Colonoscopy: Conquer Your Fears and Stay Safe
Don’t Procrastinate With A Test That Could Save Your Life
You just turned 50 and go to your doctor for a check-up. Suddenly, she suggests that you’re due for the dreaded colonoscopy. All you know is that you’re terrified of medical facilities, anesthesia, and strangers watching while you have something stuck up your butt. It’s natural to feel apprehensive, but it is a crucial tool in maintaining your good health. I’m here to explain exactly what happens when you go and why it’s crucial that you don’t wait to have one!
Colon cancer may be much more prevalent than you realize. In fact, the rate of people dying from colorectal cancer, or CRC, has increased enough in recent years that the guidelines have changed. Before, people were instructed to get one at age 50, but that has decreased to 45. The U.S. Preventative Services Task Force changed this. Here are some eye-opening statistics:
- 1 in 23 men and 1 in 25 women will be diagnosed with colorectal cancer (CRC) in their lifetime.
- CRC is the #3 most diagnosed cancer among men and women.
- The American Cancer Society estimates cases for 2025 will be about 107,320 new cases of colon cancer (54,510 in men and 52,810 in women) and about 46,950 new cases of rectal cancer (27,950 in men and 19,000 in women).
- While the overall rates of CRC have decreased by about 1% each year, this is mainly in the older populations that are getting screened.
- Additionally, older adults have seen decreased rates of death from CRC.
- In people under 50, the diagnosis rates increased 2.4% each year between 2012 and 2021, and the rates of death due to CRC have also risen steadily, about 1% per year since the mid-200’s.
Why are younger people more likely to die from CRC than older populations?
A couple of reasons. First, older adults are more likely to get screened. When you get regular screenings, there is a greater chance that the doctor will find what’s called a polyp if it’s there. A polyp is a small growth of tissue found along the colon’s lining. Most of them are benign and will be removed during the colonoscopy. The process is painless, and you won’t even know it happened when you wake up. Polyps don’t usually cause symptoms, so you probably won’t know you have one unless you get a colonoscopy. However, if you have blood in your stool, a change in bowel habits, abdominal pain, or bleeding from the rectum, these could be an indication of a polyp that has progressed and/or cancer, in which case you should get checked sooner rather than later.
On the other hand, if you’re asymptomatic and not being screened, there is a greater risk that any polyp could develop into cancer without your knowledge. If not caught in time, this could prove fatal. The best way to decrease the risk of colon cancer is to get your test. That being said, not many people know that the guidelines have changed. Now that they have, your insurance should pay for you to have the test at 45 instead of waiting to turn 50, and it’s highly suggested that you do so.
Remember, early detection of CRC can significantly increase the chances of successful treatment, making the inconvenience of a colonoscopy well worth it.
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Multiple factors increase your risk of developing CRC:
- Older age
- Smoking
- Diabetes
- Family history of CRC-in fact, it is recommended that if you do have a family history, you start getting screened before 45.
- Inflammatory Bowel Disease, like Crohn’s or Ulcerative Colitis
- Lack of exercise
- Obesity
- Radiation to the pelvic or abdominal area
- Poor diet, eating a lot of fatty foods and meat and not enough fruits and vegetables
Even if you don’t have any of the risk factors above, you are still considered “average risk” and should take your first test by 45.
Multiple options, but which test is best?
For the average-risk adult, multiple options are available. A growing number of at-home stool tests are becoming available. These tests either assess your stool DNA or blood. They are convenient and non-invasive, and most do not require dietary or medication restrictions beforehand. Since they are designed for healthy individuals with low to average risk, they may not be suitable for everyone. These at-home kits are not recommended if you have any symptoms or risk factors. While the kits are simpler and less bothersome, they are not as sensitive as a colonoscopy; they can sometimes yield a false positive, and if you receive a positive result, you will need to follow up with a colonoscopy anyway.
Also available is the Virtual Colonoscopy or CT Colonography. This is a CT scan of your abdominal organs to detect changes or abnormalities in the colon or rectum. It doesn’t require any sedation or invasive procedures. However, the patient must take a prep and cleanse the night before, just like a traditional colonoscopy. Since polyps can’t be removed and tissue samples can’t be taken, you may end up needing a colonoscopy as a follow-up if any abnormalities are noted. Another con is despite going through the prep, the test still remains less accurate than a colonoscopy.
