Can you feel a colonoscopy

Contents

What’s a Colonoscopy Really Like?

Colorectal cancer is the second-leading cause of cancer-related deaths in the United States for men and women combined, according to the American Cancer Society.

Yet unlike breast, prostate, and lung cancer, colon cancer is one of the most preventable cancers if abnormalities in the colon are detected early with proper screening.

“With colon cancer, the difference is we can detect polyps — little bumps in the colon that turn into cancer,” says Carol Burke, MD, a gastroenterologist at the Cleveland Clinic in Ohio.

“If you have your colonoscopy and have the polyps removed, your likelihood of developing colorectal cancer is substantially reduced.”

While other tests can help detect colon cancer by looking for blood in the stool, abnormal DNA in the stool, or abnormalities found on X-rays, a colonoscopy offers the most comprehensive view of the colon and is therefore more likely than other tests to detect polyps and lesions.

“When these tests are abnormal, they also need to be followed up with a colonoscopy,” says David Greenwald, MD, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital in New York City. “During the colonoscopy, the abnormality can be removed. So colonoscopy is critical as part of the screening process even when the initial screening test is not a colonoscopy.”

When to Get a Colonoscopy

The U.S. Preventive Services Task Force recommends that most adults get an initial colonoscopy at age 50, and then every 10 years until age 75. African-Americans are advised to start getting colonoscopies at age 45.

RELATED: 3 Cancer Screenings Every Adult Should Get

Keith Arian, 64, of Shaker Heights, Ohio, made an appointment for his first colonoscopy on his 50th birthday in 2001.

“I was healthy and have no family history of colon cancer,” he says. “So it was a big surprise when they found a polyp during the procedure.”

The polyp was removed, and over the next 10 years, Arian had several more colonoscopies with no further polyps. In 2012, his doctors told him he could wait five years before having another colonoscopy.

But in 2015, Arian began noticing blood in his stool. “I watched it for about a month,” he recalls. “It’d appear and then disappear. Finally, I went to the doctor, and they discovered I had a tumor in my rectum.”

He underwent chemotherapy and radiation to shrink the tumor, and then had surgery to remove it. Today he is cancer-free.

“My life has been saved by colonoscopies, literally,” Arian says. Now, “whenever someone turns 50, I say, ‘Happy birthday. Have you gotten your colonoscopy yet?’”

Is the Preparation Really That Bad?

The preparation required prior to a colonoscopy — consuming only clear liquids the day before the test and swallowing a large quantity of a laxative to clean out the large intestine — is no fun.

But, Dr. Greenwald says, it’s “generally not as bad as people expect. The preparation is typically with lower volumes of fluid than used previously — so typically half a gallon as opposed to a full gallon — and this is generally split into two doses, many hours apart.”

Arian can attest to the change for the better. “The prep has gotten much better in the 14 years I’ve been having these,” he says. “The taste is much better. It’s no longer incredibly salty and vile, or hard to finish. It tastes more like water.”

Liz Hum, 37, of Salt Lake City, agrees. Hum had a colonoscopy in her early thirties because of unexplained stomach pain.

“I was a little concerned about the prep because my aunt had told me she’d had a bad experience,” Hum says. “It was tough to get down the liquid, but it wasn’t bad. Even the diarrhea part wasn’t as bad as I was expecting.”

Does Having a Colonoscopy Hurt?

Greenwald says the most common misconception about colonoscopy is that it will hurt.

“The truth is that most colonoscopies in the United States are done with sedation,” he says. “The procedure is painless,” and most patients aren’t even aware it’s taken place.

So was the case for Hum. “I was nervous beforehand,” she says. “But all I remember was the nurse rubbing my shoulder for a second, and then the next thing I knew was I was awake and it was over. It was one of the best naps I’ve ever taken.”

A colonoscopy typically takes 30 to 60 minutes to complete, according to Cancer.net, the website of the American Society of Clinical Oncology.

First, the colonoscope is inserted into the colon, then air is often blown in to inflate the colon, making it easier for the doctor to view the inside surfaces. If any abnormal growths are seen, the doctor may use tools within the colonoscope to remove them or may take tissue samples to examine later in the lab.

After a colonoscopy, you may feel some discomfort (gas pains) from having air inserted into your colon. Walking or moving about may help to relieve it.

Getting Your Results

Most of the time, the doctor can give you your results right after the procedure.

And while some people worry about cancer being found during their colonoscopy, “The good news here is that colonoscopy generally detects polyps before they turn into cancer, and removing those polyps prevents cancer,” says Greenwald.

Dr. Burke notes that you should receive a copy of the written report and photos, as well as a follow-up letter notifying you when your next appointment should be.

“If your exam is normal and you don’t have any risk factors, like a personal or family history of cancer or polyps, then your next exam should be in 10 years. If you have risk factors, your next exam could be in 1 to 5 years,” says Burke.

Recovery

Burke says most people are fully back to their pre-procedure state within 30 minutes of completing the procedure and are able to get back to regular activities the next day.

But because the effects of sedation used during colonoscopy can linger for hours, a person should not drive for at least 12 hours after the procedure. Many practitioners require their patients to have an escort even for taking public transportation following a colonoscopy.

If you take a blood-thinning medication and had one or more large polyps removed, you may be told to stop taking that medication for several days to lower the risk of bleeding.

Complications

While complications during or after colonoscopy are rare, they can occur and may include the following:

  • Reactions to the sedative given
  • Bleeding from taking a tissue sample or removing a polyp
  • A tear in the colon or rectum wall
  • Abdominal pain

If you experience any of the following signs and symptoms after having a colonoscopy, call your doctor immediately:

  • Extreme abdominal pain
  • Fever
  • Bloody stool or bleeding from the rectum
  • Dizziness
  • Weakness

Colonoscopy

On this page:

  • What is colonoscopy?
  • How is virtual colonoscopy different from colonoscopy?
  • Why do doctors use colonoscopy?
  • Screening for Colon and Rectal Cancer
  • How do I prepare for a colonoscopy?
  • How do doctors perform a colonoscopy?
  • What should I expect after a colonoscopy?
  • What are the risks of colonoscopy?
  • Seek Care Right Away

What is colonoscopy?

Colonoscopy is a procedure in which a doctor uses a colonoscope or scope, to look inside your rectum and colon. Colonoscopy can show irritated and swollen tissue, ulcers, polyps, and cancer.

How is virtual colonoscopy different from colonoscopy?

