How does the
doctor make the diagnosis?
Most people begin by seeing their family doctor
(general practitioner) who will examine you and arrange for
you to have any further tests or X-rays. Your GP may need to
refer you to the hospital for these tests and for specialist
advice and treatment.
At the hospital the
doctor will take your medical history before doing a physical
examination. This will include a rectal examination. To do
this the doctor places a gloved finger into your back passage
to feel for any lumps or swellings. This examination may be
slightly uncomfortable but it is not painful.
You will probably have a
blood test and chest X-ray to check your general health. You
may also be asked to take a sample of your stool to the
hospital so that it can be tested for blood.
Proctoscopy/Sigmoidoscopy
This test allows
the doctor to look at the inside of the rectum or the large
bowel. It will be done in the hospital out-patient department
or on the ward.
For the test you will be
asked to lie curled on your side while the doctor gently
passes a thin tube into your back passage. A small hand pump
is attached to the tube so that air can be pumped into the
bowel. A proctoscope is a short tube which just goes into the
rectum; a sigmoidoscope is a longer tube which can be passed
further up into the large bowel. With the help of a light on
the inside of the tube the doctor can see any abnormal areas.
If necessary, a small sample of the cells (called a
biopsy) can be taken painlessly for examination under a
microscope.
A proctoscopy or a
sigmoidoscopy can be slightly uncomfortable. You should be
able to go home as soon as the test is over.
Barium
enema
This is a special X-ray of the large bowel. It
will be done in the hospital X-ray department.
For the test it is
important that the bowel is empty so that a clear picture can
be seen. On the day before your test you will be asked to take
a laxative and to drink plenty of fluids.
On the morning of your
enema you should not have anything to eat or drink. This
preparation may vary slightly from hospital to hospital but
your doctor will give you an instruction sheet to
follow.
Just before the test, to
make sure that the bowel is completely clear, you may be given
a bowel wash-out. For this the nurse will ask you to lie on
your side while he or she gently passes a small tube into your
back passage. Water is then passed through the tube. You will
be asked to hold the liquid for a few minutes before you go to
the toilet.
For the enema a mixture
of barium, which shows up on X-ray, and air is passed into the
back passage in the same way as the bowel wash-out so that a
clear picture can be seen. It is important to keep the mixture
in the bowel until all the X-rays have been taken. The doctor
can then watch the passage of the barium through the bowel on
an X-ray screen and any abnormal areas can be seen.
The test can be
uncomfortable and tiring, so it is a good idea to arrange for
someone to travel home with you if possible.
For a couple of days
after your enema you may notice that your stools are white.
This is the barium being removed from the body and is nothing
to worry about. The barium can also cause constipation and you
may need to take a mild laxative for a couple of days after
your test.
Colonoscopy
If
your doctor wants to look inside the whole length of the large
bowel, you may have a test called a colonoscopy. This will
usually be done in the hospital out-patient department and
takes about an hour.
For a colonoscopy the
bowel has to be completely empty. This means following a
careful diet for a few days before your test. The preparation
is similar to that of the barium enema (above). You will be
given instructions on this by your hospital.
Just before the test you
may be given a mild sedative to help you feel more relaxed.
Once you are lying comfortably on your side the doctor will
gently pass a flexible tube (called a colonoscope) into
your back passage. As the tube is made up of flexible fibres,
it can easily pass around curves and the whole length of the
large bowel can be examined. A light on the inside of the tube
helps the doctor to see any abnormal areas or swelling.
During the test,
photographs and samples of the inside of the large bowel
(biopsies) can be taken. A colonoscopy can be slightly
uncomfortable but the sedative will help you feel more
relaxed.
Most people are ready to
go home a couple of hours after their test. It is a good idea
to arrange for someone to collect you from the hospital as you
shouldn't drive for several hours after a sedative.
