The Cared of Colonoscopy: Dispelling Common Fears and Misconceptions
Having performed well over 5,000 colonoscopies in my career, I have heard every excuse and fear about the procedure. If you’re scared of a colonoscopy, especially your first one, the biggest worries are usually pain, discomfort, embarrassment, or fear of what we might find, but the reality is that with IV sedation, the procedure is painless, your modesty is respected, and the prep we use at Alabama Colon & Rectal Institute is more manageable than most people expect.
So I’ve decided to take my doctor’s coat off, put my stethoscope down, and give you some “real” talk about the fears I hear from my patients, often adults 50 and older coming in for screening, and what the real truth is when it comes to getting your first colonoscopy: what the prep is really like, what happens during and after the procedure, how findings such as polyps or cancer are handled, and why getting screened now can help detect or even prevent colorectal cancer when it is most treatable.
#1: It’s going to hurt - I mean, how could inserting a tube “down there” NOT hurt?
This is definitely the #1 fear I hear from people facing their first colonoscopy. People are worried that they’ll experience pain or have bleeding or post-procedure effects.
Let me just put that fear to rest: there is NOTHING about a colonoscopy that will hurt. NOTHING. First of all, the majority of our patients elect to have IV sedation, which may involve conscious sedation or moderate sedation, and the team will administer sedative medication through the IV to reduce pain and anxiety during this invasive procedure. Moderate sedation often uses a benzodiazepine plus an opioid, while propofol is commonly used for deeper sedation. IV sedation is a wonderful thing - you’re asleep during the procedure, and then as soon as the IV medicine is stopped after the procedure, you wake up and begin a brief recovery, usually resting for an hour or two while the sedation wears off. If offered by a facility, nitrous oxide can provide comparable analgesia with shorter recovery time. The IV is placed in the holding area before the procedure and this is the most uncomfortable part of the day.
Sedoanalgesia is used for safety and comfort, and some patients report greater satisfaction with propofol during the same procedure. Most patients have no pain or bleeding or any lingering effects after the procedure (other than a little excess gas) and are able to leave the office and go and eat breakfast on their way home. There is no driving until the day after the procedure.
#2: I’m so uncomfortable and embarrassed and squeamish about me showing my backside to a room full of strangers. It just seems like such a violation.
I can understand this fear, as it is a loss of control and we are performing a procedure in a very private area. But just as a reminder, we do this day in and day out and take every effort to protect your modesty by keeping you covered until the last minute and only exposing what we need to expose. So the good news is, you’ll never even know what happened, and you’ll be fully covered until you’re asleep. Everyone in that room is way more focused on your inside - NOT your outside. It’s also common to feel anxious before an invasive procedure like this, and simple therapeutic calming measures can help settle the brain and nerves. Listening to music may decrease anxiety and discomfort during the procedure, and acupuncture may help some people too, though the evidence is mixed.
#3 - I’m terrified about what you might find - I just KNOW you’re going to find colorectal cancer!
The fear of “what if you find something” is very common. I flip it around and say that if something is there, it needs to be found! I look at a colonoscopy not just as a diagnostic procedure but as a screening colonoscopy and a test that can find cancer early and help prevent colon cancer. By removing polyps before they turn into cancer, you are preventing future problems. Polyps are removed at the time of your procedure and most of the time you have no after effects of doing this. This kind of screening can prevent up to 99% of colon cancer cases by finding and removing precancerous polyps.
If a colon cancer is found at the time of a colonoscopy then most of the time biopsies will be obtained and a treatment plan will be laid out. Tissue samples help confirm the disease and guide next steps. There are several reasons a doctor may recommend colonoscopy, including symptoms, abnormal findings, or family history. The good news is that colon cancer is very treatable and often curable when caught early. If it is found at an advanced stage, it is still treatable, but much less often curable.
The take-home point is that it is much better to find polyps which can be removed or early cancer which can often be cured, rather than advanced cancer. For people at average risk, screening usually starts at age 50 and is repeated every 10 years. People with a family history are at higher risk of developing colorectal cancer, may need screening at age 40, and may need it every 5 years.
