What to Expect from a Colonoscopy

So you've seen the television ads featuring famous actors telling you they've been screened for colorectal cancer, and that now it's your turn. Maybe you're a little concerned about the process, and you don't really know what "screening" means. You may fear what you might find out. Maybe you just don't like going to doctors, or don't feel that there's anything wrong with you. You might be right, but you might just be wrong.

Colorectal cancer is the second most common cancer in the United States today. But it's the easiest to find and treat. No one in this country needs to die from colon or colorectal cancer. To find out if you have it, or are precancerous, though, you must go get tested.

Who Should be Tested?
If you are 50 or over, you should be screened, so your doctor at the very least has a baseline look at your colon. If you're younger than 50, take a look at your intestinal health. Do you have frequent diarrhea and/or constipation? Do you often have intestinal pain? Are your bowel movements painful? Have you ever seen blood in your stool? It could look maroon, or it could look black and tarry. Discuss any of these symptoms with your doctor; if he thinks that you need a test, especially if you have a family history of colon cancer, it's time for your colonoscopy.

What Is a Colonoscopy?
A colonoscopy is a test in which the doctor inserts an endoscope, a long but flexible tube with a camera and a light, into your rectum, and feeds it into your colon while watching the pictures on a video screen. This lets your doctor get a clear look at your intestines and a close-up of anything that looks suspicious. Sounds unpleasant? It won't be. You'll be given a sedative and will probably be unaware of the whole test.

What Can You Expect When it's Your Turn?
First, your primary care physician will refer you to a gastroenterologist or a surgeon who will actually perform the test. You'll have a consultation with that doctor, and she'll ask you about your symptoms and why your doctor sent you to her. Then she'll set up a time for the procedure, and tell you how to prepare for it.

The preparation is the worst part of the procedure for most people. For a week prior to your colonoscopy, you must avoid taking non-steroidal anti-inflammatories (NSAIDs) like ibuprofen (Motrin ^TM, Advil ^TM), naproxen (Aleve ^TM), or prescription tramadol (but you may take acetaminophen, or Tylenol ^TM). You should stop taking any supplements such as vitamins, minerals, calcium, or iron. Discuss all your medications with the doctor; there may be other medications, prescription and over-the-counter, that you need to avoid for that week, and the surgeon needs to know everything you're taking. You should also avoid pink bismol medications, and black licorice, both of which can interfere with the screening.

The day before the colonoscopy, you'll have to follow a strict liquid diet. You can have any clear liquid, including coffee or tea without any added dairy, sodas, light juices like apple juice, white cranberry juice, or white grape juice, and chicken or beef bouillon with no salt in it. You must avoid dairy products, orange and grapefruit juice, and any Kool-Aid ^TM or gelatin that is red or purple in color, because they can interfere with test results.

At 4:00 p.m. of the day before the colonoscopy, you'll start drinking a prescription drink called Golytely ^TM or Colyte ^TM. It comes as a powder in a one gallon plastic jug. You should fill that prescription at least two days before the colonoscopy, so that you can mix it up the night before you drink it and refrigerate it over night. It mixes best with warm water, but tastes slightly better when cold. Your doctor may tell you that you can add Crystal Light Lemonade to it, or he may tell you to add nothing to it. Follow your doctor's instructions.

You start with an 8 ounce glass, and drink it quickly. Continue to drink 8 ounce glasses every 10 to 15 minutes. Within an hour, your bowels should start to move. You should continue to drink the liquid until what comes out of your bowels is a clear liquid; it may be pale yellow. What the doctor may not tell you is that if you start the liquid diet three or four days before the colonoscopy, this part of the preparation will go much more quickly, because there won't be as much in your bowels to remove, and you may not need to drink the whole gallon before getting that clear water movement. Be prepared with a blanket or a jacket, because you could get cold as your bowels clean out. Don't worry, it's normal for that to happen.

Once your bowels are clear, you may continue to have clear liquids if you want them until bedtime. The morning of the day of your procedure, you may take any of your prescription medications that your doctor tells you to with just a small sip of water, but you shouldn't have anything else to eat or drink.

Have a responsible adult drive you to the hospital or same-day surgery center where you'll have your procedure, and stay there with you until you're ready to leave. You'll be checked in, given a hospital wristband along with a wristband that lists any allergies you may have, and given a room, usually with a comfortable chair and a television, in which you can change into the hospital gown and robe. A nurse or aid will come in and ask you some questions about how you're feeling and how the bowel clearing went, ask you if you have any questions, and then take your vital signs (pulse, blood pressure, and temperature). It's not uncommon to have a slightly higher blood pressure than usual; most people are a little nervous before a colonoscopy. If you're a woman, you'll be asked if you are or may be pregnant. If it's possible that you're pregnant, they'll do a pregnancy test, because the procedure can be dangerous for a fetus.

A nurse will ask you if you need to use the bathroom once more, then you'll be taken to the pre-op room. You'll sit in another comfy chair, and they'll put a warmed blanket over you. The anesthesiologist will come and talk to you, and the nurse will start an intra-venous line (IV) with normal saline solution. The anesthesiologist will want to know any concerns you may have, and whether or not you have any breathing problems. When he's satisfied, you'll be taken to the colonoscopy room in a wheelchair.

In the colonoscopy room, your robe will be removed and the right shoulder of your gown will be unsnapped. The nurse will help you to lie on the gurney; you'll lie on your left side with your knees pulled up to your chest. A nurse anesthetist will be introduced to you, and he'll start the sedation in your IV. Usually the sedation includes drugs like versed and fentanyl, and they also help with pain control. Very soon after that, you'll be asleep.

The next thing you'll be aware of is the nurse trying to wake you up. Although up to half an hour has gone by, you won't remember any of it; you may not even remember the surgeon or gastroenterologist coming into the room. You'll lie still for a few minutes, then the nurse or aid will help you slowly into your wheelchair and take you to your recovery room, often the room where you started. After a few minutes, they'll ask if you want something to eat. You'll probably be offered toast with coffee, tea, or juice.

What Happens Next?
Once you've eaten, if you feel that you can walk, you'll get a trip to the bathroom if you need it. Then the nurse will go through your post-procedure and post-sedation instructions with you. These instructions state, among other things, that you must have someone else drive you home and that you shouldn't drive or operate equipment for the next 24 hours; you should rest for the remainder of the day; and you can resume a regular diet unless your doctor tells you otherwise, or unless you feel any nausea. If you have nausea, stick to 7-Up ^TM, tea or broth, and if the nausea persists, call your doctor.

If your doctor biopsied your colon or removed any polyps, you should continue to avoid NSAIDs for another week, and you may ask your doctor for a prescription for pain. You can also take acetominophen (Tylenol^TM). You may experience a small amount of blood in your first bowel movement after the biopsy. If bleeding continues, or if you experience pain and cramping for more than the first couple of hours after the procedure, or if you have a temperature, you should call your doctor immediately. It's rare to have any complication, but you know your body best, so if anything seems wrong to you, call your doctor.

It may take a week or longer to get your biopsy results. Your doctor or her nurse will call you with results, or to set up an appointment with the doctor so that you can discuss the results and what you need to do from there.

There is no reason to fear a colonoscopy or a sigmoidoscopy (an endoscopy that only looks at the lower part of your colon called the sigmoid colon). While the preparation isn't pleasant, the procedure doesn't hurt, and it can save your life. If precancerous polyps are found, they'll be removed. If you have colon cancer, you'll be treated and most likely cured. If the screening shows no problems, you'll be told that unless you have bowel problems, you won't need another colonoscopy for 10 years. So if it is your turn, don't put it off or blow it off. It's your own life you can save.