Colonoscopy (Lower Endoscopy)

What is a colonoscopy?

ColonoscopyColonoscopy is a diagnostic procedure that allows your CHOC Children’s doctor to examine the entire length of your child’s large intestine. Colonoscopy can assist in identifying problems with your child’s colon, such as inflamed tissue, ulcers and bleeding. It is rare to use a colonoscopy to detect cancer in children.

An endoscope is a long, flexible, lighted tube (also called a colonoscope) that is inserted through the rectum into the colon. A colonoscope allows your child’s doctor to see inside of the colon, and to irrigate, suction, inject air and access the bowel with endoscopic instruments. During a colonoscopy, the doctor may remove tissue and/or polyps for further examination and possibly treat any problems that are discovered.

Other related procedures that may be used to assess problems of the colon include abdominal X-ray, computed tomography (CT scan) of the abdomen, abdominal ultrasound, barium enema and sigmoidoscopy. Learn more about the diagnostic tools used with gastroenterology patients at CHOC Children’s.

What are the reasons for a colonoscopy?

A colonoscopy may be used to examine colon polyps, tumors, ulceration, strictures (narrowing) and foreign objects within the colon. It may also be used to determine the cause of unexplained chronic diarrhea or gastrointestinal bleeding, or to evaluate the colon after cancer treatment. It may also be recommended based on the results of a barium enema.

There may be other reasons for your child’s doctor to recommend a colonoscopy.

What are the risks of a colonoscopy?

As with any invasive procedure, complications may occur. Complications related to colonoscopy include, but are not limited to, the following:

  • Poor reaction to the sedative or pain medication
  • Nausea, vomiting, bloating or rectal irritation caused by the bowel cleanse prep and/or procedure
  • Persistent bleeding after biopsy or polyp removal
  • In very rare cases peritonitis (inflammation of the lining of the abdominal cavity) or perforation of the intestinal wall can happen.

There may be other risks depending on your child’s specific medical condition. Be sure to discuss any concerns with your child’s doctor prior to the procedure.

Certain factors or conditions may interfere with a colonoscopy. These factors include, but are not limited to, the following:

  • Use of soap suds enemas prior to the procedure, which irritate the lining of the mucosa
  • Presence of barium from previous tests used to examine the colon (such as a barium enema)
  • Inadequate preparation of the bowel before the procedure
  • Problems that may interfere with the passage of the colonoscope, such as narrowing of the colon, surgical adhesions or disease, such as chronic inflammatory disease.

Download Preparing for a Colonscopy PDF.

About the Colonoscopy Procedure

Parents are bound to have a lot of questions about how to prepare for and what to expect after their child’s colonoscopy. All colonoscopies at CHOC are performed in our state-of-the-art procedure center dedicated to the safest hospital experience possible.

This information is intended for CHOC patients and their families. Always consult your child’s doctor for specific information.

Before the Procedure

  • Your child’s doctor will explain the procedure and offer the opportunity to ask questions.
  • A parent (legal guardian) will be asked to sign a consent form to do the test. Read the form carefully and ask questions if something is not clear.
  • Patients are provided with specific instructions on how to prepare for this procedure. Children must adhere to a special diet the day before the colonoscopy and must take medication in order to clean out their bowels. Learn more about colonoscopy preparation.
  • Notify the doctor if your child is sensitive to or is allergic to any medications, latex, tape and anesthetic agents (local and general).
  • Notify the doctor of all medications (prescribed and over-the-counter) and herbal supplements your child is taking.
  • Notify the doctor if your child has a history of bleeding disorders or if they are taking any anticoagulant (blood-thinning) medications, aspirin, ibuprofen or other medications that affect blood clotting. It may be necessary for them to stop these medications prior to the procedure.
  • Patients with diseases of the heart valves may be given antibiotics before the procedure.
  • A sedative and pain medication will be given to provide relaxation and drowsiness before the procedure.
  • Based on your child’s medical condition, the doctor may request other specific preparation.

During the Procedure

A colonoscopy may be performed on an outpatient basis or as part of a stay in the hospital. Procedures may vary depending on the child’s condition

Generally, the colonoscopy follows this process:

  1. After checking in to the hospital, patients are taken to our Tidwell Procedure Center where they will get ready for their procedure in our preoperative area.
  2. Patients are asked to remove any jewelry or other objects that may interfere with the procedure. It is best to leave jewelry at home the day of the procedure.
  3. Your child will be asked to remove all clothing and given a gown to wear.
  4. An intravenous (IV) line may be inserted in your child’s arm or hand. A sedative and/or pain medication may be injected into the IV.
  5. You will meet with both the pediatric anesthesiologist and the endoscopist before the procedure begins.
  6. Your child will be wheeled into one of our state-of-the-art operating rooms where their heart rate, blood pressure, respiratory rate and oxygen level will be monitored during the procedure.
  7. Your child will be asked to lie on his or her left side with their knees bent toward their chest.
  8. Once all before-surgery safety procedures have been performed, the anesthesiologist will then begin administering sedation.
  9. A lubricated colonoscope will be inserted into the anus and advanced into the rectum and colon. It is rare for patients to experience pain, pressure or cramping because they are usually asleep during the procedure.
  10. Air may be injected into the bowel to aid visualization. In addition, a water jet may be used to cleanse the lining of the colon and a suction device may be used to remove liquid feces.
  11. The doctor will examine the colon and may take photographs. Biopsies may be taken from both normal and abnormal tissue. If a polyp is seen, it may be removed, biopsied or left alone until a subsequent operation is performed.
  12. The colonoscope will be removed after the procedure has been completed