#4 - I’ve heard the bowel prep work prior to colonoscopy to get me “cleaned out” is horrible! I have an easily triggered gag reflex, so I just know I’m going to have a hard time with it.
Many facilities that conduct colonoscopies prescribe a prep that involves over a gallon of liquid you have to drink in a short period of time. A colonoscopy is an exam of the large intestine done by passing a scope through the rectum, so the cleansing needs to be complete. The good news is, we rarely utilize the infamous gallon prep here at Alabama Colon and Rectal Institute.
Instead, we use a low-volume prep that for most patients is ½ gallon of a liquid of their choice, most commonly Gatorade, but any clear liquid is OK as part of the clear liquid diet the day before. By utilizing a drink of the patient’s choice, it is much more palatable than in the past. For most patients, the prep is not as bad as they thought it was going to be. The worst part is just having to be near to a commode for several hours. Diarrhea is expected, and before the procedure your stool should be watery, light yellow, or clear. Be sure to complete all of the bowel prep and stop drinking liquids 2 to 4 hours before the colonoscopy so the stomach is empty for sedation safety. The most common complaint is nausea or vomiting, which can often be alleviated by slowing down the pace with which the prep is being consumed.
So I hope this frank discussion from a physician who knows all the fears associated with a colonoscopy has helped you in some way. The best advice I can give you: go ahead and schedule that first colonoscopy when you turn 50. You will be so proud of yourself that you went ahead and got it out of the way - AND I’m willing to bet you will say to me what the large majority of my first-time patients say to me: “That was nothing, and I don’t know what I was so afraid of!”
FAQs:
Does a colonoscopy hurt?
A colonoscopy can cause discomfort, cramping, or bloating, particularly from air introduced during the procedure. IV sedation is commonly used to manage discomfort, and some patients sleep through the procedure. Carbon dioxide insufflation may also help reduce post-procedure discomfort.
How should I prepare for a screening colonoscopy?
Colonoscopy preparation typically involves following specific bowel-prep instructions. This may include switching to low-fiber foods several days beforehand, consuming clear liquids the day before, and taking the prescribed laxative solution in split doses. Your doctor may also instruct you to follow a clear liquid diet and finish the bowel prep completely. Follow the instructions provided by your healthcare team regarding when to stop eating and drinking, including when to stop liquids 2 to 4 hours before the test.
What can I eat and drink after a colonoscopy?
After a colonoscopy, patients can generally start with light, easily digestible foods and drink clear liquids to help replace fluids. You can usually resume normal medications unless your healthcare provider gives you different instructions.
What should I avoid after a colonoscopy with conscious sedation?
Sedation can affect coordination and judgment after the procedure. Even if you feel normal, recovery can still impair judgment and coordination, so safety precautions matter for the rest of the day. You should avoid driving, operating machinery, and making important decisions for at least 24 hours after sedation, and you will need a designated driver to take you home.
When should I seek medical attention after a colonoscopy?
Mild cramping or bloating can occur after a colonoscopy, and a small amount of blood after a biopsy may be normal. Watch for possible complications after the procedure, especially severe abdominal pain, heavy rectal bleeding, fever, or other concerning symptoms. Call your doctor right away if these problems occur after the procedure. Colonoscopy is an important part of preventive health care, even when colorectal cancer causes no obvious symptoms.
Alabama Colon & Rectal Institute* (also known as the “Butt Hut” around town!) has been in practice since 1990 as a free-standing, private practice located in downtown Birmingham, Alabama. We are known for our efficiency and patient care, in a more relaxed office-based setting. Our doctors are known regionally for their expertise and are active in teaching surgical residents and other physicians. We are also a major sponsor of The Rumpshaker 5K, a race that promotes awareness about colorectal cancer. Check out our website for more information, or give us a call to make an appointment at (205) 922-7524, or email us at info@acripc.com.