Virtual colonoscopy and colonoscopy are different in several ways:

  • Virtual colonoscopy is an x-ray test, takes less time, and you don’t need anesthesia.
  • With virtual colonoscopy, your doctor doesn’t view the entire length of your colon.
  • Virtual colonoscopy may not find certain polyps as easily as a colonoscopy can.
  • Doctors can’t remove polyps or treat certain other problems during a virtual colonoscopy.
  • Your health insurance coverage may be different for the two procedures.

Why do doctors use colonoscopy?

A colonoscopy can help a doctor find the cause of symptoms, such as

  • bleeding from your anus
  • changes in your bowel activity, such as diarrhea
  • pain in your abdomen
  • unexplained weight loss

Doctors also use colonoscopy as a screening tool for colon polyps and cancer. Screening is testing for diseases when you have no symptoms. Screening may find diseases at an early stage, when a doctor has a better chance of curing the disease.

Screening for Colon and Rectal Cancer

Your doctor will recommend screening for colon and rectal cancer —also called colorectal cancer—starting at age 50 if you don’t have health problems or risk factors that make you more likely to develop colon cancer.1

You have risk factors for colorectal cancer if you2

  • are male
  • are African American
  • or someone in your family has had polyps or colorectal cancer
  • have a personal history of inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease
  • have Lynch syndrome, or another genetic disorder that increases the risk of colorectal cancer
  • have other factors, such as that you weigh too much or smoke cigarettes

If you are more likely to develop colorectal cancer, your doctor may recommend screening at a younger age, and more often.

If you are older than age 75, talk with your doctor about whether you should be screened. For more information, read the current colorectal cancer screening guidelines from the U.S. Preventive Services Task Force (USPSTF).

Government health insurance plans, such as Medicare, and private insurance plans sometimes change whether and how often they pay for cancer screening tests. Check with your insurance plan to find out how often your plan will cover a screening colonoscopy.

How do I prepare for a colonoscopy?

To prepare for a colonoscopy, you will need to talk with your doctor, change your diet for a few days, clean out your bowel, and arrange for a ride home after the procedure.

Talk with your doctor

You should talk with your doctor about any health problems you have and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

  • arthritis medicines
  • aspirin or medicines that contain aspirin
  • blood thinners
  • diabetes medicines
  • nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen
  • vitamins that contain iron or iron supplements

Change your diet and clean out your bowel

A health care professional will give you written bowel prep instructions to follow at home before the procedure so that little or no stool remains in your intestine. A complete bowel prep lets you pass stool that is clear and liquid. Stool inside your intestine can prevent your doctor from clearly seeing the lining.

You may need to follow a clear liquid diet for 1 to 3 days before the procedure. You should avoid red and purple-colored drinks or gelatin. The instructions will include details about when to start and stop the clear liquid diet. In most cases, you may drink or eat the following:

  • fat-free bouillon or broth
  • gelatin in flavors such as lemon, lime, or orange
  • plain coffee or tea, without cream or milk
  • sports drinks in flavors such as lemon, lime, or orange
  • strained fruit juice, such as apple or white grape—avoid orange juice
  • water

Different bowel preps may contain different combinations of laxatives—pills that you swallow or powders that you dissolve in water or clear liquids. Some people will need to drink a large amount, often a gallon, of liquid laxative over a scheduled amount of time—most often the night before and the morning of the procedure. Your doctor may also prescribe an enema.

The bowel prep will cause diarrhea, so you should stay close to a bathroom. You may find this part of the bowel prep hard; however, finishing the prep is very important. Call a health care professional if you have side effects that keep you from finishing the prep.

Your doctor will tell you how long before the procedure you should have nothing by mouth.

The instructions will include details about when to start and stop the clear liquid diet.

Arrange for a ride home

For safety reasons, you can’t drive for 24 hours after the procedure, as the sedatives or anesthesia need time to wear off. You will need to make plans for getting a ride home after the procedure.

How do doctors perform a colonoscopy?

A doctor performs a colonoscopy in a hospital or an outpatient center. A colonoscopy usually takes 30 to 60 minutes.

A health care professional will place an intravenous (IV) needle in a vein in your arm or hand to give you sedatives, anesthesia, or pain medicine, so you won’t be aware or feel pain during the procedure. The health care staff will check your vital signs and keep you as comfortable as possible.

For the procedure, you’ll lie on a table while the doctor inserts a colonoscope through your anus and into your rectum and colon. The scope inflates your large intestine with air for a better view. The camera sends a video image to a monitor, allowing the doctor to examine your large intestine.

The doctor may move you several times on the table to adjust the scope for better viewing. Once the scope reaches the opening to your small intestine, the doctor slowly removes the scope and examines the lining of your large intestine again.

For the procedure, you will lie on a table while the doctor inserts a colonoscope through your anus and into your rectum and colon.

During the procedure, the doctor may remove polyps and will send them to a lab for testing. You will not feel the polyp removal. Colon polyps are common in adults and are harmless in most cases. However, most colon cancer begins as a polyp, so removing polyps early helps to prevent cancer.

If your doctor finds abnormal tissue, he or she may perform a biopsy. You won’t feel the biopsy.

What should I expect after a colonoscopy?

After a colonoscopy, you can expect the following:

  • The anesthesia takes time to wear off completely. You’ll stay at the hospital or outpatient center for 1 to 2 hours after the procedure.
  • You may feel cramping in your abdomen or bloating during the first hour after the procedure.
  • After the procedure, you—or a friend or family member—will receive instructions on how to care for yourself after the procedure. You should follow all instructions.
  • You’ll need your pre-arranged ride home, since you won’t be able to drive after the procedure.
  • You should expect a full recovery and return to your normal diet by the next day.

After the sedatives or anesthesia wear off, your doctor may share what was found during the procedure with you or, if you choose, with a friend or family member.

If the doctor removed polyps or performed a biopsy, you may have light bleeding from your anus. This bleeding is normal. A pathologist will examine the biopsy tissue, and results take a few days or longer to come back. A health care professional will call you or schedule an appointment to go over the results.

After the procedure, you—or a friend or family member—will receive instructions on how to care for yourself after the procedure. You should follow all instructions.

What are the risks of colonoscopy?

The risks of colonoscopy include

  • bleeding
  • perforation of the colon
  • a reaction to the sedative, including breathing or heart problems
  • severe pain in your abdomen
  • death, although this risk is rare

A study of screening colonoscopies found roughly 4 to 8 serious complications for every 10,000 procedures.3

Bleeding and perforation are the most common complications from colonoscopy. Most cases of bleeding occur in patients who have polyps removed. The doctor can treat bleeding that happens during the colonoscopy right away.