A colonoscopy, often referred to as the ‘gold standard’ of CRC screening tools, is a safe and effective procedure. During this test, a small flexible tube with a camera at the end is inserted into the rectum. The doctor can directly visualize the inside of the colon, allowing for the detection, removal, or biopsy of any abnormalities. This approach is the best way for your doctor to inspect the rectum and colon, and to fix any minor irregularities if present. On the condition that a mass is found, it can be biopsied immediately.
Colonoscopy steps:
The patient must fast the day before and take a prep that will completely (and I mean completely) empty them out before the test, ensuring that there is no stool in the way of the scope and camera. When I had my colonoscopy, I thought the preparation was the hardest part, but it wasn’t that bad. Just plan ahead to stay close to an available bathroom at all times after it starts to work! Unfortunately, under rare circumstances, there are some individuals for whom the prep doesn’t work. If you are one of these individuals, you may need to return for another colonoscopy with a different preparation.
The next day, you will go to a medical facility — either a hospital, outpatient surgical center, or GI center. The staff will check you in and bring you to your preoperative room, where you will completely undress and put on a gown like the one pictured below. The nurse or nurse anesthetist will start your IV, get your vital signs, and ask you some basic preoperative questions (did you eat today, what medicines have you taken, etc.).
I know many people are terrified of the IV, but remember: it’s usually a quick stick, and then it’s over. If you can take some big breaths right before and know that it’s not the worst thing ever, it will help. Also, once the IV is in, that’s where all the good medicine will go!
You will be wheeled to your exam room on a stretcher. The rooms are typically small, and several people will be present. The doctor performs the test, and a technician assists him with the equipment and sample collection. There is always a nurse who will document and sometimes assist as well. If you’re lucky, you’ll have a nurse anesthetist, which means you’ll get the “good stuff.” If there is no anesthesia provider, another RN will medicate you. With this form of sedation, you may not remember the procedure once it’s over, but you’re less likely to stay still while the test is performed, and you’re more likely to wake up with nausea and a headache. If you are moving around, the test will take longer or may need to be canceled until you can do it with anesthesia. Neither of these situations is likely with an anesthesia provider administering the medication. I have told people that if they drink or take any drugs, or if they have high anxiety, they can request to have an anesthesia person for sedation because they have “increased medication requirements.” If you think you need this and inform your doctor well before the procedure, you will be glad you did. Usually, if an anesthetist isn’t administering the medication, it’s because someone (insurance) didn’t want to pay or there just wasn’t anyone available. Trust me, the doctors and nurses would also prefer it if anesthesia were there! Not only do they provide a better sedative experience, but they are also trained to handle any tricky medical issues if they arise.
I am well aware that many people are horribly embarrassed by the thought of “all these people” looking at your most private parts, especially when you’re being “violated” while sleeping. I’m here to tell you that there’s literally nothing to be embarrassed about, and if you still are, believe me, it’s temporary! Don’t forget that the staff in the room may perform up to 15 procedures in just one day. Also, you will get the wonderful drug propofol if you receive anesthesia. It works for almost everyone. When it goes into the IV, your arm may initially feel achy. That’s because it’s thick and contains a preservative that can make it uncomfortable at first. But this stuff works fast! You will be asleep in less than 30 seconds. Most people sleep like sweet angels. Even if you need a little extra or some help with your sleep apnea, your friendly nurse anesthetist will be by your side the whole time with all of her attention. You just take a nap and wake up when it’s over.
After you’re asleep, the doctor uncovers your bottom the tiniest bit and inserts a tiny, lubricated scope. It always goes in easily and is much smaller than some bowel movements I’ve seen after a large meal, so it’s not as invasive or uncomfortable as you might think. Once in, you are covered back up. The only thing the people in the room are looking at is what the camera sees: the inside of your colon, which doesn’t look like anything too exciting for the most part. The test usually takes around 30–60 minutes while you sleep comfortably. Once done, the scope is removed, and the medication stops. In my 15 years as a nurse anesthetist, all my patients woke up comfortably, and many told me it was the best sleep they’d ever had.
That’s it! You will be wheeled out to recovery; the doctor will come out and tell you what she found. After that, you can go on your merry way. The medicine, propofol, will start wearing off almost immediately. It doesn’t leave you nauseous or with a headache like other meds. Your ride will come, and you can return to living your life. Easy-peasie!
Now that you have read about the risk of CRC and the process of a colonoscopy, I hope you will keep up with your screenings. They are relatively easy and potentially life-saving tests that insurance should cover. If you are over 45 and haven’t had one, please consider doing so. It could save your life!
