Colonoscopy in New Zealand: Preparation, procedure, costs, and more

What is a colonoscopy and why is it important?

A colonoscopy is a procedure during which the doctor inserts a long, flexible tube with a camera into your large intestine (colon and rectum). This process is one of the most effective ways to identify several serious health issues, such as precancerous tumours and bowel cancer, which need prompt attention to improve a patient’s chances of survival.

Conditions a colonoscopy can reveal:

• Polyps: Small growths in the colon’s inner lining. Some of these polyps may be precancerous.
• Colorectal cancer
• Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis
• Diverticulosis: Small sac-like formations in the colon, which can cause abdominal pain
• Lower gastrointestinal bleeding
• Tumours.

When should you consider a colonoscopy?

In New Zealand, bowel screening (testing for bowel diseases even without symptoms) is available every two years free of charge to all eligible adults.

However, if you experience certain symptoms or are at genetic risk of developing bowel cancer, your GP or healthcare provider may suggest you undergo a colonoscopy at an earlier age. Here are some situations where your doctor may advise a colonoscopy:

• Persistent or periodic abdominal pain
• Abdominal swelling
• Blood in your stool
• Unexplained weight loss
• Changes in bowel habits, such as in the frequency or consistency of your stools
• Unexplained anaemia
• Previous history of bowel polyps
• Family history of colorectal cancer or polyps.

Who shouldn’t have a colonoscopy?

While colonoscopies are generally safe and beneficial for most individuals, there are specific circumstances where they might not be recommended.

Alternatives to colonoscopies should be considered for patients recovering from recent significant abdominal surgeries or myocardial infarction (heart attack) and those with severe inflammatory bowel disease or toxic megacolon where the risks of the procedure outweigh the benefits.  

While not an absolute contraindication, colonoscopies are generally avoided during pregnancy unless necessary, due to potential risks to the foetus.

Getting ready for your colonoscopy

Correct preparation for a colonoscopy is necessary to ensure the procedure goes well and provides clear results. Here’s a comprehensive guide on how to get ready for your colonoscopy, based on multiple sources.

1. Dietary restrictions

A few days before the procedure, you will need to modify your diet.

• Low-fibre diet: Switch to a low-fibre diet two to three days before the procedure. Avoid whole grains, nuts, seeds, dried fruits, and raw vegetables.
• Stay hydrated: The day before your colonoscopy, drink clear liquids, like water, broth, tea or coffee without milk or cream, and apple or white grape juice.

2. Bowel preparation

Effective bowel preparation is essential for a successful colonoscopy. This involves:

• Laxatives: You will be prescribed a laxative solution to empty your colon. This is typically done the day before your colonoscopy.
• Split-dose regimen: Some regimens require you to take part of the laxative the evening before and the rest on the morning of the procedure.

3. Medication adjustments

Inform your doctor what medications you’re on. Some of these may need to be adjusted:

• Blood thinners: If you take blood-thinning medications, such as aspirin or warfarin, your doctor may advise you to modify your dosage to reduce the risk of bleeding.
• Diabetes medications: If you are diabetic, your insulin or oral diabetes medication might need to be altered.
• Iron supplements: Stop taking iron supplements at least a week before the procedure, as they can darken the stool.

4. Day of the procedure

On the day of your colonoscopy:

• Fast: Do not eat or drink anything (except possibly clear liquids if advised) for several hours before the procedure.
• Make transport arrangements: Since you may be sedated, you’ll need someone to drive you home after the procedure. Arrange for a friend or family member to accompany you.

Is a colonoscopy painful, and how is it performed?

A colonoscopy is not usually painful due to the sedation used. You may feel some minor discomfort, but this is generally mild and short-lived. Always discuss any concerns with your doctor before the procedure to ensure you are comfortable and well-informed.

