Factors affecting abdominal pain during colonoscopy

Abstract

Objective: The actual degree of pain or discomfort experienced during colonoscopy varies between patients. This prospective study was conducted to determine what variables, apart from the endoscopist's skill, are associated with a patient's discomfort during this procedure.

Design/methods: From December 2003 to September 2004, 646 colonoscopy examinations performed by three experienced endoscopists were analysed. Midazolam and meperidine were administered intravenously 10 min before the procedure. The degree of patient discomfort was assessed by asking more than five times during the procedure and by using a visual analogue pain scale (0-10) examined up to 7 days after the procedure. Patients were divided into sub-groups as follows: (1) comfortable group (n=304), no complaint during the procedure; and (2) uncomfortable group (n=342), more than one complaint during the procedure.

Results: The correlation between the degree of patient discomfort and the results of the visual analogue pain scale was statistically significant (r2=0.118, P<0.01). Chi-squared analyses demonstrated that female gender, younger age (<or=40 years), presence of symptoms of inflammatory bowel syndrome, history of previous abdomino-pelvic surgery, poorer bowel preparation, longer insertion time (>480 s), technically difficult insertion, and lower body mass index (BMI) are factors associated with uncomfortable procedure. Multivariate analysis demonstrated that younger age, female gender, lower BMI, difficulty of examination, and previous gynaeco-pelvic surgery in female gender are independent factors associated with discomfort during colonoscopy.

Conclusions: An uncomfortable colonoscopic procedure will be expected in younger, female patients with a history of gynaeco-pelvic surgery.