After putting it off for years, I recently had my first colonoscopy. And I’m glad I did.
Like many others, I had put off having a colonoscopy because of the unpleasant preparation that is required. And, yes, the preparation is somewhat unpleasant; but it’s not that bad and the benefits of the test far outweigh the inconvenience of the preparation.
Read on to learn more about the colonoscopy procedure and my experience with my first colonoscopy.
What Is Colonoscopy
A colonoscopy is a medical procedure in which a physician inserts a flexible instrument which allows her to look inside your colon and rectum, primarily to search for cancerous or pre-cancerous growths called polyps.
Colonoscopy can be done by primary care physicians or surgeons, but it is usually performed by a gastroenterologist.
How Is A Colonoscopy Done
First, some basic biology.
The large intestine consists of the colon and the rectum. The beginning of the large intestine, where partially digested food goes after it leaves the small intestine, is called the cecum. Typically, the distance from the cecum to the rectum is about 4-6 feet. The rectum is about 6 inches long. The rectum leads to the anus.
The colonoscopy procedure involves the insertion of a flexible instrument about the size of your index finger, called a colonoscope, or “scope,” through your anus and into your colon.
The scope has a light on the tip and a camera which takes pictures of the inside of your colon.
The colonoscope is carefully inserted through the anus into the rectum, through the sigmoid colon, then up the descending colon, across the transverse colon and down the ascending colon to the upper end of your large intestine. Then, the scope is carefully withdrawn. Both coming and going, the doctor looks for growths and abnormalities and makes pictures through the scope’s camera.
If they are found, a doctor can remove growths, called polyps, during colonoscopy and later test them in a laboratory for signs of cancer.
Polyps are common in adults and are usually harmless. However, most colorectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.
Anesthesia For Colonoscopy
While it is possible to have the procedure without sedation, 99% of colonoscopies in the United States are done using sedation.
The sedation can be administered by the doctor performing the colonoscopy or by an anesthesiologist. In my case, a nurse anesthetist administered the sedation and monitored me.
I was extremely impressed by the anesthesia used in my case, Propofol. It was administered through an IV and took effect very quickly. At least, that is how it seemed to me. The next thing I knew, it was 15 minutes later and I was awakening in the procedure room.
I had absolutely no memory of the procedure. And there was no discomfort of any kind.
As soon as I awoke from the effects of the Propofol, I was surprisingly alert. There was no groggy, drugged feeling. After only about 15 minutes in their recovery area, I was able to walk out, feeling good. (Nonetheless, following the recommended procedure, my wife drove me home.)
Preparation For Colonoscopy
The part of the process that kept me from following my primary care physician’s annual recommendation to have a colonoscopy — not to mention my wife’s persistent entreaties — was the preparation that is required.
Since I had no abnormal symptoms and no family history of colorectal cancer, I didn’t see a reason to go through the inconvenience. However, based on my research, and my experience with my first colonoscopy, I now think I was wrong.
Before your colonoscopy, your colon must be completely cleaned out so that the doctor can see any abnormal areas. To clean the colon, you have to stop eating and take a strong laxative to empty your bowels.
My doctor’s office gave me specific, written instructions for how to prepare. Because my procedure was scheduled for mid-afternoon, I had to avoid solid food for what ended up being almost 2 days. By then, I was pretty hungry.
Late in the afternoon on the day before the procedure, I had to take a laxative pill and a laxative powder which I mixed with Gatorade.
The result was what you would expect, a series of trips to the bathroom which, in my case, lasted for several hours. I was able to sleep that night without interruption.
For me, the worst part of the preparation was being hungry. Next time, I will schedule my colonoscopy first thing in the morning. I also had withdrawal headaches because I chose to not drink my favorite caffeinated soft drink during the preparation.
Who Should Have A Colonoscopy
For those with a normal risk of colorectal cancer, colonoscopy is recommended beginning at age 50. That is because more than 90% of colorectal cancer cases occur in people ages 50 and over.
Those with symptoms or a family history of colorectal cancer, and those with a higher-than-normal risk such as African Americans, may have to be tested sooner. Consult with your doctor.
Some guidelines recommend that routine screening continue until age 76, with screening an option between ages 76 and 85, depending on overall health and risk factors. Screening is not recommended after age 85.
Studies show that too few people get colonoscopy or any of the other recommended screenings (which are listed below).
