Your First Colonoscopy! What to Expect

Whee! Time for a Tube Up Your Tuchus!

image: wikimedia commons

By Crabby McSlacker

So, some perspective here: for people with serious illnesses who've been through hardcore, painful, debilitating, invasive medical procedures? A colonoscopy is probably child's play. (Although let's be clear, that's just an expression. If your child actually plays this way? We need to talk).

But for most people, there's at least a little trepidation. And for many, if statistics are to be believed, that fear is significant enough to skip the procedure entirely! Well sure, it could save your life and all, but really? Do you have to?

There are actually some alternative colon cancer screening methods. But since I didn't get to use one of them myself, discussion of these will be brief, and possibly a little bitter.

I've had a couple of  colonoscopies now. (And an additional bowel prep due to my hysterectomy.) My second colonoscopy was just a few days ago and the memories are still fresh. So I'm thinking it's time to share some info and observations and tips?  This is after all, a health blog, although with recent posts on tattoos and winter travel, it's easy to miss that part.

Here's the thing: for some people the whole colonoscopy thing is a breeze. For a very few unlucky folks: it's horrible. For most people I know, myself included: the procedure and the prep are somewhere in the middle. Decidedly unpleasant but not intolerable.

But being a whiner myself, I get tired of all those public-spirited accounts of the colonoscopy process that make it sound entirely innocuous in order to get you to go ahead and get yours. I'm not going to lie to you just to make sure you go do it. You need to and you will be really glad you did it! But it's not exactly fun. Here's at least one chronic complainer's take on what's involved.

And for those of you who have already joined this exclusive club? I'll be curious if your experience was similar or if there are all kinds of different colonoscopy experiences.

Warning: due to mature and disgusting subject matter, reader discretion is advised.

Why You Should Suck it Up and Get a Colonoscopy (or Other Screening Test)

According to the NIH, colon cancer is the second leading cause of cancer deaths in the United States. This blows me away, considering how slow-growing and preventable colon cancer generally is.  And while overall rates are going down because of better screening, rates in people under 50 are going up. Environmental toxins? Diet? Bad karma? Who knows, but it means that screening, and even early screening, are more important than ever.

What Are Some Alternatives to Colonoscopy to Screen for Colon Cancer?

Home Stool-Testing Options: These include FIT (fecal immunochemical test) and Colorguard. There are pretty obvious upsides to not having to prep your bowels, get doped up with sedatives, and have a stranger ram a scope up your butt to see what lurks inside.

But the downsides include less accuracy, and a need for more frequent testing. Do you want to send in a smear of your poop to a lab every year? (Or, in the case of the pricier ColorGuard test, every three years?) On the other hand, if you are at low risk and would otherwise skip screening entirely, these are definitely worth looking into.

Sigmoidoscopy: These are in many ways similar to a colonoscopy. You still have to do bowel prep, and there's a scope involved, but the doctors' don't look at nearly as much once they're up in there. This may mean less sedation is needed, but you have to wonder: what's the point of going through all that if they're only going to look at the left half of your colon?

Virtual Colonoscopy: This alternative does not generally require sedation; an x-ray technician obtains images of your colon from outside your body, not from inside. Sounds great, right? But virtual colonoscopies still involve bowel prep, plus you have to swallow a contrast agent. You will still have a tube inserted where the sun don't shine, but not nearly as far up. It's there to inflate your bowels so they can get a better look. Fun times, right?

There are others possibilities in the works too, stay tuned! Like camera pills and, even more exciting, blood tests for cancer that detect cancers in early stages anywhere in your body.

When it's Time for Your Colonoscopy

1. Carefully Pick Your Provider or Facility

This may not be an option depending on your insurance or geography, but if it is... there does seem to be a difference in various facilities in terms both of expertise and patient-coddling. Some clinics are brusque and factory-like, others are extremely solicitous and try to make the experience as tolerable as possible. Ask friends who've been through it, talk to doctors, read reviews if you can find any.

If you are high-maintenance like Crabby is, you will appreciate having expert doctors and kind nurses and assistants to hold your hand, listen to your concerns (however misguided or hysterical), and get reassurance that you that will indeed survive relatively unscathed.

