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Colonoscopy

A colonoscopy is a vital diagnostic and therapeutic procedure that allows doctors to examine the inner lining of the large intestine (colon and rectum). It is an essential tool in detecting and managing various conditions affecting the lower gastrointestinal tract.

Colorectal cancer is one of the most common cancers in Australia. It begins as a growth called a polyp on the inner lining of the colon or rectum, which can become cancerous over time.

  • Causes: The exact cause of colorectal cancer is unknown, but it involves genetic mutations that lead to uncontrolled cell growth. Factors such as a diet high in red and processed meats, low in fibre, physical inactivity, obesity, smoking, and excessive alcohol consumption can increase the risk.
  • Symptoms: Symptoms of colorectal cancer include changes in bowel habits (such as diarrhoea or constipation), blood in the stool, abdominal pain or discomfort, unexplained weight loss, and fatigue.
  • Risk Factors: Risk factors include age (over 50), a family history of colorectal cancer or polyps, inherited genetic conditions (such as Lynch syndrome or familial adenomatous polyposis), a personal history of inflammatory bowel disease (IBD), and lifestyle factors mentioned earlier.
  • Treatment Options: Treatment for colorectal cancer depends on the stage and may include surgery, chemotherapy, radiation therapy, and targeted therapies. Early detection through screening colonoscopy is crucial, as it allows for the removal of precancerous polyps and early-stage cancers, significantly improving outcomes.

Colorectal polyps are growths on the inner lining of the colon or rectum. While most polyps are benign, some can develop into cancer over time.

  • Causes: Polyps form due to abnormal cell growth in the lining of the colon or rectum. Factors contributing to polyp formation include genetic mutations, age, and lifestyle factors such as diet and smoking.
  • Symptoms: Most polyps do not cause symptoms and are often discovered during routine screening. However, larger polyps can cause rectal bleeding, changes in bowel habits, and abdominal pain.
  • Risk Factors: Risk factors for colorectal polyps include age (over 50), a family history of polyps or colorectal cancer, inherited genetic conditions, inflammatory bowel disease, obesity, smoking, and a diet high in red and processed meats.
  • Treatment Options: During a colonoscopy, polyps can be removed using specialised instruments. This is known as polypectomy. Regular screening and removal of polyps can prevent the development of colorectal cancer.

Inflammatory Bowel Disease (IBD) is a term used for chronic inflammatory conditions of the gastrointestinal tract, primarily Crohn’s disease and ulcerative colitis.

  • Causes: The exact cause of IBD is unknown, but it is believed to result from an abnormal immune response to intestinal bacteria in genetically predisposed individuals. Environmental factors, such as diet and stress, may also play a role.
  • Symptoms: Symptoms of IBD include persistent diarrhoea, abdominal pain and cramping, rectal bleeding, weight loss, fatigue, and, in severe cases, fever.
  • Risk Factors: Risk factors for IBD include a family history of the disease, smoking (for Crohn’s disease), nonsteroidal anti-inflammatory drug (NSAID) use, and a Western diet high in fats and processed foods.
  • Treatment Options: Treatment for IBD aims to reduce inflammation and manage symptoms. This may include medications such as aminosalicylates, corticosteroids, immunomodulators, and biologics. In some cases, surgery may be necessary to remove damaged portions of the intestine. Colonoscopy is essential for diagnosing IBD, assessing disease severity, monitoring response to treatment, and detecting complications.

Diverticulosis is a condition where small pouches (diverticula) form in the walls of the colon. When these pouches become inflamed or infected, it is known as diverticulitis.