Your colonoscopy will probably take between 30 and 60 minutes and involves several steps. Here's a detailed overview of how the procedure is performed:

1. Sedation: Patients are given an intravenous sedative to minimise discomfort during the procedure. Patients remain awake but relaxed and may only feel mild cramping or pressure. Most do not remember the procedure afterwards.
2. Positioning: The patient lies on their side or back with knees drawn up toward the chest.
3. Insertion of the colonoscope: The specialist inserts the colonoscope through the anus and gently advances it through the rectum and into the colon. Air is used to inflate the colon slightly, providing a better view.
4. Examination: The camera on the colonoscope transmits images to a monitor, allowing the specialist to examine the bowel’s lining. Other instruments may be used to take tissue samples (biopsies) and remove polyps if found.
5. Specialised procedures: Additional procedures like argon plasma coagulation and endoscopic polyp and tumour resection can also be performed if needed.

What to anticipate following a colonoscopy

After the procedure, you’ll be taken to a recovery area where medical staff will monitor you as the sedation wears off, for up to an hour. Due to the sedation, you may feel drowsy or slightly disoriented.

Patients may experience bloating or gas due to the air introduced during the procedure. This will subside. Mild cramping can occur but should be temporary.

Your specialist will discuss their findings once you are fully awake; a written summary and any biopsy results will also be provided and forwarded to your GP.

Plan to rest at home for the remainder of the day and drink plenty of fluids. Avoid driving, strenuous activities, alcohol, operating machinery, or making important decisions until the effects of the sedation completely wear off, typically within 24 hours.

You’ll generally be able to resume normal activities the next day.

When to contact a doctor

While complications after a colonoscopy are rare, it's important to be aware of signs that may indicate a problem. Contact your healthcare provider if you experience any of the following:

• Severe abdominal pain: While mild cramping is normal, severe or persistent pain should be reported immediately.
• Heavy or prolonged bleeding: Some minor bleeding, especially if a biopsy was taken or a polyp was removed, can be normal. However, if you experience heavy or continuous bleeding, seek medical attention.
• Fever or chills: A fever of 38°C (100.4°F) or higher, along with chills, could indicate an infection and should be evaluated by a doctor.
• Dizziness or weakness: Feeling faint, dizzy, or unusually weak after the procedure are reasons to seek advice from your healthcare provider.

Colonoscopy in NZ: Costs, wait times, and how health insurance can help

Understanding the costs, wait times, and insurance cover for colonoscopies in New Zealand can help you navigate the healthcare system more effectively. Here’s what you need to know:

Eligibility for a free colonoscopy

In New Zealand, colonoscopies and subsequent treatments are free for individuals eligible to participate in the National Bowel Screening Programme. This programme invites those people aged 60 to 74 and, in some regions, Māori and Pasifika from age 50 to 74 to undergo a screening test (faecal immunochemical test) every two years. If the results come back positive, indicating abnormalities, a colonoscopy will be scheduled at no cost.

Private colonoscopy to avoid wait times

As of November 2023, 16,805 individuals were on the waiting list for a colonoscopy, with 3,875 waiting longer than the maximum time considered clinically safe.

For those not eligible for the free programme, funding a colonoscopy privately or via your health insurer offers a quicker alternative.

Cost of private colonoscopy

The cost of a private colonoscopy in New Zealand can vary but generally ranges from $1,500 to $3,600. This expense covers the consultation, the colonoscopy itself, and any necessary follow-up care. The exact cost can depend on the provider and the specifics of the procedure. Depending on your policy, private health insurance can pay for a substantial portion of this cost.

Health insurance cover

Health insurance can significantly alleviate the financial burden of a colonoscopy and subsequent medical treatments. Many comprehensive plans cover the cost of colonoscopies, especially if they are deemed medically necessary. Health insurance may also cover treatments for bowel cancer, including non-Pharmac-funded drugs, and other conditions detected through a colonoscopy.

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^{Disclaimer: This article is for general information only. Nothing in this blog or on this website is intended as medical, dietary, or financial advice. Although we aim to update our content regularly, you are advised to consult a Policywise adviser, health professional, or an appropriate specialist before acting on any information herein. They can factor in your personal circumstances or preferences and help guide your decision-making process.}