Buzz
While the idea of a doctor inserting a scope into the rectum isn’t exactly thrilling, it’s essential to consider the stakes: 50,000 individuals succumb to colorectal cancer annually. Dr. Jordan Karlitz, a gastroenterology associate professor at Tulane University and a National Colorectal Cancer Roundtable member, emphasizes that widespread screening could reduce this number by half. Unfortunately, approximately 28% of people (or 1 in 3, as per the Centers for Disease Control and Prevention) avoid screening. Some lack access to healthcare or information, while others, despite having access, shy away due to discomfort with the procedure, fear of pain, or embarrassment.
Dr. Patricia Raymond, a gastroenterologist and assistant professor of clinical internal medicine at Eastern Virginia Medical School in Norfolk, Virginia, notes that men are typically more hesitant than women to undergo screening, likely because they are less accustomed to invasive medical procedures.
Are There Alternative Screening Options?
While alternative tests exist, limited research compares their effectiveness in detecting cancerous or pre-cancerous polyps and preventing fatalities. Major organizations like the United States Preventive Services Task Force and the American Cancer Society emphasize the importance of screening but leave the method choice to you and your doctor. The latest guidelines from the U.S. Multi-Society Task Force of Colorectal Cancer, composed of gastroenterologists, highlight colonoscopy as the top choice for colorectal cancer screening. They note its superior sensitivity in identifying polyps at all stages and its dual benefit of detection and removal in one procedure. Additionally, if your initial colonoscopy results are normal and you lack high-risk factors, you won’t need another for a decade.
Another recommended option is the fecal immunochemical test (FIT), which involves testing stool samples for blood. This test requires annual repetition and may miss non-bleeding tumors. A positive FIT result necessitates a follow-up colonoscopy.
Other less common alternatives include CT colonography, the FIT–fecal DNA test, and flexible sigmoidoscopy. These methods are less accurate than colonoscopy and FIT and require more frequent repetition (every five, three, and five to ten years, respectively). They may be used if colonoscopies are inaccessible or if you lack insurance (ACA-compliant plans must cover Task Force-recommended screenings). Dr. Durado Brooks, vice president of cancer control interventions at the American Cancer Society, cautions that these tests don’t replace colonoscopies: abnormal results will still require one.
Dr. Brooks also highlights that choosing a non-colonoscopy test and receiving positive results may reclassify a follow-up colonoscopy as diagnostic rather than screening. This could result in out-of-pocket costs like co-pays or deductibles, which don’t apply if colonoscopy is your initial test.
If you’re scheduled for a colonoscopy, rest assured: the procedure is straightforward, preparation has become much easier, and the benefits are significant. Here’s what to anticipate—and how to prepare—for your first colonoscopy:
Understanding Colonoscopy: Purpose and Importance
A colonoscopy involves the use of a slender, flexible scope with a light to examine the colon's lining for polyps. While most polyps are non-cancerous, some can develop into cancer if not removed, and others may already be malignant. If a polyp is detected, it can be removed on the spot and sent for laboratory analysis.
Colorectal cancer is highly prevalent (ranking as the third most common cancer in both men and women) but is also largely preventable. The decline in colorectal cancer death rates in recent years, as noted by the American Cancer Society, is largely due to increased screening and polyp removal, which can prevent cancer development. Polyps can take 10 to 15 years to progress into colorectal cancer, often without noticeable symptoms. Early detection significantly improves the chances of a cure.
Dr. Raymond explains, 'Average-risk Americans—those without a family history—face a 6% likelihood of developing colorectal cancer. That’s a significant risk. Imagine being thrilled by a 6% chance of winning the Powerball lottery—that’s how serious this is. A colonoscopy with polyp removal can prevent up to 95% of colorectal cancer cases.'
Who Needs a Colonoscopy?
The straightforward answer is everyone; it’s a question of when, not if, you should prioritize this. If you’re experiencing symptoms like changes in bowel habits or blood in your stool, consult your doctor immediately—regardless of age—and discuss the possibility of a colonoscopy.
Individuals with a personal history of colorectal cancer, adenomatous polyps (which are more likely to become cancerous), or inflammatory bowel diseases like ulcerative colitis or Crohn’s disease should maintain regular doctor visits and undergo frequent colonoscopies. This also applies to those with a family history (including parents, grandparents, siblings, uncles, aunts, children, and half-siblings) of colorectal cancer, polyps, or hereditary conditions such as familial adenomatous polyposis (FAP) or Lynch syndrome. If this describes you, don’t delay screening until 45 or 50—bring it up with your doctor immediately. More details on recommendations for these specific risk groups can be found here.
For African-Americans without symptoms or the aforementioned risk factors*, colonoscopies should begin at age 45 and be repeated every 10 years. Due to factors like limited access to screenings, lower awareness, and lifestyle influences such as smoking and obesity, African-Americans are often diagnosed with colorectal cancer at younger ages, with more advanced stages and poorer survival rates compared to other groups.
For those who are not African-American, have no symptoms, and lack other risk factors*, colonoscopies should start at age 50 and occur every decade.
*When was the last time you reached out to your mom or grandma? Do it—not just to be kind or ease guilt, but to gather crucial information about your family’s health history. This is vital and shouldn’t be delayed (apologies for the reminder, but it’s best to have this conversation while they’re still here and mentally sharp).
Why Should Younger Adults Consider Colorectal Cancer Risks?
Recent research indicates that while overall colorectal cancer rates are declining, diagnoses and deaths among individuals in their 20s, 30s, and 40s have risen compared to past decades. Dr. Jordan Karlitz, a gastroenterology associate professor at Tulane University and a National Colorectal Cancer Roundtable member, notes that the cause remains unclear, but multiple ongoing studies aim to uncover the reasons behind this trend.