  • Causes: The exact cause of diverticulosis is not known, but it is associated with a low-fibre diet, which can lead to increased pressure in the colon and the formation of diverticula. Diverticulitis occurs when these pouches become blocked with waste, leading to infection.
  • Symptoms: Diverticulosis often does not cause symptoms. Diverticulitis, however, can cause severe abdominal pain, fever, nausea, vomiting, and changes in bowel habits.
  • Risk Factors: Risk factors include aging, a low-fibre diet, obesity, smoking, lack of exercise, and the use of NSAIDs.
  • Treatment Options: Treatment for diverticulosis focuses on increasing fibre intake to prevent diverticula formation. For mild diverticulitis, treatment may include antibiotics, a liquid diet, and pain relievers. Severe cases may require hospitalisation and surgery to remove the affected part of the colon. Colonoscopy is used to diagnose diverticulosis and assess the extent of the disease.

Colonic polyps are growths on the inner lining of the colon, which can be benign or precancerous.

  • Causes: Polyps form due to mutations in the genetic material of colon cells, leading to abnormal growth. Factors contributing to polyp formation include age, family history, and lifestyle factors such as diet and smoking.
  • Symptoms: Most colonic polyps are asymptomatic, but larger polyps can cause rectal bleeding, changes in bowel habits, and abdominal discomfort.
  • Risk Factors: Risk factors include being over 50, a family history of polyps or colorectal cancer, inherited genetic conditions, obesity, smoking, and a diet high in red and processed meats.
  • Treatment Options: During a colonoscopy, polyps can be removed using specialised instruments, preventing potential progression to cancer. Regular screening is essential for early detection and removal of polyps.

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder characterised by a group of symptoms that occur together, including recurrent abdominal pain and changes in bowel habits.

  • Causes: The exact cause of IBS is unknown, but it is believed to involve a combination of gut-brain interactions, abnormalities in the gut microbiota, and heightened sensitivity of the gut.
  • Symptoms: Symptoms of IBS include abdominal pain or discomfort, bloating, and changes in bowel habits (diarrhoea, constipation, or alternating between both).
  • Risk Factors: Risk factors for IBS include a family history of IBS, stress, certain food intolerances, and having a gastrointestinal infection.
  • Treatment Options: Treatment focuses on symptom management and may include dietary modifications (such as a low-FODMAP diet), medications to relieve symptoms, probiotics, and psychological therapies such as cognitive behavioural therapy (CBT). Colonoscopy is used to rule out other conditions with similar symptoms.

Colonic strictures are narrowings of the colon that can cause a blockage, often resulting from chronic inflammation or previous surgeries.

  • Causes: Strictures can be caused by conditions such as IBD, previous abdominal surgeries, radiation therapy, or cancer.
  • Symptoms: Symptoms include abdominal pain, cramping, bloating, and changes in bowel habits, such as constipation or diarrhoea. Severe strictures can lead to complete bowel obstruction.
  • Risk Factors: Risk factors include having chronic inflammatory conditions like IBD, a history of abdominal surgery, radiation therapy, and colorectal cancer.
  • Treatment Options: Treatment depends on the cause and severity of the stricture. Mild strictures may be managed with medications and dietary changes. Severe strictures may require endoscopic dilation or surgery to remove the affected section of the colon. Colonoscopy is essential for diagnosing and assessing the severity of colonic strictures.

Haemorrhoids are swollen veins in the lower rectum and anus, which can cause discomfort and bleeding.

  • Causes: Haemorrhoids develop from increased pressure in the lower rectum due to straining during bowel movements, prolonged sitting, chronic constipation or diarrhoea, obesity, pregnancy, and a low-fibre diet.
  • Symptoms: Symptoms of haemorrhoids include rectal bleeding, itching, pain, swelling around the anus, and a lump near the anus, which can be painful or sensitive.
  • Risk Factors: Risk factors for haemorrhoids include aging, chronic constipation or diarrhoea, pregnancy, obesity, and a low-fibre diet.
  • Treatment Options: Treatment options include lifestyle and dietary changes to increase fibre intake, over-the-counter topical treatments, and warm baths. In severe cases, medical procedures such as rubber band ligation, sclerotherapy, or haemorrhoidectomy may be required. Colonoscopy can help diagnose haemorrhoids and rule out other causes of rectal bleeding.

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