You may have delayed bleeding up to 2 weeks after the procedure. The doctor can diagnose and treat delayed bleeding with a repeat colonoscopy. The doctor may need to treat perforation with surgery.

Seek Care Right Away

If you have any of the following symptoms after a colonoscopy, seek medical care right away:

  • severe pain in your abdomen
  • fever
  • bloody bowel movements that do not get better
  • bleeding from the anus that does not stop
  • dizziness
  • weakness

Colonoscopy Brochure

A brochure with information about the colonoscopy procedure for patients following a positive iFOBT. This is sent to Program participants with their positive result notification letter to aid discussion with their doctor.

Page last updated: 03 February 2020 (this page is generated automatically and reflects updates to other content within the website)

Colonoscopy Brochure (PDF 257 KB)
You recently had a bowel screening test which found blood in your bowel motion (poo). There could be a number of reasons why blood was found and most are not related to cancer (less than 5%), but it is important to find out what the cause is. Please make an appointment to discuss your results with your doctor. Your doctor may recommend a second test, usually a colonoscopy.

  • Colonoscopy involves a colonoscope (scope) – a narrow tube with a ‘video camera’ at the tip – being passed through your anus/bottom into your bowel.
  • It is the best way to check for the cause of bleeding and remove polyps.
  • A polyp is a small growth attached to the bowel wall. These are common in adults and are usually harmless, but some can develop into cancer.
  • Removing polyps can help to prevent cancer. If the doctor finds polyps during the procedure, they will usually remove them.
  • The doctor may also take small samples of the bowel so they can review it with a microscope for signs of disease.
  • You will not feel anything if a polyp or sample is removed.

How do I prepare for colonoscopy?

If you have any health problems or take regular medicine talk to your doctor before you start your bowel preparation. They may tell you to stop taking some medicines for a few days before your colonoscopy.
Preparation of your bowel involves:

  1. Diet – your doctor will tell you what you can or can’t eat in the days before your colonoscopy.
  2. Medicine – you will be given a bowel preparation kit with instructions on how to use it. You will also take medicine which will make you go to the toilet to empty your bowel.
  3. Fluids – your doctor will give you instructions for staying hydrated.

How is colonoscopy performed?

First, you will be given a light sedative to make you feel sleepy and comfortable. You may even fall asleep. While you are lying down, the doctor will slowly insert a flexible scope through your bottom and into your bowel. The scope has a small camera at the end which will let your doctor look at the wall of your bowel.
The procedure will take about 20 to 45 minutes.

What happens after colonoscopy?

After the procedure you will be given something to eat and drink. When you wake up you may feel a little bloated, but this will only last for about an hour. Very rarely you might pass a small amount of blood, but this is normal.

You can generally go home the same day as the procedure.
Because of the sedation, you should not do any of these things for the 24 hours after your colonoscopy:

  • Drive a car;
  • Travel alone;
  • Use machinery;
  • Sign legal papers; or
  • Drink alcohol.

A friend or family member should take you home and stay with you after your colonoscopy. You should feel better by the next day.

How accurate is a colonoscopy?

Colonoscopy is very accurate, and it is the best way to find out why you had a positive test result. There is still a small chance something could be missed during your procedure. Even if no cancer or polyps are found, you should keep screening and the best way is with the free National Bowel Cancer Screening Program test kits.

Are there any risks or side-effects?

There might be some side effects, but they are not common. You may have a headache or vomiting from the bowel preparation, or have bleeding after the colonoscopy. You might have a reaction to the sedation but this is rare. Very rarely, some people will need to go back into hospital.
You should talk to your doctor about these risks before your colonoscopy.

What are my options?

You can choose to have your colonoscopy in a public or private hospital or clinic. If it is a public facility, it will be free of charge.
If it is a private facility, you may have to pay depending on your private health insurance. You may also need to pay for the bowel preparation.

Who can I contact if I have any questions?

Please note this brochure is provided as a guide and your doctor should provide you with more information.
If you have any questions, please talk to your doctor before your colonoscopy.
Further information about the program can be found at www.cancerscreening.gov.au/bowel
For information in your language, phone the Translating and Interpreting Service: 13 14 50 or visit www.cancerscreening.gov.au/translations

Does a Colonoscopy Hurt?

Prep, procedure and aftercare: the three steps of colonoscopy

In order for the healthcare provider to best visualize the tissues and structure of the colon, a process of bowel preparation is required prior to colonoscopy. This generally involves being on a clear liquid diet along with the use of a prescribed preparation or the day prior to the procedure to clean out the colon. This process is painless but may cause some discomfort associated with an increased frequency of bowel movements during that day.

None of the sensations associated with colonoscopy vary significantly from those experienced during normal functioning of the bowels. Although the procedure would otherwise be associated with a tolerable level of pain and discomfort, anesthetics are used during colonoscopy to enhance patient comfort. Thanks to the use of special anesthetics that allow conscious sedation, also referred to as “awake sedation,” most patients remember little if any of the procedure or any associated discomfort.

If a patient were to remain fully aware during a colonoscopy, he or she would notice a feeling of fullness in the lower abdomen with a sensation similar to a strong need to have a bowel movement. This is a natural reaction of the body to the presence of the colonoscope in the colon. An awake patient would also likely report some abdominal cramping with a sensation similar to bloating or “feeling gassy.” This is caused by the gas introduced into the colon during the procedure.

The procedure itself does not require any recovery time. However, the anesthetic used during colonoscopy can cause some lingering drowsiness. This makes it important to have friends or family members available to drive patients home after the procedure. Patients should also plan to spend the remainder of the day relaxing. During those hours of post-anesthesia recovery, there may be a bit of residual bloating until any gas remaining from the procedure passes naturally from the body.

Protecting and enhancing your digestive health with colonoscopy

Colonoscopy is an indispensable tool to help detect and treat some of the most common causes of cancer and digestive tract disease. While this article is intended to be informational, it cannot replace professional medical advice. If you have questions or concerns around colonoscopy or other digestive health issues, please contact a medical professional in your area.

Consider choosing Digestive Care Physicians for all your digestive health screening and treatment needs. The Digestive Care Physicians team includes three board-certified doctors and a physician’s assistant who serve the greater Atlanta area from their four locations in Alpharetta, Johns Creek, Cumming, and Dawsonville. Digestive Care Physicians also welcomes patients from the surrounding areas of Buford, Gainesville, Sugar Hill, Woodstock, Norcross, Lilburn, Winder, Mountain Park, Duluth, Roswell and beyond.

