What to expect from a Colonoscopy
Julie Lindholm, MD, is a general surgeon at Page Hospital
Question: I'm over 50 years old and have not had a colonoscopy, it might be because of fear. What can I expect from one?
Answer: Colonoscopies are done by gastroenterologists and general surgeons. The age to qualify for a first colonoscopy is 50 years old (unless you have family risks for colon cancer, pain, or bleeding…in which case you might need a colonoscopy before the age of 50).
The current recommendation for screening is one colonoscopy every 10 years starting at age 50. Screening is performed because colon cancer is common and because early detection and prevention saves lives.
The procedure itself only takes about half an hour but the preparation, done the evening before the scope, is an event. One gallon of “golytly” or “nulytly” is a lot to drink, and is not very delicious. Most patients do not enjoy the prep. It must be accomplished near a bathroom.
The procedure itself is an exam of the large bowel that is performed with a fiberoptic scope which is the size of an index finger. Only longer. Any polyps found during the exam can be completely removed. Since polyps could later degenerate into cancer, removing them prior to malignant changes prevents cancer. If masses larger than polyps are found they can be biopsied (sampled) for diagnosis.
The usual medications given for sedation during a colonoscopy are carefully measured to allow patient cooperation and comfort at the same time. Patients do not suffer attacks of bad speech or behavior while sedated. They just become sleepy and sometimes say “yes”, “no”, or “OK”. Pain medication is needed because air is passed into the colon through the scope, to allow visualization. The air in the colon can be more uncomfortable than the scope itself.
Complications from colonoscopy are not common. The worst complication is bowel perforation, which is very rare for experienced physicians.
The more recent “virtual CT colonoscopy” is an option and is risk-free but it has certain limitations. It needs to be performed more frequently than a colonoscopy - every five years instead of every 10 years – because it is a less accurate screening tool. There is CT scan radiation exposure and if any abnormalities are found, then the scan needs to be followed by an actual colonoscopy.