Colonoscopy and Faecal Occult Blood Testing (FOBT)

 This procedure was first introduced to Australia in the early 1980s. Initially, colonoscopy was used to investigate patients who had abdominal symptoms. Gradually it came to be used as a screening test for the early detection of bowel cancer in patients with no bowel symptoms, and for surveillance of the remaining colon after bowel cancer or removal of a polyp. 

Informal colonoscopy screening had a significant impact on the rate of death from bowel cancer in Australia. Without formal guidelines, it wasn’t uncommon for patients to have a colonoscopy every two or three years.

Faecal Occult Blood Testing (FOBT) is a test for blood in the stool (faeces) introduced in Australia in 2006 to develop a national bowel cancer screening program - similar to mammogram screening for breast cancer and Pap smear screening for cervical cancer. 

Since 2019 this screening program is fully established and aims to replace colonoscopy as the method of choice in screening and surveillance, except in special circumstances.

OK - so who should have a colonoscopy?

Patients with symptoms: Colonoscopy should be considered in patients with symptoms such as abdominal pain, bleeding from the bowel, mucous (“slime”) from the bowel, or a change in bowel habits. Change in bowel habits is a general term that includes change in frequency - constipation, more frequent eg two to three times a day, or diarrhoea that doesn’t return to normal in a few weeks.  It also includes a change in the stool - shape, colour, amount etc - speak to your doctor. 

Patients with a family history of bowel cancer: If you have a first degree relative - parent, sibling, child - who had bowel cancer under the age of 55 then you should have a colonoscopy from age 45 or age 50, depending on how many relatives  - including second degree relatives - and at what age they were diagnosed. Speak to your doctor.

Patients with a previous bowel cancer: The colonoscopy is repeated 12 months after treatment, then at 6 and 11 years, depending on findings. Speak to your surgeon.

Patients with a previous polyp: Generally after 10yrs, or earlier depending on the number, size and nature of the polyps - speak to whoever did the colonoscopy when the polyp was removed.

Who should have an FOBT?

Everybody else from age 50! 

The FOBT is repeated every two years, unless you have had a colonoscopy in the last four years, in which case four years after the last colonoscopy.

The government will send a free kit to the address listed on your medicare card when you turn 50. Keep your details up-to-date!

Start earlier (age 45) if you have a family history of a first degree relative who had bowel cancer over age 55, or two or more second degree relatives. Your doctor can organise this.

Government funded screening ceases at age 74 as population statistics show other causes of death start to become more likely than bowel cancer. However, if you are in good health, then your own doctor can continue to refer you for FOBT every two years.

What should I know about colonoscopy?

Colonoscopy is a telescope examination of the colon (large bowel). 

Anaesthetic: In Australia, all colonoscopies are done with a qualified anaesthetist in attendance to administer the anaesthetic required and monitor the patient. Anaesthetic requires a period of fasting beforehand. Generally, it is six hours with nothing by mouth - no water, food, gum, prep you forgot to take - NOTHING! The only exception is that sometimes you can be permitted to take regular medications with a sip of water - check with your specialist or the hospital.

Bowel Prep: The bowel must be cleaned of all faecal matter to ensure a good view is obtained. The cleaning is done by administration of a “bowel prep” which your specialist or the hospital will advise you about. Listen carefully, read the instructions and follow them to the letter! At the completion of the prep you should be passing watery faintly green or yellow fluid. If you are still passing thick fluid, or solid material, tell the staff when you are admitted. 

In the Hospital: You will be asked to come to the hospital a few hours before your procedure is scheduled. This allows time for you to be admitted, and a pre-operative check to be done of your blood pressure, temperature, pulse etc. This waiting time can drag a little as exact times may be difficult to estimate, particularly with a busy list. This can be irritating for the patient, but apologies in advance. The general principle is that it is safer to ensure you are thoroughly checked on the day, rather than rushing you through the process.

Some colonoscopies are more difficult than others, but generally the procedure will take about twenty minutes. You will spend about half an hour in the recovery ward and be ready for discharge after about two hours. Obviously, these times can vary as some patients take longer to leave the recovery ward and be ready for discharge. 

You can’t drive for 24 hours so someone will need to pick you up! Ideally you should have someone with you on the first night.

First 24 hours: It is quite common to have cramping abdominal pain until the gas used to expand the bowel escapes as you pass wind afterwards. You may feel a little nauseous, so plan simple foods for this time. 

You may continue to pass residual bowel prep for a few hours, but often the bowels won't open properly in the first 24 hours, or even longer. Let your doctor know if the bowels still have not opened after three days.

Significant complications are rare, but the bowel can be perforated during the procedure. If this happens, you will experience increasing, severe abdominal pain that isn’t relieved by passing gas or faeces. Let your doctor know urgently, or if necessary attend your local emergency department. Don’t have anything more to eat or drink until the pain is sorted out.

Follow up: Generally your specialist will see you after the procedure - on the day, or in their rooms later on. Sometimes your doctor will just contact you by phone or letter, or just send the report through to your own doctor for you to follow up with them. Ask your specialist about what follow up you can expect.

Haemorrhoids 

Bleeding when you open the bowels is a common reason to have a colonoscopy. This is usually from haemorrhoids but must be checked out. The colonoscopy will not fix the haemorrhoids, but will ensure there is not actually something else causing the bleeding.

If your specialist plans to do a procedure to stop the bleeding from haemorrhoids at the same time, then you may experience pain at the haemorrhoid site. This can be mild or quite severe. If severe pain persists longer than 24 hours, let your specialist know.

You may also experience a feeling that you want to open the bowels. Remember that it is unlikely that you will really need to open the bowels in the first 24 hours, so if you feel like you want to go but nothing is happening, don’t sit and strain on the toilet as this can undo the internal stitching or banding. This feeling settles down after about a day.

You can get significant bleeding after a haemorrhoid procedure. After a few days this should settle down just to spotting which can last for several weeks. If significant bleeding persists after a few days, or you experience an increase in bleeding after a week or so, let your specialist know, or attend your local emergency department.