Many people seem intrigued to learn more about the colonoscopy experience but don't exactly know who to have this type of discussion with. A physician* might sound like the ideal person, but these days docs are (a) hard to nail down for a chat and (b) often charge you for anything outside of the scope of the appointment. Enter moi--a rare individual not squeamish about talking about these types of matters with you.
Sometimes people want to chat because they haven't yet had the procedure but are coming up on the recommended age to get one. They want to have a better idea of what they can expect. Others have recently had a colonoscopy and have this unexplainable desire to share their experience with someone who won't make gagging noises, cover their ears, or roll their eyes at them. There are also people who have had multiple colonoscopies over the decades but since their last one was so long ago, they may have forgotten the finer details of the prep and procedure, and need a refresher.
What I have found from having so many conversations about colonoscopies with a wide variety of people is that the experiences can be oddly similar and drastically different at the same time.
Let's start with the aspects of the colonoscopy experience that tend to be common, like these lovely things...
Food deprivation. When the day of our colonoscopy draws near (shivers just ran up my spine), our gastroenterologists are generally going to have us start modifying our diets days before. This typically means cutting out entire food groups from our meals, including whole grains, raw fruits and vegetables, nuts and seeds...Ummm, me-thinks they got this list wrong because this is actually the list of the top 4 foods I eat every day! Then, the day before the procedure, we usually have to cut out all solid food. But, mercifully, (I guess?), we are allowed to eat jello, broth, popsicles, and similar clear options. Ya know, all the foods that really fill a gal up--LOL. At least, for us caffeine addicts, they don't typically take away our black coffee or tea--one silver lining! Eventually, though, when we're only a few hours away from the procedure, we're down to zero options for food or drink, which is why most of us try to book our colonoscopies for as early in the day as possible.
As if this whole fasting process wasn't bad enough, at the same time we all are going through a...
Bowel cleanse. It seems really counterintuitive that while we are starving ourselves, we are also being asked to drink a horrific-tasting fizzy liquid (or whichever "colonoscopy cocktail" your doc prescribes), that makes us rid our digestive system of anything that we might be storing there for future sustenance. It also makes us very wary of being more than a few strides away from a toilet at any given moment. About halfway through this "cleanse," many of us are wondering if there is really anything else left to come out...And, if you check the toilet after going for the umpteenth time, you'll see that the final poops are pretty much nothing but clear or yellowish matter. Nothing like your normal #2s look (hopefully!). The best part is, even then, when we are 110% certain there is absolutely nothing left in our bowels, we still generally have to continue with the no-eating, diarrhea-inducing drinking process.
A brief pause to apologize to those reading this thinking it would be uplifting about the colonoscopy experience. There's just no way to make this all sound like sunshine, rainbows, and lucky charms. If you were hoping this article was going to make you think, "Ah, this might not be that bad after all," I am probably greatly disappointing you. However, I'd rather you expect the worst, and then have it not be as bad as you thought it would be than have someone sugarcoat this whole process for you and then have it rock your world.
Of course, this suffering does serve a very important purpose. The protocol your physician gives you is critical to follow to ensure that your bowels are spic-and-span for your colonoscopy. Why does your physician need you to have the clearest colon possible? So they can do their job, which is to visualize abnormal tissue in your large intestine, e.g., polyps, tumors, ulcerations, inflammation, diverticula, narrowed areas, and any objects that might be obstructing your colon. As you can imagine, too much poop lining your intestine can greatly affect visibility.
I would also guess that doctors having their patients cleanse their bowels before they stick the colonoscope in them is partially self-serving. Because even if you're the most passionate gastroenterologist, I don't think you want to poke around someone's pipes if they are clogged up and about ready to burst!
Now, if you've ever thought of trying to skip the prep or half-assing it, here's a stat that might persuade you to keep giving it your all even in your darkest moments:
According to research published in the journal Gastroenterology, up to 25% of colonoscopies are canceled due to an unsuccessful bowel prep.
The last thing any of us wants to happen is to show up rarin' to go for our procedure and then be turned away only to have to go through the whole prep process again.
Once we've made it through the prep, the rest is almost always the easiest part. We get a ride to and from the appointment; we get an IV that starts to deliver some fluids, sedatives, and pain meds; then we get rolled into a room where our Doctor and their team await us, eager to get a look at our insides. Then, snap, we're waking up from the procedure--having lost 30 minutes of our day, but generally feeling quite light and airy after this momentary blackout. When we recover from our wooziness, we get a quick chat with the doctor and may or may not get some results immediately (or learn when we will get them); we get driven home; and we get the rest of the day to shake off the cobwebs and start to eat normally again.
For a procedure with such a treacherous beginning, the ending is almost anti-climactic (but we're probably all okay with that).
So, now that we've explored the basic process of the colonoscopy and how it is mostly the same for all of us who go through it, let's run through a few ways that it can veer off in different paths for people...
Glued to the toilet or sporadic pooping. While some people spend their entire prep day on the toilet crapping their brains out, others may have little squirts of bowel activity. My totally non-medical perspective on this is that it depends on your eating behaviors. If you're a pretty clean eater in general--meaning you consume healthy and reasonable amounts of food most of the time--then I think your body will react more gently to the cleansing process.
Fast asleep or cat nap. While most people will be out cold within a short minute or two of being rolled into the exam room, others might go in and out of consciousness during the procedure. I have done both--slept through the whole thing once and then woke up in the middle of the procedure another time. But I wasn't conscious for long as my sweet and attentive anesthesiologist just bumped up the gas a little bit, sending me back into La La land. There is one other entirely different set of people who want to be awake, possibly because they want to get a load of exactly what the doctor is seeing or maybe they just don't want to take any medication. Whether you're curious about what your colon looks like or want to be alert for some other reason, please discuss this with your gastroenterologist way before the actual day of your colonoscopy so both of you can be well-prepared.
Feeling fresh or feeling famished. While some people really get into the cleansing and detoxification outcomes of the colonoscopy experience, others can't wait to eat a Big Mac, large fries, and an Oreo Cookie McFlurry on the way home. Personally, I find that introducing foods slowly for the rest of the day is the approach that makes me feel the best. In addition, I don't tend to eat any differently than I would on any other day, which means I'm not rewarding myself with fast food or sugary sweets just for taking a tube up my bum-bum like a champ. However, if you want to recognize this accomplishment every 10 years with a splurge, I am not going to say you're out of line to do so!
See you in 10, or see you sooner. For most people, a colonoscopy is a once-in-a-decade experience that the American Cancer Society now recommends should start at age 45 years if you are at average risk. However, a smaller proportion of the population does end up having to get this procedure more frequently, or at a younger age, including me and my unfortunate tuckus. The following are a few reasons why you might be required to get your colon checked more regularly:
A personal history of colorectal cancer or certain types of polyps
A family history of colorectal cancer
A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer
In my case, family history clinched my place in the "needs more frequent colonoscopy" category. So, even though I'm just 52, I've already had two procedures--my first one around 2015 and my most recent one in 2020. And I've got my reminder scheduled for my next exam in 2025.
As much as I'm not eager to go through the prep or probing process again in just a couple of years, I know how critically important is to stick to this schedule to ensure that my insides look pink and healthy!
A final footnote: These stories come partially from my own experiences but also those of family members, friends, clients, and acquaintances who have been open to sharing their colonoscopy ups and downs with me. I would love to hear about your unique colonoscopy experience--seriously--and encourage you to get your first or regular colonoscopies as recommended.