What to Expect During Your First Colonoscopy
Not that many people are thrilled at the prospect of a doctor’s asshole, but consider the alternative: 50,000 people die of colorectal cancer every year. If everyone got tested, that number could be cut in half , says Dr. Jordan Karlitz, associate professor of gastroenterology at Tulane University and a member of the National Roundtable for Rectal and Rectal Cancer. Unfortunately, many people ( about 28% , or one in three people, according to the Centers for Disease Control and Prevention) are not screened – some due to lack of access to information and healthcare, while others know they should be screened and tested. examination. access, but are squeamish about anything to do with poop, or fear it will be painful or uncomfortable.
(According to Dr. Patricia Raymond, a practicing gastroenterologist and assistant professor of clinical internal medicine at the Eastern Virginia School of Medicine in Norfolk, Virginia, men tend to be more reluctant to get tested than women, perhaps because men were less likely to undergo invasive procedures.)
Are there no other tests?
Other tests exist, but due to the fact that there is little research comparing how different forms of screening work together in terms of detecting cancerous or precancerous polyps and preventing death, major organizations including the US Preventive Services Task Force and the US The Cancer Society recommends only to undergo an examination, leaving the choice of the examination method to the discretion of you and your doctor. In its brief guidelines , the US Multi-Society Colorectal Cancer Task Force, a group of gastroenterologists, states that colonoscopy is the preferred method for diagnosing colorectal cancer. They say that when it comes to detecting polyps at all stages of development, colonoscopy is the most sensitive and offers a two-to-one deal: it allows the doctor to see the polyps and remove them all at once. Also, if your first one is normal and you don’t have high risk factors, you don’t need to get another 10 years.
Doctors also recommend a stool immunoassay (FIT), in which a small amount of stool is smeared on cards or collected in test tubes and checked for blood. This test needs to be done once a year and may not detect tumors that are not bleeding. If you test positive for the FIT test, you will need to have a colonoscopy.
Less commonly used options include CT colonography, FIT-fecal DNA test, and flexible sigmoidoscopy. All three are less sensitive than colonoscopy and FIT and should be performed more frequently (every five, three, and five to ten years, respectively). You may have one of these tests if colonoscopy is not available in your area or if you are not insured (all ACA-eligible insurance plans must follow the guidelines of the Cancer Screening Task Force). “People need to understand that these less invasive tests are not the way out of colonoscopy,” says Dr. Durado Brooks, vice president of cancer control at the American Cancer Society. “If the results of these tests are abnormal, you will need to have a colonoscopy.”
Brooks says it’s also important to know that if you decide to take a test other than a colonoscopy, get positive results and then be sent for a colonoscopy, that colonoscopy can be classified as a diagnostic test, not a screening test, which means you may be responsible for a surcharge or a deductible to cover it. This is not the case if the colonoscopy is the first test you will receive.
If you are attached to colonoscopy, know that the procedure itself is very simple, preparation has become much easier, and the payoff is enormous. Here’s what to expect and how to prepare for your first colonoscopy:
What is a colonoscopy and why is it needed?
During a colonoscopy, your doctor uses a very thin and flexible endoscope equipped with light to examine the lining of your colon for polyps. Most polyps are benign, but some can become cancerous if not removed and others can be cancerous. If the doctor finds a polyp, it can be removed immediately and sent to the laboratory for analysis.
Colorectal cancer is indeed common (it is the third most common cancer in men and women), but it can also be prevented. The death rate from colorectal cancer has been declining in recent years, which the American Cancer Society associates with increased screening and removal of polyps that, if left in place, could turn into cancer. It may take 10 to 15 years for a polyp to turn into rectal cancer, and during this time, you may not have any symptoms that indicate its existence. As with most cancers, if colorectal cancer is detected early, it is much more likely to be cured.
“Americans at average risk – with no family history – have a 6% chance of developing colorectal cancer. This is a huge chance, ”says Dr. Raymond. “Just think how excited you would be if you had the chance to win the 6% Powerball lottery – you would be excited about the high odds. Colonoscopy with polyp removal prevents up to 95% of rectal cancers. ”
Who should have a colonoscopy?
