Medicine

Patient information for Translation

GI Physiology Unit – Colorectal Investigations

Introduction

Your doctor has arranged for you to have some tests on your lower bowel/back passage. Each of the tests can tell the doctor something different about how your bowel is working, and enable them to decide on the best treatment option for your problem.

This leaflet has been written to give you more information about the tests you are going to have and to ease any concerns that you might have.

Do I need to do anything before my appointment?

If instructed (see your appointment letter), you may be required to stop all laxative medication and the use of suppositories before your appointment. Otherwise, you do not need to do anything before your arrival at the Unit. You can eat and drink as normal and continue to take any medication that you would normally take. You do not need to use any bowel preparation (laxatives, enemas).

Do I need to bring anyone with me?

No. There is no reason why the test should have any adverse effects. However, you are welcome to bring along somebody for support if you wish to do so. Please note that due to the equipment involved, anyone you bring with you will not be able to come into the investigation room with you during the test. If you have children, please arrange for someone to look after them whilst you have the investigation as we cannot provide someone to watch them during your appointment.

I have been sent a questionnaire. What is this for and what do I need to do?

In order for us to fully understand your condition and enable us to interpret the investigations correctly, we have sent you a questionnaire. Please make sure that you complete all aspects of the questionnaire and bring it with you when you attend your appointment. In order to improve the Unit’s performance, information from this questionnaire may be used in an anonymous manner in audits and research. You will have an opportunity to opt out of this if you wish, but please still complete the questionnaire as it is required for your appointment. If you need any help with any questions, your clinician will be able to help you when you attend.

What will happen when I arrive for my appointment?

You will be asked to change into a gown before the test and we will measure your height and weight. You will be asked some questions relating to how your bowel works and the problems you have been having. We will then explain the procedures to you, and you will be asked to sign a consent form, giving us permission to do the tests. We will explain the benefits and risks involved in performing the tests, which can include some mild discomfort, occasional bleeding, or use of radiation. You will be able to ask for the test to stop at any point if you need to.

What will I need to do for the tests?

For all tests, you will be lying down on a couch. If you are undergoing defaecography, you will be moved to a sitting position. Depending on the test you are having, this may be on your left-hand side, front or back. We will explain to you what we are doing at each stage of the tests.

How will I feel?

It can be embarrassing and may be a little uncomfortable to have these tests done on your back passage, but these tests are carried out by experienced professional staff who are committed to ensuring that any discomfort is minimised and that your privacy is maintained at all times.

Do you need to know about my allergies?

If you are allergic to anything, please let us know. For these investigations, it is particularly important that you tell us if you are allergic to latex, gluten, barium, or plasters. We will still do the investigations but will make adaptations to ensure you are not exposed to your allergen material.

I am a female of childbearing age (12-55) – what do I need to know?

Two of the tests we perform involve x-rays. These are not advisable for pregnant women as there is a small risk that they can harm the unborn baby. When you arrive for your tests, we will ask you questions, some of which are personal, to determine your pregnancy status, and you will be asked to sign a form regarding this. Please be aware that if we are not sure if you are pregnant, we will need to postpone the test until after your next period.

Some of our tests can be performed during pregnancy, but only if your referring doctor knew about the pregnancy. If you have become pregnant since you were referred to us, please contact us to let us know as soon as possible.

Will I be asleep during the tests?

No. These investigations are dynamic and require your participation – for example squeezing your muscles – so we are unable to use any sedation for these investigations.

Why are these tests needed?

These tests are an important part of the investigation and the future management of your bowel condition. The results of these tests assist your doctor in planning appropriate treatment for you, so it is important for you to keep your appointment. If you have any concerns or want further information about these tests, please do not hesitate to contact the department.

Which investigations am I having?

Your appointment letter will tell you which investigation(s) you are having. Depending on your symptoms, you may have anything from a single test to all of the investigations listed in this booklet.

What are the GI Physiology Colorectal investigations?

Anal Sensory Testing

This test measures sensation in the back passage (anal canal). It involves inserting a small tube, through which is delivered a very small electric current. You may feel this as a pulsing, twitching or prickling sensation in your back passage, which may be a little uncomfortable.

Rectal Sensation

This test enables us to measure how much volume your rectum can hold, mimicking normal filling of the last part of the bowel. To do this, a small tube with a small balloon attached to it is passed into your back passage. We then inflate the balloon with air to determine what you can feel and the capacity of your rectum. During the test we also look for the presence of a nerve reflex in your back passage.

Anorectal Pressure Measurements (Anorectal Manometry)

This test measures the strength of the muscles in your back passage. To do this, we insert another small tube. You will be guided through a series of manoeuvres (rest, squeeze, cough, push). This enables us to tell whether the muscles are functioning correctly.

Pudendal Nerve Function Test

This test studies the function of the nerves in the pelvic floor, which control the muscles in your back passage. This involves inserting a finger-sized probe, with a small electrode on it, through the back passage into the rectum. A very small electric current is then passed over the nerves causing the pelvic floor muscles to twitch, which can be a little uncomfortable.

Endoanal Ultrasound

This test, which involves inserting a finger-sized probe into the back passage, can tell if the muscles around your back passage (called the anal sphincters) are intact or damaged. The test can also detect abscesses or anal fistulas. 3D scans (pictures) are taken to fully visualise your anal muscles.