PMC

The other day, I ate lentils for lunch and then went on a bike ride. It was 9.75 miles of pure agony. And then I thought of all of you. Because next to that, my unsedated colonoscopy was a walk in the park.

I believe I’m the only person ever to have my colonoscopy immortalized in the pages of the Wall Street Journal. The story, which appeared on February 13, 2009, was entitled, “Take a Deep Breath. Doctors are pushing sedation-free colonoscopies. Really.”

My editors thought I was crazy. But I absolutely loved it. The discomfort was minimal, and the benefits were great. All the patients who had been in the waiting room with me before the procedure were either dead asleep, or wandering around talking nonsense. I jumped off the table, took a bite of the rubbery muffin they gave me, tossed it aside, and went out to a Thai restaurant for lunch. After that I pumped iron in my home gym and then put in a productive afternoon at the office.

After the experience, what struck me, is why is this option a secret? The only reason I found out about it is because, well, I’m a reporter. The hospital had sent me a thick packet of information pre-procedure, but all of it was about the prep and it did not even discuss sedation. So I called the Faulkner Hospital endoscopy unit, where I was scheduled for the next morning, and asked my options for sedation or anesthesia. The nurse said, “You’ll get Versed.” I said, um, “are there other options?” She said, “Well you can have it with nothing at all.” But the tone of the voice conveyed that would be a really, really stupid idea.

I looked up Versed online and found out that a major side effect, which some consider its major benefit, is to make you forget what happened. According to the package insert for midalozam, its generic now, 71% of patients getting a colonoscopy had no recollection of the tube being inserted, and 82% had no recollection of it being withdrawn. I also read that many patients don’t remember the conversation with the doctor after the procedure. Okay, so I’m going to find out information important to my health and I’m not going to remember it? As a control freak, this didn’t sit well.

Still, the nurse had sounded so ominous when she talked about the nonsedation option. When I got to the hospital the next morning, I still hadn’t made up my mind. When they took me in back to take my blood pressure, put in the IV etc., I asked the nurse if doing it without sedation was very painful. She said, “All the doctors and nurses do it that way.” I was shocked. I thought, okay, if it’s so nuts, why do all the medical professionals do it? I asked another nurse, and she said she’d had it unsedated and it was fine–a little rocky at the first turn, but after that not too bad. She said if I tried it she would help me breathe. I was sold.

When I got home I did some research on the Web, and I found out that the unsedated option is common in Europe and Asia. Here’s a study by researchers at the University of Lausanne, in Switzerland, published in 2002, which included data from some five thousand patients at 21 centers in eleven European countries. As you can see, nearly 20% of the procedures were done unsedated. I wasn’t able to find U.S. numbers, but everyone I spoke with estimated that fewer than 1% of procedures are done unsedated. Most of those people are doctors, nurses and other highly paid professionals.

What is the reason for the gap between Europe and the U.S.? One thing that shocked me about the email listing criticisms of the funding application for this conference was the comment that the conference needed to discuss how to convince patients. You don’t need to convince patients. It’s the doctors that need convincing.

Joseph G. White, a gastroenterologist at Scott & White Healthcare in Temple, Texas, found that 72% of 158 patients offered the sedation-free option chose it. Most completed the operation successfully and would do it again. He presented his data at the 2000 meeting of the American College of Gastroenterology and at the time, called for unsedated colonoscopy to be the new standard in the U.S.

But he chickened out–and still does sedation with most of his patients. He told me in a conversation for the story, “If you go in stone cold and say ‘Hi, I’m Dr. White, let me try this without sedation, that isn’t going to come across real well. It’s easier to go with the flow, and the standard is sedation.”

We got some mail on this story. This person wrote, “You are an idiot. Period. End of discussion.” But this reaction was not typical of our readers (Fig. 1). Of the 34 letters we received, 24 were positive about the idea of unsedated colonoscopy. Five were negative, including one gastroenterologist, three patients who had not tried it but didn’t think they’d like it, and the guy who called me an idiot. Five were neutral–they wrote to say they liked the story, or had a question about it, but they didn’t express an opinion on sedation-free colonoscopies.

Wall Street Journal (WSJ) readers say getting scoped sedation-free was not painful.

We also got letter from 17 readers who had actually had at least one sedation-free colonoscopy each. Five of them specifically said that they chose this option as a result of the article, and all were delighted. Fifteen of the 17 readers who tried the unsedated option said the pain was minimal–in the words of one, “totally bearable.” Two said they had intense pain, but even those two would do it again. One had already had seven or eight unsedated colonoscopies, and only the last one was excruciating. The other one said the pain was only in the last few moments, so he’d happily put up with it again.

Here’s what some of them said. “I’ve had worse experiences in the dentist’s chair.” “The discomfort of the procedure is mild compared to the colon prep.” “Despite the intense pain at the end only, I would do it again.” “I was proud of myself, and played golf all afternoon.”

WSJ readers are, for sure, an elite segment of the population. We have a circulation of about 2 million. The average age of our subscribers is 55. Eighty-one percent are male. The average household income is $253,000 and the average household net worth is $2.5 million.

But our reader experience, like mine, demonstrates that doctors are not adequately informing patients that the option to skip sedation exists. One reader said, “The hospital staff was quizzical, but cooperative.” Another wrote, “The doctor looked flabbergasted. After an argument, he seemed annoyed. I told him the nurse could hook up the IV. If I started screaming, she could insert the drugs.” And I really like this one, “Doctors were wary of my ability to withstand the so-called pain.” That person went on to have his colonoscopy unsedated, and had four polyps removed, all with no problems.

Here’s somebody who didn’t read the article in time: “I wish I knew about this before last Friday. Being sedated not only caused me to miss a day of work but also to be in a quasi fog-like state until 5 p.m.” Her colonoscopy was at 9 a.m., so that’s a whole day lost, and she wasn’t happy about it.

Several readers wrote to say they wanted to find a doctor who would do it. This one, from Portland, Maine, is so eager she’d happily travel–thought maybe not this far.

While preparing this talk, I called Benjamin Smith, the doctor who did my colonoscopy. Dr. Smith is director of the Gastrointestinal Endoscopy Center at the Faulkner Hospital in Boston. As a measure of his skill, I can tell you that many doctors and nurses ask for him to do their colonoscopies.