The Government Accountability Office found that only a quarter of all Medicare beneficiaries ages 65 to 75 had undergone any of the recommended screenings from 2005 to 2009. And the Centers for Disease Control and Prevention and the National Cancer Institute found that only 58.6 percent of men and women between the ages of 50 and 74 got screened in 2010, far short of the national goal of 70.5 percent.
It is recommended that colonoscopy be done every 10 years unless polyps are found. In that case, the test should be repeated in 5 years.
In my case, a small non-cancerous polyp was found, and removed, so I intend to return for my second colonoscopy in 5 years.
Why Should You Have A Colonoscopy
Colonoscopy is used for a number of specific reasons including investigation of these problems::
- Rectal bleeding
- Change in bowel habits, like persistent diarrhea
- Iron deficiency anemia (a decrease in blood count due to loss of iron)
- Chronic, unexplained abdominal or rectal pain
- An abnormal x-ray exam, like a barium enema or CT scan
- Unexplained weight loss
However, the most common reason for colonoscopy is to screen for colorectal cancer.
Colorectal cancer is the second leading cause of cancer death in the United States and the fourth worldwide. While deaths from colorectal cancer have been declining for more than two decades – mostly because of screening such as colonoscopies – more than 143,000 new cases of cancers of the colon or rectum are expected in the U.S. this year and nearly 52,000 people will die from it, according to the American Cancer Society.
Because of these realities, don’t be as naive as I was. Remember this: Just because you don’t have any pain, bleeding or other symptoms does not automatically mean that you don’t have colorectal cancer.
How Effective Is Colonoscopy
A study done at Memorial Sloan-Kettering Cancer Center in New York and reported in the February, 2012, issue of the New England Journal of Medicine, removed any lingering doubt about whether colonoscopy is effective in preventing deaths from cancer.
That study, which involved following patients who had polyps removed for as much as 20 years, concluded that removing precancerous growths spotted during colonoscopies can cut the risk of dying from colon cancer in half – by 53% actually.
What Are The Alternatives To Colonoscopy
There are alternative screening tests for colorectal cancer.
One is a stool test, such as the fecal occult blood test (FOBT), the fecal immunochemical test (FIT), or the stool DNA test (sDNA). If this is what you use, it is recommended that you do the FOBT and FIT every year or the sDNA every 5 years.
Another option is the Sigmoidoscopy, which involves inserting an instrument which allows your doctor to examine the rectum and sigmoid colon, but not the rest of the colon. This test is recommended every 5 years.
Still another option is the Computed tomographic colonography (CTC), which is also called a virtual colonoscopy. This test should be done every 5 years
Colonoscopy finds more polyps and cancers than other screening test and permits their immediate removal or biopsy. But there are some downsides.
For one, it is expensive, and insurance doesn’t always cover the cost. (However, the new health care reforms will greatly expand the number of people who can get colonoscopies and other proven preventive services without paying anything out of pocket.)
Another downside is that the bowel preparation done in advance is unpleasant, as I have discussed.
Also, most patients are sedated during the procedure, so they can’t go home on their own afterward.
Most importantly, in one of every 400 colonoscopies, there are complications — serious bleeding, colon perforation, infection, abdominal pain, or a cardiovascular event.
Obviously, the risk of complications is reduced if you are being treated by an experienced and skilled colonoscopist. See tip 1, below.
Tips for Your First Colonoscopy
1. Before choosing a doctor to do your colonoscopy, ask about the doctor’s polyp detection rate. Doctors doing colonoscopy should find one or more polyps in at least 25 percent of men and 15 percent of women who are age 50 or older and undergoing screening colonoscopy. Practitioners who find fewer than that may not be careful or thorough enough.
2. Ask for a copy of the report and the photos that were taken. If there is a video, you can ask for that; but there will probably be a charge. You can look at the pictures and assure yourself that there were no polyps that were missed, or you can show them to another doctor for a second opinion if you have any doubt.
3. Be smarter than me, don’t put off your first colonoscopy. Talking with my doctor before my test, I admitted that I was still not sure why I was having the procedure done, other than to keep my wife happy. So, I asked him: with no symptoms or any kind and no family history of colorectal cancer, why am I having a colonoscopy? He said, “because colorectal cancer is a terrible way to die, and it’s completely preventable.”
In short, colonoscopies save lives.