Dr. Karlitz emphasizes, 'The best course of action is to treat any symptoms seriously and consult your physician about a colonoscopy, even if you’re young.' He also highlights the importance of understanding your family health history, as patterns of certain cancers within a family may indicate a higher risk of early-onset colorectal cancer.
Preparing for Your Appointment
Doctors use various sedation methods for colonoscopies, so discuss your options to determine the best choice for you. Propofol is the most common, providing rapid, deep sedation similar to general anesthesia but with a quicker recovery. Most patients fall asleep within seconds, remain unaware during the procedure, and have no memory of it afterward. It’s typical to wake up in recovery, confused about how you got there or when the procedure occurred. (Due to its potency, an anesthesiologist or sedation team will monitor you.) Other options include lighter sedation or no sedation at all, depending on patient preference.
Your doctor will provide detailed instructions, which you should review promptly. These may include following a special diet in the days leading up to the procedure to avoid foods that are hard to digest and could leave residue in your colon. You might also need to pick up prescription preparations and possibly special wipes, if preferred. If you take morning prescription medications, consult your doctor about adjusting them on the procedure day. Don’t hesitate to ask questions if anything is unclear.
Since sedation is involved, you’ll need to arrange for someone to drive you home afterward. Depending on the facility’s policies, a taxi or rideshare may be acceptable. Some facilities prohibit patients from leaving alone due to potential light-headedness. If transportation is an issue, discuss it with your doctor; this is a common concern, and most facilities have solutions.
Colonoscopy Prep: Easier Than You Think
If you’ve ever experienced severe diarrhea, you’ll find colonoscopy prep far less unpleasant. While it’s not exactly enjoyable, and you’ll spend significant time on the toilet the night before and possibly the morning of the procedure, it’s not like being sick. You shouldn’t face painful cramps, nausea, or regret over something you ate. (If you share a bathroom, plan ahead; you’ll need it for a while and will likely want privacy.)
Preparing the Day Before
You’ll likely be advised to consume only clear liquids the day before the procedure. This includes options like Sprite, lemon Jell-O, apple juice (not cider), and water. As Dr. Karlitz explains, 'If you can read a newspaper through it when held up in a glass, it’s clear enough. Avoid anything opaque.' These liquids, along with dietary adjustments and a special prep drink (more details below), ensure your colon is thoroughly clean, providing your doctor with a clear view during the examination.
Preparing the Night Before
Your doctor may prescribe a liquid solution to begin the cleansing process. Fortunately, these solutions are generally more palatable and require less volume than in the past. Some doctors now use a 'split prep' method, where half the solution is consumed the night before and the remainder the morning of the procedure. Reactions to the liquid vary—some find it unpleasant, while others consider it tolerable.
The process typically involves drinking a specific amount at set intervals over about an hour. Within another hour, you’ll likely feel a strong need to 'evacuate,' as medical professionals term it. Over the next few hours, you’ll experience frequent bowel movements, eventually passing only clear liquid, which is the desired outcome (well done!).
Rest assured, the process will end. You won’t be up all night or interrupted by unexpected urges. If you’ve followed your doctor’s instructions, you’ll have ample time to sleep normally. You’ll likely be instructed to avoid food and drink (except the prep solution) after midnight. If you’re doing a split prep, you’ll wake up at a designated time to finish the solution, but by then, you’ll know what to expect—and only clear liquid will remain. Then, it’s off to your procedure.
Arriving at the Facility
Your colonoscopy may occur in an ambulatory surgical center, hospital, or doctor’s office. Upon arrival, you’ll complete paperwork, including consent forms for sedation (agreeing not to drive, operate machinery, or sign documents for the rest of the day). You’ll change into a gown, have your vitals checked, and answer questions from staff, nurses, or an anesthesiologist (don’t worry—general anesthesia isn’t used!). You’ll also receive a briefing on the procedure and have the chance to ask questions.
Pre-Procedure Preparation
In the procedure room, you’ll likely find the doctor, a nurse, an attendant, or an anesthesiologist. You may be asked to lie on your side with your knees drawn up, and a drape will cover you. Sedation medication will be administered through an IV.
The procedure typically lasts around 30 minutes, according to Dr. Karlitz, but can extend to an hour if polyps are detected and removed. The colonoscope, about the width of a finger, includes a camera, light, and an air channel to slightly inflate the colon for better visibility. Starting at the far end, the scope travels the length of the colon, with the doctor viewing the images on a high-definition screen. If polyps are found, they’re removed using tiny instruments passed through the scope and sent for lab analysis. Any minor bleeding is controlled with specialized tools. Complications are rare, and your vital signs are monitored throughout.
Post-Procedure Overview
The effects of sedation may linger, leaving you drowsy or disoriented for a few minutes to several hours. If you’ve arranged for a companion, they may join you in the recovery area as you regain full awareness.
Feeling slightly bloated is common due to the air introduced into your colon during the procedure, and you might expel some gas (apologies to your ride home!). Once your doctor confirms your mental clarity, they’ll discuss their findings, the timeline for receiving results, and may share images captured during the exam. They’ll outline typical post-procedure experiences (like minor blood in stool if polyps were removed) and warning signs (such as pain, fever, or significant bleeding). You’ll receive guidance on managing any issues, details on when to expect lab results, and recommendations for your next screening.
Doctors typically recommend taking it easy for the remainder of the day and may provide light snacks like juice or crackers. After sufficient rest, you’ll be cleared to dress, leave the facility, and enjoy a meal that’s more substantial than clear liquids.