I asked him what he did to make it less painful for me, and whether it took longer. Starting with the last question, yes, it took longer–but not much. Dr. Smith is already slow by the standards of many endoscopists; he schedules one procedure an hour. He says eliminating the sedation adds about five minutes to his usual time of 20–30 minutes. On the other hand, doing the sedation takes about three or four minutes, so it’s almost a wash. If it’s the patients’ first time unsedated, a conversation may be needed–which could add some time.

Technique-wise, Dr. Smith told me that he always uses a pediatric scope for sedation-free colonoscopies. He also goes more slowly on the way in, and carefully manages the amount of air he puts into the colon. He uses some water to help compensate for the reduced air, but I don’t think as much water as was demonstrated here this morning. There’s also a few technical tricks, which I imagine all of you know, such as pulling the endoscope back so the colon folds over it like a curtain, which reduces stretching of the colon, and having the nurse press the abdomen to help it travel smoothly.

During my colonoscopy, I didn’t know any of this. From my perspective as a patient, here are the things that made it a good experience for me. It really helped me to know that Dr. Smith had done it before, was confident in his skill and did not seem shocked that I wanted to do it. Also, the backup plan was incredibly comforting. He told me if I found the pain unbearable I could choose Fentanyl, an analgesic, or Versed, or both. I’d feel the effect in two to three minutes, he said.

The single most important factor in making this a good experience for me was the nurse guiding me in deep breathing. It helped relax my body, and by dissipating the tension, the pain reduced.

And the video entertainment was awesome. I have some 600 channels on my Comcast cable TV and nothing comes close to seeing my own colon, in real time, when I’m awake enough to really appreciate it.

In conclusion, I hope all of you will not chicken out. If you are here today, you probably have a strong interest in unsedated colonoscopy. But you may feel that you are bucking the trend that it is easier to go with the flow. But I would like to help give you faith that this is an option that is good for patients. Offering unsedated colonoscopies is not something that needs to be pushed on patients. It is an option that at least a substantial minority of patients will jump at, with delight. Let’s end the secrecy, and start telling patients that they have the choice.

Thank you.

90.9
WBUR
wbur

Guest Contributor

I’m one of an elite group of American patients. Only about one percent of us undergo colonoscopy without sedation. The big secret: it doesn’t have to be painful. And it’s probably safer than with sedation.

Like most Americans, I was ignorant of all of this until about a month ago. In my imagination, a sedation-free colonoscopy would have been painful indeed, the device snaking up my GI tract, pushing against my insides as it resisted the twists and turns. Then my best friend, Greg, who has made several suggestions that have resulted in distinct improvements in my life, suggested forgoing the drugs, as he had recently done.

Gateway to the author’s colon (Courtesy)

It made sense. I could drive myself to and from the hospital, and I’d be able to work when I got home.

Greg had also told me that there’s a correlation of anesthesia with loss of memory later in life. Some googling revealed that this may be true in some cases. But despite that uncertainty, that made the unmedicated colonoscopy far more compelling.

It helped to learn that Dr. Douglas Horst, who would be doing the colonoscopy, did a number of them unsedated, and even more, that he called me to discuss it, putting my mind even more at ease. (He gets top grades on several different doctor evaluation websites.)

And overall, the discomfort was minimal, hitting maybe 3-max out of 10 on the pain-meter for seconds at a time here and there, and otherwise never going beyond 2 out of 10, comparable, perhaps, to a very mild cramp. I’d much rather have another colonoscopy than an upset stomach.

The Prep: Dystopian Poison

Far worse than the colonoscopy was the “prep.”

And the really bad part of the prep was the drinking of the laxative. At 7pm the night before the colonoscopy, and again at 4:30 in the morning, I had to drink 15 ounces — two cups — of the supposedly lemon-lime flavored magnesium citrate. The prep sheet from Beth Israel Deaconess Medical Center in Boston recommended putting it in the icebox prior to use, to blunt the taste, which they suggested because chemical reactions, including those involved in taste, proceed more slowly at lower temperatures. I went one better. I stuck the bottles in the freezer for the last 45 minutes. But even with ice beginning to form in the bottles, the taste was still strong and dreadful. The drink combined the wonderful fizziness of soda — the elixir of the summertime American childhood — with a cloyingly sweetened base metallic taste. There are plenty of bad-tasting medicines, but that juxtaposition of good memories with sweetness gone sickly made this stuff seem like a post-apocalypse dystopian poison.

During the 7pm episode, it took me an hour and a half to down the two cups’ worth, washing each bit down with some ginger ale in a largely vain attempt to banish the dystopian aftertaste. During the 4:30 am episode, I tried chugging it down more quickly, but it still took 40 minutes.

The magnesium citrate had to be followed with at least three normal-sized cups (24 ounces) of clear liquid, to maintain hydration in the face of the saline onslaught. The prep sheet warned that failure to do so could endanger your kidneys — just one more thing to go wrong if you failed to follow the directions in the middle of the night.

Ironically, my biggest fear—the fear that had kept me from getting the colonoscopy for the first nine years after I turned 50, was the vision I’d had of being a prisoner in the bathroom while my guts violently wrung themselves out for hours on end. Yet, the diarrhea, which began after about an hour of drinking the gag soda, was not the least bit gut-wrenching, and not particularly copious — thanks probably to the day of fasting. During the hour and a half or so that it continued, it quickly became liquid, and gradually became clear (your results may vary). While I’d set out magazines and books on the little table, as well as a radio, figuring I wasn’t going to leave the bathroom for a couple of hours, I found I was able to move around the house with impunity.

The Procedure: Up Mine

After a few more hours of sleep, I got up, and drove the 35 minutes or so in mild traffic from Lexington into Beth Israel, arriving around 9:30. I’d been afraid I might need to go to the bathroom on the way in, but the diarrhea was over.

At 10:45, Nurse Tina DiMonda rolled me into the procedure room. She installed an IV — just in case — and asked me to lie on my left side. Then, Drs. Douglas Horst and Byron Vaughn began feeding the colonoscope inside my plumbing.

In our society, and perhaps generally among our species, the rear end carries a lot of baggage, as is obvious from the various epithets and other expressions that have the word, “ass” in them. This is not helpful in the medical theater. But between my own blasé attitude, and the docs’ and Nurse DiMonda’s excellent bedside manner, during these proceedings the anal orifice became a mere porthole into the gastrointestinal plumbing. Mine might have been exposed, but it was totally safe, and I soon forgot about it, despite the fact that it was propped open, mildly uncomfortably, by the colonoscope.