The short answer is everything ; the question is when, not what you need to do business. First, if you are currently experiencing symptoms such as bowel changes or blood in your stool, see your doctor right away – regardless of your age – and ask about a colonoscopy.
If you have a history of colorectal cancer or adenomatous polyps (which are most likely to become cancerous) or have a personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease), you should see your doctor regularly and often. colonoscopy. The same goes for those of us with a family history (and “family” includes not only parents, grandparents, siblings, but also uncles, aunts, children, and half-siblings) * colorectal cancer or polyps or a family history of hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome. If this is you, don’t wait until you’re 45 or 50 to get tested. Tell your doctor as soon as possible. Here you will find more information on the recommendations for these specific risk groups.
If you are African American, have no symptoms and do not have any of the risk factors listed above *, you should have a colonoscopy every 10 years from the age of 45. For reasons that are unclear (but may include lack of access to and awareness of tests, and so-called “lifestyle factors” such as smoking and obesity), African Americans are generally diagnosed with colorectal cancer at a younger age with later forms of cancer. , and have worse survival rates than other groups in this country.
If you are not African American, have no symptoms and do not have any of the other risk factors listed above *, from age 50, you should have a colonoscopy every 10 years.
* When was the last time you called your mom? Or grandma? Do it. Not just to show kindness or to appease your guilt; do this so you can ask them about your family’s health history. This is so important and you don’t want to put it off until later (sorry to bring this up, but you want to talk about it while they are still around and have all their balls).
I’m under 45. Why should I think about colorectal cancer?
Recent studies have shown that while the incidence of colorectal cancer is generally declining, people in their 20s, 30s, and 40s develop colorectal cancer and die more often than in previous decades. Dr Jordan Karlitz, associate professor of gastroenterology at Tulane University and a member of the National Colorectal Cancer Roundtable, says that no one knows why this is happening, but that there is a lot of research underway hoping to answer the question.
“The most important thing you can do is take any symptoms you may have very seriously and see your doctor to discuss the possibility of having a colonoscopy, even if you are younger,” says Dr. Karlitz, who also notes family history is very important because clusters of certain cancers in a family may signal an increased risk of colorectal cancer at a young age.
When you make an appointment
Different doctors use different types of sedation for colonoscopy, and you should discuss options with them and choose the level of sedation that is right for you. Most often, propofol is chosen, which is fast acting and provides a level of sedation comparable to general anesthesia, without a long recovery period. For most people, propofol takes effect within a few seconds, leaving you unaware of what is happening during the procedure and not remembering it afterwards. Very often he wakes up in the recovery zone and wonders how you got there and when the procedure will be performed. (Because it has a strong sedative effect, you will likely have an anesthesiologist or sedation team in the treatment room to watch over you.) Other drugs make you wake up, but you feel sleepy. Some patients prefer to stay awake during the procedure.
Your doctor will give you very specific instructions and you should read them when you receive them because you may need to follow a special diet (to avoid things that are difficult to digest and which will leave residues in the colon) for several days before the procedure and you may have to collect your prescription drugs (you can also purchase special tissues if you like). If you usually take prescription medications in the morning, talk to your doctor about how to take them on the day of your procedure. If you don’t understand anything, ask.
Because you will be sedated during your procedure, you will need to ask someone to pick you up after or, depending on the procedure’s policy, arrange for a taxi or travel to pick you up. Some institutions do not want you to come home alone because you may feel dizzy. If you think transportation might be a problem, talk to your doctor; this is common, and most remedies have workarounds.
Colonoscopy preparation: not so bad, really
Have you ever had severe diarrhea? I’m sorry. The good news is, getting ready for your colonoscopy is nowhere near as bad. Yes, it is disgusting, and yes, you will spend some time in the toilet the night before the test and possibly in the morning, but you are not sick. You shouldn’t experience painful cramps, nausea, or feeling like a complete idiot for eating something that you think made you nauseous. (If you’re sharing a bathroom, plan it accordingly; you’ll be monopolizing the place for a while, and probably want some privacy.)