2. Don't Blow Off  the Instructions, Read 'Em When You Get  'Em

If you are freaked out about the whole thing, you may attempt to pretend it isn't happening. Totally understandable! Yet if in order to maintain this illusion you  avoid the literature you've been given? You will run into trouble.

Sorry, you can't wait til the last minute to deal with the details, or you'll have to reschedule and probably pay a hefty cancellation fee. Some of the prep starts a week in advance, with certain foods (mainly nuts and seeds), medications, and supplements you need to avoid. Then a few days out there are even more prohibitions.

There is also a prescription you'll have to fill, and lead-time can be essential on this one. My first bowel prep they RAN OUT of the Rx I wanted and I had to drink twice as much of an old-school kind because that was all they had.

Also, while there are "generic" prep instructions like I'm giving here, each practitioner has their own take on it, so read what THEY send, don't rely on The Google.

So steel yourself, make yourself read the damn thing when they send it, then mark your calendar or send yourself a reminder or whatever on the first date when you're supposed to start doing things differently.

Colonoscopy Prep

Part 1: The Part Where You Starve Yourself

OK, technically you won't be starving. The "clear liquid" diet you have to be on the day before you go in will actually let you drink and eat a days worth of calories in the form of Seven Up and chicken broth and jello. (But not red or purple jello).

A clear liquid diet is no fun. You can have coffee or tea (yay!) but can't put any milk in it. You will feel cranky and deprived no matter how much of that stuff you have.

But here is an important tip: Get a few calories, even if they're stupid, pointless, ridiculous calories.

If you are trying to lose weight or are otherwise mindful of calories or carbs, this may seem like an excellent opportunity to bank a lot of missed meals. You can't eat normal food anyway. And really, is Seven-Up any more satisfying than club soda or iced tea or a diet drink? Why not just have a no-sugar beverage instead? Nothing you're going to have under the "clear liquids" category, whether caloric or not, resembles actual food. So why not just hydrate and skip the sugar?

Well, a little of this caloric deprivation is fine, especially if you are used to fasting. You will probably have a pretty low-cal day just because of the "no fun" aspect.

But I discovered something interesting: Even though I occasionally do some intermittent fasting , and I'm totally used to functioning normally without calories for a day? Total fasting can be a really bad idea before a colonoscopy because you need a reasonably strong stomach for disgusting nature of the upcoming bowel prep.

The combo of the laxative regimen below, combined with low blood sugar from fasting was, for me, pretty much a disaster, even though I was very conscientious about hydrating. So my advice: get at least half a days calories in you, even if they're of necessity mostly sugar.

Part 2: Choke Down the Most Disgusting Fluid You Will Ever Consume in Your Life

Photo: Missy Meyer

There seem to be many variations in formulas. I've tried three: the first was the hilariously named GoLytely. Yep, I think that's pronounced "Go Lightly." Could anything be further from the truth?

Don't kid yourself: you will not be "going lightly."

I've also had "HalfLytely," which is a version of GoLytely that requires a smaller volume of fluid and, as I recall, some pills. Neither of these taste totally horrible, not that they're pleasant. But the texture is icky and the grossness factor builds exponentially as you force yourself to drink more and more of the liquid.  Of the two I'd go with the Half version.

My third, and least favorite, was SuPrep. It required the least amount of dilution and the overall volume was the smallest. But the taste was horrific. The grapey faux-fruit overlay did not conceal the essential bitter, metallic and salty grossness it. It was a two step process, and for reasons I will bore you with below I would never, ever, ever, ever do that again.

Part 3: Station Yourself Near the Toilet and Pray for Mercy

(Sensitive readers: you may want to skip these next paragraphs).

Again, the first two times were not so bad with the GoLytely variants. More fluid was involved in the ingestion process, so the clean-out was not painful, just extremely thorough. Sort of amazing and amusing really. But it was all over the day before the procedure, and I slept just fine the night before.

This time, the SuPrep was a nightmare.  I took the first dose, as instructed, at 5 p.m. the night before my procedure, but it only worked little by little. By bedtime I was exhausted but I was terrified to sleep because it was still wreaking havoc on my innards, and I was petrified I'd soil the bed. (I managed not to, thank god). But I had to get up repeatedly during the night, and as of 5 a.m. the next morning, I was still running to the john from the first dose.