(TipsTimes/flickr)

Dr. Horst immediately launched into some jokes, and soon I felt as if I’d gone to a bar with some friends. Of course, there were some major differences, such as the spectacular view on the screen of the pinkish tunnel with the skinny ridges encircling the passageway, looking the way one might imagine a hallway down the inside of a segmented worm. What is the evolutionary reason for the ridges, I wondered. Dr. Horst said he didn’t know of one, but he’d come up with a theory if I could write it up and make him famous.

Soon, a small clump of tiny white things appeared, adhering to the inside of my colon. “Did you take a capsule?” Dr. Horst asked. “Niacin.”

What Happens During a Colonoscopy?

The colonoscopy is performed by a doctor experienced in the procedure and lasts approximately 30-60 minutes. Medications will be given into your vein to make you feel relaxed and drowsy. You will be asked to lie on your left side on the examining table. During a colonoscopy, the doctor uses a colonoscope, a long, flexible, tubular instrument about 1/2-inch in diameter that transmits an image of the lining of the colon so the doctor can examine it for any abnormalities. The colonoscope is inserted through the rectum and advanced to the other end of the large intestine.

Colonoscopy Animation

The scope bends, so the doctor can move it around the curves of your colon. You may be asked to change position occasionally to help the doctor move the scope. The scope also blows air into your colon, which expands the colon and helps the doctor see more clearly.

You may feel mild cramping during the procedure. You can reduce the cramping by taking several slow, deep breaths during the procedure. When the doctor has finished, the colonoscope is slowly withdrawn while the lining of your bowel is carefully examined.

During the colonoscopy, if the doctor sees something that may be abnormal, small amounts of tissue can be removed for analysis (called a biopsy), and abnormal growths, or polyps, can be identified and removed. In many cases, colonoscopy allows accurate diagnosis and treatment without the need for a major operation.

Colonoscopy

What is a colonoscopy?

A colonoscopy is an outpatient procedure in which the inside of the large intestine (colon and rectum) is examined. A colonoscopy is commonly used to evaluate gastrointestinal symptoms, such as rectal and intestinal bleeding, abdominal pain, or changes in bowel habits.

Colonoscopies are also performed in individuals without symptoms to check for colorectal polyps or cancer. A screening colonoscopy is recommended for anyone without risk factors for colorectal cancer starting at 50 years of age. The timing of your colonoscopies varies depending on the findings of your test. You may need to have a colonoscopy at a younger age if you have an increased risk of colon cancer. These risk factors can include:

  • Having familial polyposis syndrome (a condition that runs in your family and is linked to an increased risk of forming polyps).
  • Having inflammatory bowel disease.
  • Having first degree relatives with colon cancer.

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What to Expect During a Colonoscopy

What Happens After a Colonoscopy

It takes about an hour to begin to recover from deep sedation. Patients will need someone to drive them home because it can take up to a day for the sedative’s full effects to wear off. Patients should be able to resume normal activity the next day. If an adenomatous polyp was removed during a colonoscopy, the gastroenterologist may put the patient on a special diet temporarily.

The GI doctor will go over the results with each patient. The results of a colonoscopy are considered either negative or positive. A negative result is when the doctor did not find any abnormalities in the colon. A positive result is when the doctor found colon polyps or abnormal issues in the colon.

The gastroenterologist may recommend having a follow-up colonoscopy in as little as three months depending on the size and number of colon polyps found. If no polyps were found, the patient’s next colonoscopy will need to be in 10 years, but it could be sooner depending on factors such as family history.

Colonoscopy: When you need it and when you don’t

Colonoscopy is the most accurate test for cancer of the colon and rectum, proven to detect the disease early and save lives. But even a very good test can be done too often. Here’s when you need it, and when you might not.

Having a colonoscopy more than once every five or ten years usually isn’t necessary.

A grape-like growth, or polyp, in the colon or rectum is common in adults and usually harmless. But some polyps—known as adenomas— may eventually turn into cancer. Health care providers can spot and remove polyps during a colonoscopy, which uses a flexible, lighted tube to examine the colon and rectum. If the test doesn’t find adenomas or cancer and you don’t have risk factors for the disease, your chance of developing it is low for the next ten years. That’s because the test misses very few adenomas, and colorectal cancer grows slowly. Even if one or two small, low-risk adenomas are removed, you’re unlikely to develop cancer for at least five years, and repeating the test sooner provides little benefit. So most people need the exam just once a decade, and only a few with larger, more serious polyps may need it more often than every five years.

The test can pose risks.

Colonoscopy is a safe procedure. But occasionally it can cause heavy bleeding, tears in the colon, inflammation or infection of pouches in the colon known as diverticulitis, severe abdominal pain, and problems in people with heart or blood- vessel disease. Some complications can lead to blood transfusions, surgery, hospitalization, or rarely, death. The test also has inconveniences. You have to restrict your diet and take laxatives beforehand. And because the exam requires sedation, someone has to drive you home and you may miss a day of work. So you don’t want to have the test more often than necessary.

So when is it warranted?

Colon cancer screening should begin at age 50 for most people. If a colonoscopy doesn’t find adenomas or cancer and you don’t have risk factors, the next test should be in ten years. If one or two small, low-risk adenomas are removed, the exam should be repeated in five to ten years. Ask your health care provider when and how often to have a colonoscopy if you have inflammatory bowel disease; a history of multiple, large, or high-risk adenomas; or a parent, sibling, or child who had colorectal cancer or adenomas. Routine checks usually aren’t needed after age 75.

Protect against colon cancer:

The following steps can help:

Make lifestyle changes. Eat more fruits, vegetables, and whole grains, and less fatty foods and red or processed meat. Lose excess weight, exercise, limit alcohol, and don’t smoke.

Get accurate test results. Carefully follow your health care provider’s instructions preparing your bowels before the procedure. If you have questions, call the office and go over them with the nurse.

Consider alternatives. If you’re at average risk, talk with your health care provider about other test options, and ask your insurer about coverage. Other tests that can find polyps and cancer, and require bowel prep, include flexible sigmoidoscopy, which uses a short tube to examine the rectum and lower colon, and CT colonography, in which a tube is inserted into the rectum and an X-ray scanner creates pictures. Stool tests can find signs of cancer and don’t require bowel preparation. Abnormalities found on an alternative test must be followed up with a colonoscopy.

