A colonoscopy performed through a stoma, often referred to as a stoma-scope or ostomy endoscopy, is a specialized medical procedure used to examine the lining of the colon or small bowel that remains after ostomy surgery. Instead of inserting the flexible, camera-equipped tube through the rectum, the endoscopist accesses the bowel directly through the surgically created opening on the abdomen. The primary goal of this procedure is surveillance, including screening for colon cancer, investigating symptoms like bleeding, or assessing the health of the remaining intestine for conditions such as Crohn’s disease or pouchitis.
Patient Sensation and Pain Management
The question of whether a colonoscopy through a stoma is painful is addressed by understanding the anatomy of the stoma itself. The stoma, which is the exteriorized portion of the bowel, does not contain pain-sensing nerve endings, meaning the initial insertion of the endoscope should not cause sharp pain. Patients generally report little to no pain when the scope is introduced through the stoma site. Any discomfort experienced during the procedure is typically internal, stemming from the manipulation of the bowel and the introduction of air or carbon dioxide (insufflation).
The sensation is most frequently described as pressure, bloating, or cramping rather than acute pain, as the scope navigates the natural bends of the colon. This pressure occurs because the air is necessary to inflate the bowel walls, allowing the physician a clear view of the lining. The use of carbon dioxide (CO2) for insufflation can significantly reduce post-procedure discomfort because CO2 is absorbed by the body much faster than regular air, minimizing the lingering feeling of bloating and cramping.
To ensure patient comfort and successful completion of the examination, sedation is routinely offered and widely used. Options typically include conscious sedation, administered intravenously, which makes the patient feel relaxed and sleepy, often resulting in little to no memory of the procedure. Sedation is generally recommended to minimize discomfort related to internal bowel manipulation. If a patient is unable to receive conscious sedation, general anesthesia is an alternative option.
Unique Preparation Steps for Ostomy Patients
The preparation for an ostomy endoscopy involves specific steps tailored to the patient’s altered digestive system. Before the procedure, patients are typically required to follow a clear liquid diet for a full day, avoiding solid foods and liquids that are red or purple in color, as these can interfere with the clarity of the bowel examination. The preparation also involves taking a prescribed laxative solution, which causes the bowel to empty all contents.
This bowel cleansing process is managed through the stoma, resulting in a high volume of liquid output. Patients are strongly advised to use a drainable ostomy pouch to manage the frequent discharge. It is important to apply a barrier wipe around the stoma to protect the surrounding skin from the irritating effects of the constant liquid output. Patients must bring a complete set of extra stoma supplies, including pouches and wafers, to the hospital, as the medical facility may not have their specific brand in stock.
What to Expect During the Procedure
Upon arriving for the procedure, the ostomy appliance will need to be removed to allow the physician direct access to the stoma site. The endoscopist may first perform a gentle finger examination of the stoma to confirm it is safe to pass the colonoscope. The thin, flexible scope is then lubricated and carefully inserted through the stoma and guided into the remaining section of the bowel.
The duration of a stoma-scope is often shorter than a traditional colonoscopy, typically lasting between 30 and 45 minutes. During the examination, the physician may take tiny tissue samples, known as biopsies, or remove any polyps that are found. Once the procedure is complete, the patient is moved to a recovery area, and a nurse will immediately clean the area and reapply a fresh ostomy pouch.
The recovery period is generally brief, lasting a couple of hours, allowing the effects of the sedation to wear off. Patients may notice increased gas or mild abdominal cramping immediately afterward due to the air introduced, but this usually resolves quickly as the gas is passed through the stoma. Due to the sedation, a responsible adult must drive the patient home, and patients are advised to refrain from operating machinery or making important decisions for 24 hours.