You turned 50 and it started. Your doctor kept telling you it was time for your colonoscopy. And whether you procrastinated or immediately took your doctor’s advice, you were probably not very excited about the prospect. But you went ahead and booked the appointment and now you wonder what you should expect.
Who So Much Pressure to Get a Colonoscopy Anyway?
Doctors suggest colonoscopy for two different purposes – diagnosis and screening. A diagnostic colonoscopy may be performed if you have symptoms that cause suspicion of a problem in your colon. Doctors recommend it only as needed, not according to a particular schedule. On the other hand, a screening colonoscopy is performed in an effort to detect disease before it causes symptoms, and the schedule is determined in an effort to maximize the benefit while minimizing the risks.
The United States Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer in all adults aged 50 through 75. They give the recommendation a grade of A, meaning there is a high certainty that the net benefit of screening is substantial.
Other people who need screening for colorectal cancer include younger folks with a family history of certain cancers or genetic syndromes. If you think this may apply to you, it is important to have a conversation with your doctor about the right approach.
Screening can be performed by a number of methods, but colonoscopy is the most sensitive, meaning it misses fewer cancers than the other screening options. In addition, you only need it once every ten years, as long as results are normal. The other options require more frequent testing. Unless there is a health reason you shouldn’t have a colonoscopy, your doctor will probably recommend one.
What Happens Next?
Prep. As your colonoscopy appointment approaches, you will be instructed to “prep your colon.” This involves drinking a beverage designed to clear out the contents of your bowels. We won’t lie – most people don’t enjoy this process. But diligently following your prep instructions means your doctor will be able to have the best possible view of your colon walls, and that reduces the chance that a problem will be overlooked.
Sedation. The idea of a colonoscopy can make a lot of folks nervous and it can be a bit uncomfortable, as you might imagine. For this reason, the doctor will administer IV sedation. It allows you to remain awake, but less aware of any discomfort from the procedure. Sometimes the doctor recommends anesthesia, and in that case an anesthesiologist will administer the anesthesia and be present throughout the procedure.
The procedure. The test itself is pretty straightforward. You will lie on your left side, and the doctor will thread a long tube, or “scope,” through the anus and up the entire length of the colon. It is about a half inch in diameter and has a camera at the end. As the doctor withdraws the scope, they will watch the image of the colon wall looking for any abnormalities. If they notice anything out of the ordinary, they will note the location and take a biopsy if appropriate.
Recovery. You will remain in a recovery room for a short while to be sure you are awake and feeling okay. You might have a little gas, which is normal. You’ll be able to eat normally and get back to your regular activities pretty quickly.
What Will the Colonoscopy Show?
We go into the colonoscopy expecting it to detect early colon cancer – which it will do. It is 95 percent sensitive, a statistical term that means it finds 95 percent of cancers that are there.
But the colonoscopy may reveal a number of other findings. Some require immediate attention, some just need to be monitored periodically, and some are just good to know about. Let’s look at what colonoscopy can find.
Hemorrhoids. These little troublemakers are swollen clumps of veins around the entrance to the rectum. When they flare up, they can cause some very annoying pain and itching. But the good news is that’s usually all they are – an annoyance. If you have hemorrhoids that cause symptoms, call your doctor because there are treatments that can give you some relief.
Diverticuli. These little pouches in the wall of the colon occur in about half of all adults. They form because the muscle in the wall of the colon becomes weak and allows the lining of the colon to push through. Most people are never bothered by diverticuli, but in some cases diverticulitis develops. This is where these little pouches become blocked and infected, causing a fair amount of abdominal pain. In severe cases they can perforate, or tear, which is an emergency that may require surgery. If these show up on your colonoscopy, it may explain intermittent abdominal pain. But if they aren’t causing symptoms, you don’t need to do anything about them.
Polyps. These are little outgrowths of the colon wall into the colon, and they are often benign and of no concern. Occasionally they harbor early colon cancer. So just to be safe, your doctor will probably remove them during the colonoscopy. If they are particularly large, surgery may be required.
Ulcerations. Drugs, inflammatory bowel disease, and cancer can cause ulcerations in the lining of the colon. The doctor will perform a biopsy during the colonoscopy to rule out cancer. They may also talk to you about your medication usage, particularly NSAIDs, which commonly cause this problem.
Bleeding. Many issues cause bleeding in the colon, but it isn’t normal. If colonoscopy reveals blood, your doctor will make an effort to track down the source to recommend appropriate treatment. Sometimes additional tests may be necessary to find the source of the bleeding.
A normal colon. Hooray! This is the report everyone hopes for after a colonoscopy. If your colon appears normal, you can relax your shoulders and not think about it again until ten years out – when it’s time for your next colonoscopy.
If a colonoscopy reveals a diagnosis of cancer, don’t panic! The whole point of colonoscopy is to find small cancers or precancers before they cause serious problems. You may need more tests to decide what the next steps will be, but it’s not automatically a tragedy.
Do I Really Have to do This?
There are 140,000 newly diagnosed cases of colorectal cancer each year, and 50,000 deaths due to the disease. Screening at the appropriate age and interval offers your best chance of catching such a cancer early when it can be cured.
The good news is that new procedures are being developed that may make screening colonoscopies obsolete in the future. They involve examining the stool for cancerous DNA or other evidence of cancer. But right now, the evidence tells us that colonoscopy is your best test for catching a colorectal cancer. So go ahead and make an appointment for yours if you are due. In the meantime, we will hope that the new testing continues to improve so your next screening colonoscopy can be your last.