Report warning signs. Those include changes in bowel habits lasting a week or two, such as rectal bleeding, dark or narrow stools, constipation or diarrhea, abdominal cramps, or the urge to move your bowels when you don’t need to. Constant fatigue, anemia, and unexplained weight loss can
be later signs.

8 Reasons to Get a Colonoscopy (It’s Really Not a Big Deal)

Colon cancer is more serious and more common than you might think.

In fact, 5 to 6 percent of people will develop colon cancer in their lifetimes, according to Murtaza “Kittu” Parekh, MD, and Rig Patel, MD, of REX Digestive Healthcare. It’s the second leading cause of cancer death in the United States after lung cancer, when counting cancers that affect both men and women.

“But there is good news,” Dr. Parekh says. “Colonoscopy makes colorectal cancer one of the few cancers we can actually prevent.”

A colonoscopy is an examination of the inside lining of the colon, which is where colon cancer starts. During a colonoscopy, a long, narrow, flexible tube with an HD camera at the end is used to evaluate the rectum and colon.

Colonoscopies can detect conditions like colitis, inflammatory bowel disease and diverticulosis. But mainly, doctors are looking for precancerous or cancerous colon polyps, which are growths on the inside of the colon’s lining. If the doctors spot polyps, they can quickly and painlessly remove them during the same colonoscopy.

Talk to your doctor about having a colonoscopy if you are any of the following:

  • Older than 45
  • Older than 40 with a family history of colon cancer or colon polyps
  • You’ve noticed a change in your bowel movements or have bleeding or pain, regardless of your age

There’s no reason to avoid this painless, quick and potentially lifesaving procedure.

Here’s why having a colonoscopy isn’t that bad:

1. A colonoscopy is painless.

Yes, the tube goes exactly where you think it does. But you won’t feel a thing.

Colonoscopies employ monitored anesthesia. You’ll be given medicine through an IV that will keep you comfortable, virtually pain-free and unaware of the procedure.

A nurse anesthetist will administer the medicine and watch you intently—monitoring your heart, breathing and blood pressure—for the duration of the procedure, so the doctors can focus on the colonoscopy.

The only soreness you might feel after would be associated with your IV site, but that typically doesn’t hurt, Dr. Parekh says.

You might pass gas with some startling force for a couple of hours after the procedure. This is normal and not painful.

2. A colonoscopy is quick.

It’s recommended you take the whole day off work to recover from sedation, but going and getting a colonoscopy only takes about half a morning. (The actual procedure can take as little as 15 minutes.)

At REX Digestive Healthcare, if you are healthy and without bowel symptoms, you don’t have to have a consultation and then go through the process of scheduling a separate appointment. You can meet your doctor and have the procedure in the same short session.

3. Forget what you’ve heard. Colonoscopy prep is NOT. THAT. BAD.

People like to talk about the unpleasantness of colonoscopy preparation. But over the past 15 years, colonoscopy preparation has been improved and refined. The truth is, it’s not that bad anymore.

Doctors use split prep, which means you drink a prescribed laxative that will cause diarrhea for a couple of hours, starting around 7 p.m. You should be done around 10 p.m. and able to get some rest. Then, in the morning, you take the second half of the laxative. You’ll need to visit the bathroom with some urgency, but it shouldn’t be as intense as the previous evening, since the majority of your fecal matter will have been flushed out.

Then—boom—you’re done and ready for the quick procedure. Plus, you’ve perhaps finished a crossword puzzle or two? Good job!

But seriously, proper preparation is the patient’s end of the bargain. After all, this procedure might save your life. It’s the most effective when prep is done as directed.

4. You’re not necessarily too young for a colonoscopy.

Guidelines call for colorectal cancer screening starting at age 50 if you’re at average risk. If you’re at increased risk, based on family history of colon cancer or other factors, you’ll want to start earlier, typically at age 40. No matter your age, if you have blood in your stool, weakness and fatigue, or a major change in your bowel habits, talk to your doctor. Recent research from the American Cancer Society found a sharp rise in colorectal cancer rates among adults in their 20s and 30s; in fact, a person born in 1990 has double the risk of colon cancer and four times the risk of rectal cancer compared with people born in 1950.

5. There are alternatives, but colonoscopies remain the most effective, long-term option for colon cancer screening.

There are screening methods besides a colonoscopy, but none comes with as many advantages. For one, a colonoscopy usually needs to be repeated only every 10 years if results are normal. Some other methods, like flexible sigmoidoscopy (a similar procedure that looks at only part of the colon and rectum), must be done every five years. A double-contrast barium enema involves putting barium in the rectum and taking X-rays; it, too, must be done every five years. With these and other alternatives, if a polyp or suspicious mass is found, a colonoscopy will be ordered to follow up. Long story short: Might as well start with the colonoscopy.

And watch out for those at-home colon cancer screening stool tests. Some people are tempted to try fecal immunochemical tests (FITs) because they think the colonoscopy prep and procedure are far worse than they actually are.

At-home colon cancer detection tests are highly sensitive for cancer only when you already have the disease. Colonoscopies detect precancerous lesions and prevent them from growing into anything detectable by a home stool test.

If you do a FIT test or fecal DNA (Cologuard®) test (which can be pricey and require repeat testing after the first one), and it detects cancer, you’ll need a colonoscopy anyway.

6. Colonoscopies can find more conditions than just cancer, and you might feel better as a result.

Colonoscopies also detect the inflammatory bowel diseases (IBD) Crohn’s and ulcerative colitis. Both are inflammatory diseases of the intestines. Identifying them early helps reduce the long-term damage they can do, including scarring and bleeding in the colon, malnourishment, pain and intestinal blockages that require surgery. These diseases also might increase risk of colorectal cancer.

Diverticulosis is a condition that arises when pockets form on the inside lining of the colon. Finding diverticulosis early allows doctors to make suggestions for simple dietary changes, such as eating more fiber, that can prevent the condition from ever causing painful symptoms. If left unaddressed, the pockets can become inflamed and infected, leading to painful complications.

7. Having a colonoscopy is not as embarrassing as you think.

The procedure is typically done at an endoscopy center, and all the patients are there for gastrointestinal care. In other words, everyone is in the same boat.

Yes, everyone is there to have something done that may feel embarrassing. But you can relax—this is regular, everyday work for the clinical staff that will be taking care of you. So don’t worry.

Also, the anesthesia will help you relax, it will be over before you know it, and did we mention it is a virtually painless procedure?

