr Hampton.
He said there is a need to do more colonoscopies in the community served by Victoria Hospital. In First World countries, such as Britain and America, there are national age-based screening programmes where colonoscopies are offered to healthy patients at risk of colon cancer on the basis of their age and population characteristics. There are similar mammographic screening programmes for non-symptomatic women at risk of breast cancer in these well-resourced countries.
“South Africa is unlikely to ever have these types of programmes, because there isn’t enough money, resources or skill to set up something of that magnitude. Instead, we investigate patients who come to us with symptoms,” said Dr Hampton.
At Victoria Hospital, eight to 10 colonoscopies are performed each week, and there is a waiting list of four to five months for non-urgent bookings. Emergency cases are done as they present, which often places enormous pressure on the hospital and staff who need to take on this extra work.
Patients have often been seen numerous times at their local clinic or day hospital before they are referred for a surgical consultation, which often leads to further delays to investigation and eventual treatment of their colonic or rectal disease.
WHAT TO EXPECT
You’ll have to fast for a day, pooping out more food than you ever imagined consuming.
But it’s better than being sick or dying from otherwise treatable conditions. Just think of it as an internal spring clean.
The other good things are that you’ll feel really skinny for a day, and if someone tells you, “You’re full of sh*t”, you can honestly tell them you’re not.
Prior to the procedure, you have a physical examination and are shown a colour diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Nkandla.
Leaving the office with written instructions and a box of Klean-Prep the plan is to thoroughly clean out the colon.
It’s best to have the procedure in the afternoon so you get some sleep the night before.
It’s also best to plan ahead.
Take the day off work and be alone, because when the poopathon begins you’ll be farting fireworks, clenching your butt cheeks and should be close to a loo.
Also arrange for a good friend to fetch you after the procedure as you aren’t allowed to drive.
On the day, you can drink clear fluids – tea or coffee without milk, soft drinks, clear soup. The box of laxatives contains four sachets of powder. Each one must be mixed with water in a 1-litre jug. The liquid tastes vile: a mixture of goat spit and toilet cleaner, and should be drunk during one hour, and then repeated three more times. Another tip is not to trust a fart, a sneeze or a cough, unless you’re sitting on the loo.
As per instructions, ‘’a loose watery bowel movement may result 45 to 60 minutes after you start drinking.’’ It’s more like a rocket launch as you spurt violently and then, when you feel like you are totally empty, your insides rumble. At this point, you’re wondering whether you’ve travelled into the future and are eliminating food you haven’t eaten yet. But it’s important to continue drinking until you are passing straw-coloured fluid.
After an action-packed morning, you arrive at the doctor and make a beeline for the loo. Wearing a gown tied at the back you have to sign an indemnity acknowledging that you understand and agree to whatever is done.
Then the nurse will put a needle in your arm, and, if you are lucky, you wake up having no idea what has happened. A pharmacist in Constantia Village said her gastroenterologist phoned her after the procedure and said she had given away her top-secret potjie recipe while under sedation. She says she has never made a potjie in her life.
If you are awake, you won’t see the flexible camera on a 1.9m tube being inserted into your rectum and then passed through the large bowel, a distance of between 90 and 110cm.
It will be uncomfortable at times as the nurse manipulates your tummy or turns you onto your back to enable the camera to move forward. Watching on the big high-definition, flat-screen TV on the wall in front of you, you embark on a truly miraculous kaleidoscopic journey, venturing where no one has ever been before… thank God.