Transperineal Ultrasound

An ultrasound probe is placed on your perineum (the skin between the vagina and anus) and you will be asked to squeeze, push and cough whilst a video is recorded showing movements of your anorectum (lower part of your bowel), vagina and bladder.

Transvaginal Ultrasound

This test involves inserting a small probe, about the size of a finger, into your vagina, to look at your pelvic floor structures, including the bladder and rectum. You will be asked to squeeze, push and cough as images are recorded.

Whole Gut Transit

For this test, you will be asked to swallow the capsules that we will have sent you. The capsules contain a total of 60 markers which can be seen on an x-ray. These markers do not undergo any changes in the gastrointestinal tract and will pass out of your body when you open your bowels. They are not a medicine, and they are not absorbed. They do not dissolve and pass straight through your digestive system. On the day of your appointment, you will have an x-ray of your abdomen, which will show up any markers left in your bowel.

Defaecography

This test is used to investigate any problems that you may have when you try to open your bowels. Barium paste (a metallic, chalk-like substance, which shows up on x-ray) is inserted into your rectum via an examining scope until you have the urge to go to the toilet. You will then be asked to sit on a specially-designed toilet in front of an x-ray machine and given instructions to open your bowels so as to pass the barium out of your back passage. While you do this, you will be given privacy behind a screen in a darkened room.

Wireless Motility Capsule (Smart-Pill)

For this test, you will swallow a relatively large capsule (slightly bigger than a multivitamin tablet) when you attend for your appointment. You will then be sent home wearing a small recorder (about purse-sized) which receives information from the capsule about your gut function while the capsule is inside you. You will be asked to return the recorder to the department a few days later.

Cancelling your appointment

This is a specific appointment for you, and we operate on a very tight schedule. Please arrive at least 10 minutes before your appointment time. Unfortunately, if you arrive more than 20 minutes late, we will not be able to see you and we will have to reschedule your appointment.

If you are unable to attend your appointment, please let us know immediately, so the appointment can be offered to somebody else, and we can offer you an alternative date. Please remember that patients who fail to attend appointments not only waste time but increase the waiting time for all patients.

Please note, if you cancel your appointment more than twice, or if you fail to attend an appointment without informing us before hand, we will not be able to offer you an alternative appointment and you will be discharged back to your referring doctor.

Contacting us

If you have any further questions or want to reschedule your appointment, please call us on 0203 594 1791.

Finding the GI Physiology Unit

The new Royal London Hospital

Our unit is located within the new Royal London Hospital, Whitechapel, London, E1 1BB.

Enter the new Royal London Hospital (Whitechapel entrance). Follow signs to LIFT CORE 8 and take the lift to 1^st floor.

You will see signs for Outpatient Imaging (X-ray).

Go through the doors on the right.

You will see main imaging reception – go to the right-hand side.

Report to GI Physiology reception desk.

Parking

There are no dedicated car parking facilities for patients or visitors within the hospital. However, there are a small number of metered parking spaces available on the streets located to the rear of the hospital. There is no disabled parking at the hospital.

By bus

The following buses stop outside or close to the hospital on Whitechapel Road: numbers 25, 106, 205 and 254. Low-floor wheelchair accessible buses run on all routes serving The Royal London Hospital.

By tube and rail

The hospital is located opposite Whitechapel underground station. It is served by the Hammersmith and City and District lines and well as the London Overground. Liverpool Street is the nearest National Rail Station.

Large print and other languages
This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. For more information, speak to your clinical team.
 

এই তথ্যগুলো সহজে পড়া যায় অথবা বৃহৎ প্রিন্টের মত বিকল্প ফরম্যাটে পাওয়া যাবে, এবং অনুরোধে অন্য ভাষায়ও পাওয়া যেতে পারে। আরো তথ্যের জন্য আপনার ক্লিনিক্যাল টিমের সাথে কথা বলুন।

Na żądanie te informacje mogą zostać udostępnione w innych formatach, takich jak zapis większą czcionką lub łatwą do czytania, a także w innych językach. Aby uzyskać więcej informacji, porozmawiaj ze swoim zespołem specjalistów.

Macluumaadkaan waxaa loo heli karaa qaab kale, sida ugu akhrinta ugu fudud, ama far waa weyn, waxana laga yabaa in lagu heli luuqaado Kale, haddii la codsado. Wixii macluumaad dheeraad ah, kala hadal kooxda xarunta caafimaadka.

Bu bilgi, kolay okunurluk veya büyük baskılar gibi alternatif biçimlerde sunulabilir, ve talep üzerine Alternatif Dillerde sunulabilir. Daha fazla bilgi için klinik ekibinizle irtibata geçin.

یہ معلومات متبادل فارمیٹس میں دستیاب کی جا سکتی ہیں، جیسا کہ پڑھنے میں آسان یا بڑا پرنٹ  اور درخواست پر متبادل زبانوں میں بھی دستیاب ہو سکتی ہیں۔ مزید معلومات کے لیے، اپنی کلینکل ٹیم سے بات کریں'۔

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Reference: BH/PIN/989

Publication date: June 2020

All our patient information leaflets are reviewed every three years.

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