and the doctor cannot see the bowel lining, the
COLONOSCOPY CONSENT
procedure will be cancelled.
INFORMATION
WEBSITE SAMPLE PATIENT COPY
What is a colonoscopy?
This is a procedure where your doctor uses a
flexible, lighted instrument with a camera
called a colonscope to look at the inside lining
of your colon, also called bowel. This is done to
find any growths, polyps, cancers or disease in
your bowel. The doctor looks at the picture of
your bowel on a video screen. The scope bends
Will there be discomfort?
so the doctor can move it around the curves of
The procedure can be uncomfortable but to
your colon. The scope also blows air into your
make the procedure more comfortable, sedation
bowel so the doctor can see better. This may
medications can be given. Discuss this with
cause some pressure, bloating or cramping
your doctor before the procedure. If you want
during the procedure.
the sedation, an IV catheter will be placed in
The scope enters your back passage (anus) and
your hand or arm and the sedation medications
goes to the right side of the colon. You will lie
will be injected into the IV catheter.
on your side during the procedure. If the
What is sedation?
doctor finds any growths or polyps he will
remove them. He may also take pieces of the
It is the use of drugs that give you a “sleepy like”
bowel lining (biopsy) to use for testing.
feeling. You will feel very relaxed and may or
may not remember all of what occurs during
You should plan on several hours for waiting,
the procedure.
preparation and recovery. The procedure itself
usually takes 15 to 60 minutes.
Sedation is very safe, but every anesthetic has
some side effects. Most are usually temporary;
You may or may not require sedation for the
some may be longer-term problems. The risk
procedure. Discuss this with your physician.
will depend on whether you:
The preparation of cleansing your colon is very

important. Follow the preparation directions
completely. If the colon is not well cleansed,
1
Are overweight, smoke

Have asthma, diabetes, heart disease,

kidney disease, high blood pressure or
the physician will not be able to pass
other medical conditions.
the colonoscope through the bowel and
cannot see. In this event, the
What are the risks of a colonoscopy?
colonoscopy will end.
There are risks and complications with this

procedure. They include, but are not limited to,
A polyp(s), growth or bowel disease
could be missed.
the following:

If the bowel has not been cleaned well,

Heart and lung problems resulting in
Mild pain and discomfort due to
pneumonia, heart attack or respiratory
trapped air. Moving around will
distress. Emergency treatment may be
generally get rid of this. It may last 1-5
necessary.
days.

Nausea and vomiting

Faintness or dizziness when you first

A medical condition that you already
have that worsens.
What do I do before the procedure:
begin to move around.

Headache.

Pain, redness or bruising at the IV site.
medications, including herbal remedies

Muscle aches and pains
and vitamins.

Allergy to medication given



rare risks of this procedure, but could be
Do not drink or take recreational drugs
24 hours before the procedure.
potentially life-threatening:

A hole in the bowel causing leakage of
If you take a blood thinner, ask your
doctor if you should stop taking it
bowel contents into the abdomen. This
before the procedure. This includes
is called a perforation of the colon and
aspirin. Do not stop taking them
requires surgery to close the hole and
without your doctor’s permission.
leak. About 1 person in every 1,000
How do I clean my bowels before the
cases will accidentally receive a
procedure?
perforation.

Tell the nurse or doctor of any allergies
you have.
Uncommon and rare risks: The following are

Bring your medications or a list of your
When a polyp is removed, there is a 1

person in every 100 that will
Stop taking all iron tables one week
before the procedure.
experience significant bleeding. To

stop the bleeding, a blood transfusion
Follow the bowel cleansing routine and
the diet your doctor/nurse gives you.
or an operation may be necessary.
2

You will either drink a large amount of
Are there other tests I can have done
a special cleansing drink or clear
instead?
liquids with oral laxatives. You will
Yes. You can have a guaiac-based fecal occult
need to stay close to a toilet. You may
blood test every year, a flexible sigmoidoscopy
feel dizzy, have a headache or vomit.
and double contrast barium enema every 5
What is a polyp? What is a biopsy?
years or a CT colonoscopy every 5 years. If
there is any indication of cancer or bowel
Polyps are fleshy growths in the bowel lining.
disease, a colonoscopy may be necessary.
They can be very tiny up to several centimeters
in size. They are usually not cancer but can
What happens after the colonoscopy?
grow into cancer with time. They will be

removed to prevent bowel cancer. The removal
You will be in recovery for several
hours until the sedation wears off.
is not painful.

Your doctor may take a small piece of bowel
YOU MAY NOT DRIVE, OPERATE ANY
MACHINERY, COOK OR MAKE
lining for Pathology to examine. The lining
IMPORTANT DECISIONS FOR 12
may or may not have polyps. The biopsy is used
HOURS AFTER YOUR COLONOSCOPY.
to diagnose conditions of the bowel, including

cancer.
YOU MUST HAVE A DRIVER TO DRIVE
YOU HOME.

If your colonoscopy is being done to find the
You may have some bloating or
cramping afterwards. Moving around
sites of bleeding, your doctor may stop the
will help get rid of the gas.
bleeding by injecting drugs, or using heat

treatment or using small clips.
An appointment may be made for you
to return if a biopsy was taken. You
What if I don’t have the procedure?
will be told what was found before you
leave.
Colonoscopies are recommended for everyone
beginning at the age of 50 to screen for bowel
NOTIFY THE EMERGENCY DEPARTMENT IF
cancer. After your first colonoscopy, it is
YOU HAVE:
recommended you have one every 10 years
unless your doctor recommends one sooner.
If you are having the colonoscopy due to

Severe abdominal pain

Black tarry bleeding from the anus (1/2
cup or more of blood)
symptoms, the symptoms could worsen. The
doctor will not be able to provide the correct
treatment without knowing the cause of the
problems.
3

A fever

Chest or throat pain

Redness, swelling, pain at IV site
4