Your Doctor has scheduled you for testing at the clinic for women.
Your check-in to the clinic will be at 8:00 AM the first morning after your menstrual period begins as instructed by your doctor.
Special Note: Please be sure you drink at least 24 ounces of water before you report to the clinic and refrain from urinating before being checked in to the clinic. Be sure to also limit your breakfast to clear fruit juice, tea, and/or coffee.
INITIAL EXAM
Upon arrival you will be taken to an exam room by a nurse for an initial physical exam. In the exam room you will be instructed to disrobe and put on a hospital gown. You will then be placed on an exam table and your legs placed in the stirrups. Your legs will be strapped in the stirrups and a strap will be placed around your chest and arms to insure your safety should you be startled by a cold or unfamiliar instrument. You will then be asked to urinate in a specimen container which the nurse will hold for you. If you cannot urinate at this time a specimen will be collected later. It is important to get this specimen to verify that you are not pregnant even though your period has started. Next the nurse will administer a 4 ounce mineral oil enema to prepare you for a rectal exam. After the enema is administered the nurse will insert a device similar to a tampon in your rectum to help retain the enema.
After you have been prepped, the Doctor will arrive to examine you. Your exam will begin with a routine pelvic exam, a PAP smear, and a visual exam of you vagina and cervix by the use of a speculum. While your vagina is dilated with the speculum it will be irrigated and suctioned out. Next the Doctor will insert a small cup-like device made of rubber called a “Keeper”* into your vagina. The cup fits around your cervix and will catch your menstrual flow. This device will eliminate the need for tampons or pads during your visit and provide laboratory samples. Your nurse will remove the keeper for samples and cleaning on a regular basis. Next the Doctor will remove the retention device from your rectum and you will be instructed to empty your bowels into a bedpan. The Doctor will then insert a gloved finger in your rectum to examine it. After your initial exam is completed your nurse will take you to your room.
PREPARATION FOR YOUR TESTSSince several of the tests you will receive will include x-rays and endoscopic instruments,
it will be necessary to purge all solids from your digestive tract. This will be accomplished with a series of laxatives the day before and one or more cleansing enemas the morning of the tests. Your Nurse will insure you follow this schedule:
10:00 AM You will be given 10 ounces of Magnesium Citrate, followed by an 8 oz. glass of water
11:00 AM 8 oz. glass of water
NOON Jello and clear fruit juice.
1:00 PM 8 oz glass of water
2:00 PM You will be given a 2 oz bottle of “X-Prep” liquid and an 8 oz. glass of water.
3:00 PM 8 oz. glass of water
4:00 PM 8 oz. glass of water
5:00 PM Clear Bullion Soup and 8 oz. glass of water
9:00 PM The nurse will insert a Dulcolax suppository in your rectum. You must retain this suppository for at least 30 minutes before having a bowel movement even if the urge to evacuate is strong.
10:00 PM You will be given 4 Dulcolax tablets to take with an 8oz. glass of water before retiring to bed.
NOTE: The laxatives will start to take effect around 11:00 AM. It is advisable to stay in your room within easy reach of the restroom.
THE DAY OF YOUR TESTS
The morning of your tests will begin with your nurse administering a 2 liter soapsuds enema. You will be instructed to get in the knee-chest position and a tube will be inserted about 6 inches into your rectum. There may be some cramping sensation during the enema. After the enema has been administered you will be instructed to hold your water for about 5 minutes. The nurse will then escort you to the restroom and watch you expel the enema to determine if you will need further cleansing. The nurse may administer another enema if necessary. You will then have your pubic area shaved. You will then be taken to your testing locations by your nurse in a wheelchair. A seatbelt will be used for your own safety.
Your tests schedule will be as follows:
UROLOGIC TESTSYou will first be taken to the Urology Lab. You will be tested for bladder control, capacity and urine flow. You will first be instructed to lay on an exam table with your feet placed in stirrups. Next the Lab Technician place special sensor electrodes in your rectum and your vagina with the aid of an insertion device. Next your urethral area will be cleansed with a sterile solution. A thin rubber tube (catheter) will then be inserted through your urethra and into your bladder. A small balloon at the end of the catheter will be inflated inside your bladder to retain the catheter. Your urine will be drained into a specimen container and another sensor electrode will be inserted through the catheter and placed in your bladder. Next the Technician will connect a syringe to the catheter and fill your bladder with sterile water. You will feel a very strong urge to urinate as your bladder becomes full.