And I still had one more dose to come. I briefly considered doing a swan dive out the third floor window instead, but then the whole torture of the first half of the prep would have been wasted and I don't know if 3 floors would even be fatal.

The second dose made me feel so nauseated that I threw it all up an hour later, and I feared that my whole procedure would be cancelled because I still wasn't entirely, um, "cleansed." I was still using the restroom minutes before the procedure.

What Happens During Your Colonoscopy?

Sedation:

You change into a hospital gown (I was allowed to keep my socks and bra on) and they stick you with an IV in your arm or on the back of your hand. Or in my case, they stick you and stick you and stick you and stick you. My veins are shy that way, initially defeating even the most veteran of nurses, but eventually they always manage to get in.

At this point, patient accounts vary. Most people get conscious sedation, which is supposed to relax you, ease discomfort, and induce amnesia.  A few people are so resistant to the drugs they remember the whole thing, and some of these people report more than mild discomfort.  Yet I've read that most people don't experience much distress at all.

But see the catch here? Personal accounts of an entirely painless procedure are inherently unreliable. Most patients have no clue because they don't remember!  And I suspect there's something of a health industry conspiracy to maintain the illusion that because you don't remember pain, there wasn't any.

My first colonoscopy I definitely felt a sharp poke at the first bend and yelped. No memories after that. The second time? The last thing I remember was the request to roll over on my side.

So I don't remember them snaking a tube up my colon but I'm confident they did. In fact, procedures were undertaken each time involving hot snares. I can't imagine I enjoyed these, but I was pretty doped up, so it's possible I didn't feel 'em much.  No way to know, right? Which creeps me out more than a little.

Another tip:  tell the staff before they sedate you if you've had bad experiences in the past with nausea and vomiting following anesthesia. I have, so they added anti-nausea medication to the IV, and hallelujah, it worked! Not barfy at all afterwards.

After Your Colonoscopy

You have to have someone there to take you home, and don't make any big plans afterwards. My first time we'd scheduled dinner with friends and I was practically face down in my plate of tacos and we had to leave early to get me back to bed.

Many people feel only a little groggy and are fairly functional afterwards. I am so NOT one of those people. I become a zombified lump of useless humanity with limited ability to speak or move, though my wife claims I am quite adorable in this state. All I can do is sleep. Possibly this is because the staff know a high-maintenance whiner when they see one coming and they dope me up accordingly. This time I was even more out of it than before, and it became quickly apparent when I tried to leave that I needed a wheelchair to get to the car. Once home, my patient wife got me to bed and I went straight to sleep in my clothes and slept all afternoon. I woke up for a couple hours, ate, and went back to bed and slept like a dead person through the whole night.

But the next morning... It was over and I felt great. I was Queen of the World!

This is a cool thing about a colonoscopy.  You survive it, and it's like a rite of passage. Even more than that stupid AARP card you get in the mail, your post-colonoscopy status qualifies for full membership in the Sensible and Responsible Middle-Aged Person Club.

And let's stop apologizing for that, ok? We Responsible Middle-Aged People rock and we are setting ourselves up to be healthy, vital, and Bad-Ass Old People. We should all have wild tribal post-colonoscopy ceremonies or something a few days after the procedure. What do you say, maybe we do some jello tequila shooters and play our old Rolling Stone albums at full volume and sing and dance and howl at the moon? Well, as long as moonrise is early enough than we can be in bed by nine p.m.

What If They Find Something?

This will be the subject for a future post, since I'm one of those people who Has Things to Find. I'm still awaiting pathology results, but I can say this much: Don't panic! It's the people who have these things and don't know about them who are in trouble, not you.

I'm thinking maybe I'll follow up later with a post about polyps, diverticulosis and hemorrhoids since I am lucky enough to host these. I'm sure all you readers can't wait to read about these and all the other fascinating aspects of colon health that we could discuss!

Or, um, maybe not.

Do you dread your first colonoscopy or have you already survived it? Any other medical procedures or tests that strike fear in your heart?