The day before
You will most likely be asked to drink only clear liquids the day before your test. This means pure sodas like Sprite, lemon jelly, apple juice (not cider), and water. As Dr. Karlitz says, “If you keep it in glass, you can read the newspaper through it. It doesn’t have to be opaque. ” Clear liquids, dietary changes, and a special drink you’ll enjoy (more on that below) all work to keep your colon clean and shiny so that when your doctor looks inside, he gets a really clear picture of what going on. on the.
Last night
Your doctor may advise you to drink a prescription liquid to get started. The good news is that liquids are generally less unpleasant than they used to be and are much less drunk than in years past; some doctors now also use what is called “split-preparation”, where you drink half the night before the procedure and half in the morning. Liquids vary, as do the people who drink it; some people find the liquid disgusting and some just not that good.
Results vary, but it usually takes about an hour to drink a set amount at regular intervals to finish your diet. After about an hour, you will probably start to feel a strong urge to “evacuate,” as the professionals say. For the next few hours, you will be evacuating on a fairly regular basis, and you will end up just passing clear liquid, which is the goal (congratulations!).
And then we promise it will stop. You won’t sleep all night waiting for it to end, and you won’t get up in the middle of the night for a sudden evacuation. If you have followed your doctor’s instructions, you will have ample time to go to bed at your normal times and get a good night’s sleep. You will most likely be asked not to drink or eat anything (other than cooking liquid) after midnight. If you are doing split preparation, you will get up in the morning at the set time before the procedure and drink the remaining liquid, but by this point you will know what to expect (plus, you will only have liquid to prepare, evacuate), and then proceed with the procedure.
When you arrive at the facility
Your colonoscopy may be done in an outpatient surgery center, hospital, or doctor’s office. When you arrive, you will likely complete some paperwork, including consent forms for the sedation medication you will be given (you agree not to drive, operate machinery, or sign any paperwork for the remainder of the day after procedures. ). You will change into a dress and your vital organs will be taken; You can answer questions from the reception staff, nurses or anesthesiologist (don’t be alarmed – you will not be given general anesthesia!), they will instruct you on the procedure and provide an opportunity to ask questions.
Before the start of the procedure
A nurse, paramedic or anesthesiologist may be in the treatment room along with the doctor. You may be asked to roll onto your side and raise your knees; the drapery will cover you. You will be given a sedative through an IV.
According to Dr. Karlitz, the procedure takes an average of 30 minutes, but can take up to an hour, depending on whether the polyp (or polyps) is found and removed. The colonoscope is very thin (about the thickness of a finger) and has a camera, light, and a duct through which air passes, which slightly inflates the colon to provide a clearer view of its lining. The colonoscope begins its journey at the far end of the colon and travels along its length, during which the doctor monitors what he sees on a large HDTV screen. If polyps are found , they are removed with tiny instruments, which are passed through a scope and sent to a laboratory for analysis. If there is bleeding, other tiny instruments are passed through the scope to stop it. However, any bleeding is usually mild, and complications from colonoscopy are rare . Blood pressure, heart rate and respiration are monitored throughout the entire procedure.
After the procedure
You may feel drowsy or pass out until the sedation wears off; this can happen in a matter of minutes or up to a couple of hours. If you have agreed that someone will accompany you home, they can be with you in the recovery room when you wake up.
It is not uncommon to feel a little bloating due to air getting into your colon, and it is possible that you expel some residual gas (sorry, friend who came for you!). Once the doctor is satisfied that you are mentally clean, he will explain to you what he found, how soon you will receive results, and possibly show you photographs taken during the procedure. They will explain what you may encounter in the next couple of days (a small amount of blood in the stool if the polyps were removed), and what not (pain, fever, severe bleeding). You will be given instructions on what to do if you have any problems, they will tell you how and how soon you will get results on the samples taken; You will also be told when to get your next checkup.
Doctors will also advise you to relax for the rest of the day and may be offered juice or crackers. Once you are rested, you are ready to get dressed and go out into the world and most likely eat something other than clear liquid.