Next the Technician will slowly remove the catheter while leaving the electrode in place in your bladder. You will then be helped off of the exam table and escorted to a special commode seat. The electrodes from your bladder, vagina, and rectum will be connected to a monitor called a “UROLAB”. You will first be instructed just to hold your urine while your bladder pressure is measured. Next you will be instructed to start your urine flow just momentarily and then stop it. The technician will repeat this test about 3 times to measure your bladder control. You will then be instructed to urinate normally until your bladder is empty. Your urine will flow into a container which is measured to check how completely your bladder has emptied. You will then be placed back on the exam table and the electrodes will be removed.
NOTE: If you have difficulty starting your urine flow the technician may induce your flow by administering a mild electric shock through the electrodes. This is not painful but you may feel a slight cramping sensation.
COLONOSCOPYYou will next be taken to the Endoscopy Lab for a complete visual examination of your rectum and your entire large intestine. This test is performed using a long flexible fiber-optic scope called a colonoscope. You will be placed on an exam table and instructed to lie on your left side with your knees drawn up. Next the technician will lubricate your anus and insert a finger into your rectum to help the anus relax. The colonoscope will be inserted in your anus and guided through your colon. As the scope is inserted the technician will occasionally inject air in your colon through the scope to inflate it. You may start to feel a bloating sensation or mild cramping. It is important to retain the air so your colon can be visualized properly. The scope will be inserted about 1.5 meters into your colon and then slowly withdrawn while your colon is examined. After the exam is completed the colonoscope will be removed and you will be instructed to lie on your stomach. The exam table will positioned to elevate your hips. You will then be instructed to expel the air from your colon. It is important to expel as much air as possible to prevent abdominal cramps and to prepare you for further tests. The technician may insert a tube in your rectum to aid in expelling the air if necessary.
X-Ray ExamsYour nurse will take you to the Radiology department for x-rays. The tests will begin with a standard mammogram. The x-ray technician will place your breast in a special retention device which will compress it to provide the best x-ray. You may feel a slight discomfort while your breasts are compressed.
*You will next be taken to another room for x-rays of your bladder. You will be instructed to lie on your back and place the bottoms of your feet together and your knees apart in “frog” position. The technician will clean your urethral area and insert a catheter into your bladder the same as it was done in the Urology Lab. Next the technician will inject a solution into your bladder that shows up on x-ray film. You will feel a strong urge to urinate as your bladder gets full. The technician will then take an x-ray of your bladder. Next the catheter will be removed. It is important to hold your urine at this point. When the technician is ready you will be instructed to urinate while you are lying on the table and take an x-ray while you are emptying your bladder. Don’t forget, it’s only the sterile solution coming out ! You will then be taken to the restroom to finish emptying your bladder. It is normal if you have some air bubbles expelled when you urinate.
You will return to the x-ray room for x-rays of your colon. This is done by the use of a Barium Enema. A Barium Enema involves injecting 3.5 to 4 liters of a thick white chalky fluid into your colon to make it visible on x-ray. You will be placed on the x-ray table on your back and a preliminary x-ray will be taken of your abdomen. Next you will be instructed to lie on your left side. Next the technician will lubricate your anus and insert the barium enema nozzle into your rectum. The enema tube and nozzle are approximately the diameter of a garden hose. Next the technician will pump air into the nozzle to inflate the retention balloon to keep the nozzle in and keep any barium from leaking out. The technician will then release the hose clamp and the barium will start filling your colon. An image of your colon filling will be observed on a video monitor. You will be instructed to assume different positions as you are being filled and spot x-ray films will be taken in these positions. You will begin to feel very bloated as your colon gets completely filled with barium.
Once your colon is full a small bulb will be attached to the enema tube and the technician will slowly pump air into your colon. You will again be instructed to assume various positions for x-rays as the air is being injected. When sufficient air has been added you will be rolled onto your stomach. The retention cuff will be deflated and the enema nozzle removed. It is very important to retain the barium and the air until the exam is completed. You will then be positioned for a final set of x-rays. After the exam is completed you will be taken to the restroom and allowed to expel the barium.
You will return to the x-ray room for another study of you colon called a Defecogram which tests your bowel control. The technician will have you lie on your stomach on the x-ray table. Next a syringe will be inserted in your anus and a thick barium paste (about like peanut butter) will be injected into your rectum and lower colon. Next you will be moved to a special commode chair and the x-ray tube will be positioned to view your colon. The technician will then turn on the fluoroscope and a video recorder and monitor your colon at rest. Next you will be instructed to expel the barium into the commode while your bowel is x-rayed and video taped. A final x-ray film will be taken to see how much of the paste remained in your bowel.
This will conclude your initial diagnostic testing. Your nurse will take you back to your
room. The nurse will administer a 2 liter plain water enema to remove the residual barium
from your colon. You will then be given a dose of Milk of Magnesia and a large glass of
water to further help in cleaning out the barium.
Your doctor will prescribe certain therapies based on these tests….
