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This factsheet is intended to provide access to relevant evidence-based information. The national guidelines, research, data, pharmacokinetic properties and links shared are taken from various reference sources, they were checked at the time of publication for appropriateness and were in date. These are provided where we believe the information may be useful but we do not take any responsibility for their content. The factsheet is provided to empower users to make an informed decision about their treatment; but it does not constitute medical advice and cannot replace medical assessment, diagnosis, treatment or follow up from appropriately trained healthcare professionals with relevant competence.
The Breastfeeding Network factsheets will be reviewed on an ongoing basis, usually within three years or sooner where major clinical updates or evidence are published. No responsibility can be taken by the Breastfeeding Network or contributing authors for the way in which the information is used.

If you have any questions about this information, you can contact the Drugs in Breastmilk team through their Facebook page or on druginformation@breastfeedingnetwork.org.uk.

Colonoscopy is carried out under light sedation in order to examine the inside of the colon. A small flexible tube is passed in through the anus and into the intestine. It may be used to diagnose or exclude conditions such as inflammatory bowel disease or diverticulitis. The examination takes under half an hour and in most cases the patient is not asleep but drowsy and relaxed. For further information see www.patient.info/cancer/colon-rectal-bowel-cancer-colorectal/colonoscopy

The colonoscopy procedure is uncomfortable but not painful and is over in a short period. In many instances the preparation period is worse as the urgency to pass motions can be extreme. If a breastfeeding mother needs to have this procedure it may be important that someone is with her to look after the baby during the bowel preparation period, as well as on the day following. She may be drowsy afterwards from lack of food in addition to the colonoscopy and sedation.

In order that the medical staff can examine the gut thoroughly, bowel cleansing is necessary to clear out all faeces in advance of the procedure. This requires a low residue diet for one or two days and the use of a strong laxative the day before the procedure to produce liquid motions as the gut is cleared.

The laxative normally used is a stimulant laxative such as sodium picosulphate (Picolax ®) which is not known to be absorbed into breastmilk or the osmotic laxative macrogol 3350 (Klean Prep ®). Macrogol is an inert substance that passes through the gut without being absorbed into the body. It works because it causes water to be retained in the bowel instead of being absorbed into the body. Enemas such as Fleet ® may also be used without affecting the breastfed baby.

Care should be taken to ensure that the mother remains adequately hydrated throughout the preparation period and on the day of the procedure by drinking plenty of water as permitted by the pre-operative instructions.

Short acting hypnotics such as midazolam, fentanyl and pethidine are used during the procedure itself to sedate the patient and are not contra- indicated during breastfeeding unless the baby is at risk of respiratory depression.

Midazolam: The small amounts of midazolam excreted into breastmilk would not be expected to cause adverse effects in most breastfed infants. New guidelines from the Association of Anaesthetists (2020) state that no delay is necessary in any age group.

Fentanyl: No waiting period or discarding of milk is required before resuming breastfeeding after fentanyl is used for short procedures (e.g., for endoscopy) [Lactmed]

Pethidine: A single dose for anaesthesia or conscious sedation usually does not cause problems in older breastfed infants. [Lactmed]

Drugs used in this procedure are not licensed for use during breastfeeding and are therefore not recommended for use by the manufacturers. This does not imply that they are unsafe. See our factsheet on patient information leaflets for further explanation.

Bibliography

British National Formulary
Hale T. W Medications in Mothers Milk 2016 (17th Ed) Hale publishing
Jones W Breastfeeding and Medication 2013 Routledge
Drugs and Lactation Database (LactMed®): www.ncbi.nlm.nih.gov/books/NBK501922/
Mitchell J, Jones W, Winkley E, Kinsella SM. Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2020;75(11):1482-1493. doi:10.1111/anae.15179
ASGE Standard of Practice Committee, Shergill AK, Ben-Menachem T, et al. Guidelines for endoscopy in pregnant and lactating women [published correction appears in Gastrointest Endosc. 2013 May;77(5):833]. Gastrointest Endosc. 2012;76(1):18-24. doi:10.1016/j.gie.2012.02.029

Colonoscopy and Breastfeeding Mothers

Bibliography

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