Current guidelines are that people without symptoms or a family history of colon cancer should have their first colonoscopy at age 50, at which point about 40-45% of people will have a polyp that could eventually turn into cancer (these are called pre-cancerous adenomas).
Unfortunately, there are no specific symptoms of a pre-cancerous polyp or even an early colon cancer. People who wait to undergo colon cancer screening until they develop symptoms, such as rectal bleeding or abdominal pain, are more likely to have an advanced colon cancer.
To put it another way, colon cancer screening via colonoscopy is a preventative exam, like screening for high blood pressure or high cholesterol to avoid heart disease and strokes. Ideally, you should undergo colon cancer screening BEFORE symptoms develop to find pre-cancerous polyps early, remove them, and decrease your future risk of colon cancer. Research shows that colonoscopy not only decreases the risk of getting colon cancer but also a person’s overall chance of dying from colon cancer.
Most colon prep solutions are comprised of largely tasteless laxative(s) in a weak salt solution. (The salt solution helps prevent fluid loss during the colon prep process.) The salt solution does not taste good. Some people mind it a lot and some people do not mind it at all. Many people find that they can minimize the taste by drinking the prep solution cold and with a straw.
You can also add sugar-free flavor additives (like Crystal Light) to the solution BUT avoid any red/purple colors (which look like blood in the colon) and test the flavor in one glass of the prep before adding it to the entire container (to make sure you like the flavor).
Generally it is best to drink all of the prep. The prep schedule provided at the pre-colonoscopy visit is designed to have you finish the prep a certain time before the colonoscopy. If you stop drinking as soon as your stool turns clear (generally the color of light urine because of bile staining), some stool may still be in the colon or thick bile-stained liquid may start building up again in the upper colon.
Generally, if you get nauseous, the best thing to do is to drink it slower over a longer time period or to try to minimize the flavor by drinking the prep chilled and with a straw. If you get nauseous and have been drinking the prep ice-cold, you may want to warm it somewhat to see if it you are less nauseous while drinking it. If you are unable to tolerate the prep without vomiting, please contact our office
Drinking an adequate amount of clear liquid makes it more likely your colon will be clean at the time of colonoscopy. Just make sure to avoid red/purple liquids so that the residual liquid does not look like blood during your colonoscopy. And stop drinking the liquid at the time you are supposed to be fasting before the colonoscopy.
The quality of your colonoscopy depends on how clean your colon is. Liquid or solid stool can make it hard to find polyps or other abnormalities. The goal of the colon prep is to remove as much stool as possible. While the usual colon prep solutions work well in many people to clean the colon, individuals with constipation or a prior colonoscopy with inadequate colon cleansing often need additional laxative. Milk of magnesia is a gentle laxative that can be given for several days prior to a colonoscopy, as a pre-treatment, to begin to encourage slightly looser and more frequent bowel movements. After the milk of magnesia, the usual colon prep solution has a better chance of fully cleansing your colon. If milk of magnesia was added to your prep instructions, your physician felt that you could benefit from additional laxative therapy. Occasionally, despite addition of milk of magnesia, colon prep quality can still be inadequate; if this occurs, your physician may shorten the interval until your next colonoscopy and/or discuss additional colon prep prior to your next colonoscopy.
During colon prep, you will have frequent bowel movements. The frequent wiping with toilet tissue can cause irritation. The best way to manage this is to have some wet wipes (like baby wipes) on hand during the colon prep so that you are not repeatedly wiping with drying toilet tissue. In addition, you can apply a thin layer of Vaseline to the area around the anus as a barrier to protect the underlying skin.
After receiving sedating medications, your reflexes will be slowed for many hours. For this reason, you must have a licensed driver over age 18 available to drive you home and you cannot drive the remainder of the procedure day. For your driver’s convenience, we offer a comfortable waiting room with free WiFi.
The lining of the colon is not very sensitive and you are unlikely to feel polyp removal. In rare cases, such as with removal of very large polyps, there may be some pain, though this can usually be managed with pain relievers such as acetaminophen (Tylenol). (Non-steroidal medications such as ibuprofen [Motrin, Advil, etc] and naproxen [Aleve] should generally not be used for a few days after polyp removal as they can increase the risk of bleeding; however, your gastroenterologist will give you specific instructions on when it is safe to resume use of non-steroidal medications.)
During colonoscopy, gas is used to expand the colon to permit a thorough exam of the colon walls. In the past, we used air for this purpose, trapped air occasionally caused abdominal discomfort after the procedure. We now use carbon dioxide (CO2) instead of air. CO2 is absorbed through the colon walls and exhaled by the lungs. This has dramatically reduced gas pains after colonoscopy.
With the use of CO2, it is unusual to have severe pain after a colonoscopy. If you have pain, it is generally safe to take low doses of acetaminophen (Tylenol) for the pain. If you develop severe pain, you can either call our office during normal business hours or proceed directly to a local emergency department.
Most colonoscopies are performed with a level of sedation called “conscious sedation”, which means that the patient is able to be aroused and can maintain basic bodily functions (breathing in enough oxygen, maintaining a stable blood pressure, etc.). The goal of this sedation is comfort. However, the typical medications affect memory for a short period, so many patients cannot recall their colonoscopy afterwards. Also, most of the discomfort during a colonoscopy is during insertion of the scope at the beginning of the procedure.
There is generally no significant discomfort during scope withdrawal, so it is not unusual to avoid giving additional medications to patients who begin waking up during scope withdrawal. This means that you may have fuzzy memories of the end of your colonoscopy but will also be ready to go home after the procedure sooner.
Yes, the physician doing the procedure will talk with you after the procedure. However, as the medications given for colonoscopy often affect short-term memory, you may not recall the conversation when you are more alert later in the day. It is not unusual for patients to have no recollection of events between the beginning of their colonoscopy and arriving at home, even if they were talkative after the procedure.
For this reason, we suggest that your escort be available to talk with the physician after the procedure, though – in some cases – patients prefer that their escort not know the results of their procedure.
The key thing is to wear comfortable clothes and footwear that are easy to take off and put back on. During the colonoscopy, you will be dressed in a standard medical exam gown, though you may choose to keep your socks on. The rest of your clothes will be placed in a bag until after your procedure.