After the Procedure

Patients are taken to the recovery area after the procedure. Each patient’s recovery time will vary depending on the type of sedation that is given. Once your child’s blood pressure, pulse and breathing are stable and they are alert, your child will be taken back to their preop room or hospital room. Some children will go home the same day.

Some children may be asked to fast for a few hours and avoid foods high in fiber for the first 24 hours after the procedure.

It is common for children to experience flatulence (passing of gas) and gas pains after the procedure. Walking and moving about may help to ease any discomfort. It is also common to see some blood if biopsies are taken, although it should be less with every bowel movement.

Notify your child’s doctor of any of the following:

  • Fever and/or chills
  • Frequent bloody stools
  • Abdominal pain and/or bloating
  • Inability to pass gas.

Your child’s doctor will provide additional or alternate instructions after the procedure, depending on your child’s particular situation.

Preparing for Colonoscopy

Clear Liquid Diet

Your child should begin a clear liquid diet starting when they wake up the day before their procedure. A clear liquid diet includes:

  • Pedialyte or Gatorade in any color but red.
  • Jell-O in any color but red.
  • Popsicles without pieces of fruit and in any color but red.
  • Chicken, beef or non-red vegetable broth. It is important that the child eat only liquid broth—not soup with meat or vegetables.
  • 7UP or Sprite.
  • Apple juice or white grape juice.

It is very important that red drinks, Jell-O and popsicles be avoided prior to colonoscopy, as the fluid left in the large intestine will look like blood. Blue, purple, yellow and orange drinks, Jell-O and popsicles are fine.

Bowel Cleanout

In order to see as much as possible during the colonoscopy, your child’s doctor will prescribe a bowel cleanout for the day before the colonoscopy. This cleanout will clear most, if not all, stool from your child’s body. The doctor or his staff will provide specific instructions that will be based on your child’s condition, age and other factors. Your child’s doctor will advise ONE of the methods below. All medications are available without a prescription.

Magnesium Citrate: Magnesium citrate is generally used for children over the age of 3. It requires three doses to be given the day before the procedure and should be spread out during the day. Last recommended dose should be given at 5 p.m. to avoid the patient getting up at night to go to the restroom. Lemon lime or cherry flavors are both fine for children to take, as the red dye in magnesium citrate is different than that used in foods and drinks. To make the magnesium citrate taste better, it is important to keep it as cold as possible. It can also be mixed with Gatorade or juice. Another option is to mix Crystal Light fruit drink mix powder into the magnesium citrate (one tablespoon of Crystal Light for smaller doses or two tablespoons for larger doses).

  • 2-5 years old: 2-3 oz.
  • 6 years and up: 1 oz for every year of birth up to 10 oz max.

Milk of Magnesia: Milk of Magnesia is generally used for children younger than 3 years of age. The doses below are given the day before the colonoscopy procedure every four hours until the child has heavy diarrhea.

  • Children up to 2 years: 0.25 ml/kg per dose
  • 2-6 years: 1ml/kg per dose
  • 7-12 years: 2ml/kg per dose
  • Adolescents and young adults: 30-60ml per dose.

Your child’s doctor will provide exact dosing based on the child’s age and weight.

Miralax: Miralax is an alternative cleanout for children of all ages. If your child will be using Miralax, they will be drinking it throughout the day. All of the needed Miralax solution for the day can be made ahead of time and kept in the refrigerator. (Each capful of Miralax is equal to 17 grams.)

  • For children under the age of 7, parents should speak with the doctor about dosing.
  • Children between the ages of 7 and 13 will drink 126g (7.5 capfuls) of Miralax with 32oz of Gatorade throughout the day.
  • Adolescents and young adults ages 13 and older should drink 263g (15.5 capfuls) of Miralax mixed with 64oz of Gatorade throughout the day.

The doctor may ask that your child take one Dulcolax pill after the first four glasses of Miralax, and a second Dulcolax pill after the last four glasses of Miralax.

Questions Before Colonoscopy

If you have any questions or concerns leading up to the day of the colonoscopy – including those having to do with the clear liquid diet, cleanout or signs of illness in the days leading up to the colonoscopy or day of the colonoscopy – please do not hesitate to contact us at 714-509-7646.