8. A colonoscopy could save your life.

Last but not least, right? Colonoscopies save lives. Lots of them.

A study published in the New England Journal of Medicine suggests that the removal of cancer-causing polyps during a colonoscopy reduces the chance of death from colorectal cancer by 53 percent.

Ultimately, a quick, easy and safe colonoscopy just might save your life.

If you’re 45 or older or have symptoms of a bowel disorder, talk to your doctor about scheduling a colonoscopy. You can schedule one at REX Digestive Healthcare in Wake County or at the UNC GI Clinic in Chapel Hill. If you’re looking for a gastroenterologist, find one year you.

How Safe Is a Colonoscopy?

According to the American Society for Gastrointestinal Endoscopy, serious complications occur in around 2.8 percent of every 1,000 procedures when done in people of average risk.

If a doctor removes a polyp during the test, your chances of complications may increase slightly. While very rare, deaths have been reported following colonoscopies, primarily in people who had intestinal perforations occur during the test.

Choosing the outpatient facility where you have the procedure may impact your risk. One study showed a marked difference in complications, and quality of care, among facilities.

Risks associated with colonoscopy include:

Perforated intestine

Intestinal perforations are tiny tears in the rectum wall or colon. They can be made accidentally during the procedure by an instrument. These punctures are slightly more likely to occur if a polyp is removed.

Perforations can often be treated with watchful waiting, bed rest, and antibiotics. Large tears are medical emergencies that require surgical repair.

Bleeding

If a tissue sample is taken or a polyp removed, you may notice some bleeding from your rectum or blood in your stool a day or two after the test. This is typically nothing to be worried about. However, if your bleeding is heavy, or doesn’t stop, let your doctor know.

Post-polypectomy electrocoagulation syndrome

This very rare complication can cause severe abdominal pain, rapid heart rate, and fever after a colonoscopy. It’s caused by an injury to the bowel wall which results in a burn. These rarely require surgical repair, and can usually be treated with bed rest and medication.

Adverse reaction to anesthetic

All surgical procedures carry some risk of negative reactions to anesthesia. These include allergic reactions and respiratory distress.

Infection

Bacterial infections, such as E. coli and Klebsiella, have been known to occur after colonoscopy. These may be more likely to happen at medical centers that have inadequate infection control measures put in place.

Colonoscopy risks for older adults

Because colon cancer grows slowly, colonoscopies aren’t always recommended for people of average risk or who are older than 75, provided they had the test at least once during the last decade. Older adults are more likely than younger patients to experience complications or death after this procedure.

The bowel prep used can sometimes be of concern for seniors because it can lead to dehydration or electrolyte imbalance.

People with left ventricular dysfunction or congestive heart failure may react poorly to prep solutions containing polyethylene glycol. These may increase intravascular water volume causing complications such as edema.

Prep drinks containing sodium phosphate might also cause kidney complications in some older people.

It’s vital that older people completely understand their colonoscopy prep instructions and are willing to drink the full amount of prep liquid required. Not doing so could result in lower completion rates during the test.

Based on underlying health conditions and health history in older adults, there can also be an increased risk for heart- or lung-related events in the weeks following a colonoscopy.

A colonoscopy is a scary-sounding procedure (who wants a scope going up their most private orifice?!), but it’s one of the best detection tools doctors have for colorectal cancer and bowel diseases. Knowledge is power when it comes to any health procedure, and knowing what to anticipate will make things less worrisome. Here’s what to expect before, during, and after a colonoscopy.

1. Um, how do I know if I need a colonoscopy?

For people with no personal or family history of colorectal cancer or inflammatory bowel disease like ulcerative colitis or Crohn’s, colonoscopies don’t need to begin until the age of 50, according to the Centers for Disease Control and Prevention (CDC). After that first one, you’ll need a test every 10 years.

But for those who meet any of the aforementioned qualifications, you may need to start much sooner and be screened more frequently. The American Cancer Society offers an excellent breakdown (with charts!) of when you should get a colonoscopy based on risk factors like a family history of cancer.

2. Do I have to follow a special diet before the colonoscopy?

The Colon Cancer Alliance recommends that you begin a low-fiber diet the week before your scheduled colonoscopy. In addition to sticking with low-fiber foods, they recommend avoiding fatty foods, fruits and raw vegetables with skins, whole grains, and anything with seeds or nuts, including popcorn. That’s because in order for your doctor to successfully view your colon (aka your large intestine), it must be completely empty—and these foods can become caught in your colon for longer than typical waste. Their recommended meal plan includes things like eggs, white bread, turkey or chicken, Greek yogurt, spinach, and melon.

According to Rudolph Bedford, M.D., gastroenterologist at Providence Saint John’s Health Center in Santa Monica, California, preparation is the most important part. “If you don’t do a good job of emptying out your colon, your doctor won’t be able to see it clearly,” Dr. Bedford tells SELF. “That can result in a missed polyp, a longer procedure, or even a need to repeat the procedure.”

3. OK, so what can I eat the day before the colonoscopy?

The day before your procedure, a clear liquid diet must be followed. According to the Mayo Clinic, this includes water, clear sodas, fat-free chicken or beef broth, and coffee or tea without added milk or cream. Some doctors have added restrictions or allowances (like hard candy), so make sure you follow their individual instructions. Dr. Bedford suggests checking the ingredients list on anything you eat the day before, and “avoiding any fluids that contain red, blue, or purple food coloring” as they can look like blood in your colon during the colonoscopy.

4. Is the prep really as bad as everyone says it is?

There is no sugar-coating this part: The final step of readying your digestive tract for a colonoscopy is to clear it completely, and this is…unpleasant. Each doctor has their own preferred method, but the end result will be the same: complete emptying of your colon. Some doctors prescribe a large volume of liquid laxative prep, while others recommend over-the-counter pill or powder laxatives. Regardless, you should do this part at home or somewhere you’re comfortable—you’ll be going to the bathroom frequently over the course of several hours, until what you pass is totally clear.

Some helpful prep tips from the Colon Cancer Alliance include chilling the prep solution, using a straw so the liquid goes to the back of your mouth and you avoid too much taste, and following the prep by sucking on a lemon slice or a piece of hard candy.

5. Well, now that all that is over, what happens the day of the procedure?

Some patients will have to finish the rest of their bowel prep that morning, while others will go directly to their appointment. Since you’ll be given anesthesia, you’ll need to arrange a ride home from the procedure ahead of time. On procedure day, you’re not allowed anything by mouth (not even water or gum).

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