You’ve just turned 50 and you know you need to make That Appointment … to schedule your first colonoscopy. But you’re putting it off. You’ve heard the prep is really unpleasant; who wants to go through all that?
This is the attitude of many people facing their first colonoscopy, says Dr. Douglas Purdy, of Gastroenterologists, P.C. in Cedar Rapids. Yet, he says, the benefits of a colonoscopy far outweigh any unpleasantness and could possibly save your life.
“Since screening has taken off, the death rate from colon cancer has declined,” Purdy says. According to the American Society for Gastrointestinal Endoscopy, colon cancer deaths have declined 26 percent since 1975, a decline largely attributed to better screening for the disease. Still, only slightly more than half of Iowans have had the recommended screenings.
So what can a nervous, but resigned, 50-year-old expect at their first colonoscopy?
First of all, getting an appointment is easy.
“You don’t need a referral for a screening colonoscopy,” says Purdy. Often, the initial consultation can be done over the phone. A nurse can take your information, explain the procedure and prescribe the colon purge preparation — the liquid solution that you will drink to clean out your colon.
The prep, or colon purge, is perhaps the most dreaded part of the colonoscopy. In order for the screening to be most effective, your colon needs to be completely empty, meaning you’ll need to drink a prep solution that will empty your colon in the hours before your colonoscopy.
Although you’ll need to begin drinking the prep solution the day before, it’s important to begin a low-fiber diet about four days before the procedure. While fiber is normally important for colon health, it can cause problems during screening.
“Small pieces of nuts or grains can sometimes get clogged in the scope,” Purdy says. “They can also cover up the polyps we are looking for.” He suggests patients abstain from nuts and popcorn and other high-fiber foods for several days before a colonoscopy.
About one day before the screening, you’ll need to stop eating solid food and switch over to clear liquids like broth, apple juice, clear soda, Popsicles and plain Jell-O (without fruit).
Because most colonoscopies are done in the morning, many people follow a “split prep.” This involves drinking half the colon purge solution in the evening and half the next morning.
“This gives it time to work — and people tolerate it better when it’s split up,” says Purdy. Drinking the solution in two rounds also leads to a better screening because the colon has one last clean-out right before the procedure.
Most people find the prep solution tolerable. Your doctor may allow you to add flavorings, but be sure to check first — sometimes the solution already has a slight fruity flavor to mask its saltiness. The important thing is to keep drinking: one eight-ounce glass every five to ten minutes. You’ll feel slightly bloated, but that feeling will disappear once bowel movements begin.
Purging the colon is unpleasant, but not painful. Usually, bowel movements will begin within one hour of drinking the prep and will continue for another hour or two. Stools will be frequent, and will become progressively looser and clearer as the solution moves through your intestines.
After the second dose of purge prep the next morning, stools should be yellowish-clear, a sign that your colon is ready for its close-up. When you arrive for your procedure — along with someone to drive you home afterward — a nurse will take you to a private room to take your history, check your vitals and insert an IV that will be used to administer a mild sedative.
In the procedure room, the doctor will briefly talk with you before starting the anesthesia drip. Most people don’t remember anything about the procedure, which takes only about 30 minutes. During that time, the doctor uses a flexible, lighted tube equipped with a tiny camera to inspect the entire colon, removing any small polyps that are found.
Afterward, you’ll feel sleepy from the anesthetic, so most doctors recommend having someone stay with you the rest of the day while you enjoy a well-deserved rest, comfortable in the knowledge that you did the right thing to protect your health.
Most colon cancers — 90 percent, in fact — occur in people ages 50 and over. That’s why doctors suggest getting your first colonoscopy at 50, with another colonoscopy every 10 years. If you have any family history of colon cancer or have ulcerative colitis, Crohn’s disease, inflammatory bowel disease or a change in your stool habits, you should talk to your doctor about being screened even earlier.
There are other screening methods, including a double contrast barium enema, virtual colonoscopy and flexible sigmoidoscopy, but they require the same prep and may require a full colonoscopy to remove any polyps that are found.
The colonoscopy procedure is not painful. Patients are given anesthesia and pain medications so that they won’t be in any discomfort, even if polyps are removed.
Yes, it’s very important that you follow the prep directions to the letter to ensure that the medical staff has a clear view of your entire colon.
Most colonoscopies are conducted under “conscious sedation,” a combination of drugs that relax you and block pain. It will be administered through an IV. Most people don’t have any recollection of the procedure itself.
The colonoscopy itself only takes about 30 minutes. The prep begins at home the evening before the procedure. The morning of your colonoscopy you’ll spend about three hours at the clinic or hospital. Then you’ll return home to rest for the remainder of the day. You can usually return to your usual activities the next day.
The majority of health insurance companies cover colon cancer screening, including colonoscopies.
A number of free screening programs are also available.
In the Cedar Rapids area, call the Linn County Health Department, (319) 892-6081, or His Hands Free Medical Clinic, (319) 862-2636 for more information about free colon cancer screenings.
You also can contact the Iowa Department of Public Health, call (515) 242-6516 or go online to www.idph.state.ia.us/IGS.
By Jane Nesmith for The Gazette