If you are experiencing colorectal problems or are over the age of 50, your doctor will probably want to do some diagnostic testing of the colon, often called the large intestine. Many problems, such as hemorrhoids, anal fissures, diverticulosis, colitis or rectal bleeding, can lead you to your doctor’s waiting room. Because a routine examination is usually inconclusive, your healthcare provider will probably order some diagnostic testing to find the cause of your symptoms.
There are several diagnostic procedures for colorectal problems:
- Barium enema tests are usually done in the radiology department of a hospital. You will receive instructions on how to clean out your colon before the procedure. After lying down on an X-ray table, barium will be inserted into your colon through a lubricated tube which is monitored by a healthcare provider. Often air is introduced into the large intestine as well to enhance the image on the X-ray fluoroscope screen which is similar to a TV monitor. As you lie on the table, it will be slightly tipped at times, and you will be asked to take different positions to accommodate the x-ray pictures. After the exam, the tube will be removed, and you will be helped to the toilet, so the barium can drain out.
- Sigmoidoscopy is an examination of the last third of the large intestine, called the sigmoid or descending colon. It is less preferable to the colonoscopy which can examine the whole colon. However, a sigmoidoscopy can be done quickly in your doctor’s office (in about twenty minutes) and without as much preparation as a colonoscopy. An enema is given an hour or two before the procedure to remove all solids from the descending colon. You will lie on your side while the doctor inserts a long, flexible, lighted tube into the anus and the sigmoid colon. A camera on the scope will transmit an image of the colon to a computer screen which the doctor views for any abnormalities. Since you are awake during the exam, there can be mild discomfort from the endoscope and the air which is added to inflate the walls of the colon. If any growths, called polyps, are found, they can be removed during the procedure and biopsied.
- Virtual colonoscopy or computed tomographic colonography (CTC) is a newer procedure to find abnormalities in the colon and has been much debated to its effectiveness. It is noninvasive, and uses x-rays and computers to produce 3-D images of the large intestine, after you have completed the same extensive prep as for a standard colonoscopy. Most studies show that CTC is as efficient as the other exam at finding polyps, but the drawback is that the growths cannot be removed during the procedure. Also, Medicare has announced it will no longer cover the expense, even though the exam is much less expensive than a regular colonoscopy. Only patients who would be considered at a low risk for polyps and other abnormalities are advised to have a virtual colonoscopy.
- Colonoscopy is an examination of the whole length of the colon for irregularities with a lighted, flexible tube called an endoscope. Your doctor will thread this scope up through your colon and watch the findings from the scope’s camera on a computer screen. If lesions or polyps are found, they can be removed immediately with instruments inserted through the scope. According to most patients, the worst part of the procedure is the day-long prep before the exam to clean out the colon. As patients lie on their side in a hospital setting, anesthesia is used to make them comfortable and unaware. Better techniques and the improved skill of physicians have contributed to the ease and reliability of this exam in recent years. The colonoscopy is considered the gold standard of colorectal procedures.
Your healthcare providers will be the best advisors of which test to undergo for your particular situation, and you need to rely on their expertise. However, it is helpful to know what is involved in each procedure, so you are aware of the medical care that you are receiving.
Written By Joy Seeman
(c) 2009 Hemorrhoid Information Center
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Sigmoidoscopy. (2008, March 8). Retrieved August 13, 2009, from Medline Plus: http://hlm.nih.gov