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Mayo Clinic Q and A: So you’re having a colonoscopy: What to expect
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DEAR MAYO CLINIC: I just turned 45 and am dreading my first colonoscopy. Why do I need to be screened if I'm not having issues? Can you walk me through the process?
ANSWER: Feeling anxious or afraid surrounding a procedure, particularly when you've never done it before, is completely normal. The purpose of screening is to act before someone develops symptoms. If we're able to identify polyps, which are precancerous lesions in the lining of the colon, we would then have the opportunity to remove them and prevent the development of cancer in the first place. So through screening, we can prevent cancer. At the time of diagnosing cancer, we've missed that opportunity.
There are a number of ways we can screen for colorectal cancer. In the U.S., we most often use a colonoscopy. Colonoscopy is an invasive test, but it allows us an opportunity to not only see polyps, but also remove them at the same time. For people with no additional risk factors besides age, it is recommended to start screening at the age of 45. If other risk factors are present, though, it may be recommended to have a colonoscopy sooner than 45.
The colon preparation prior to the colonoscopy is key. The goal of colonoscopy prep is to make sure that there is nothing in the colon by using a laxative liquid solution. Then, at the time of the colonoscopy, we're able to see and detect even small precancerous lesions so they can be removed.
It is very common to hear complaints from patients about the preparation, such as the consistency or taste of the solution, cramping, abdominal bloating or discomfort. That's to be anticipated. Unfortunately, some patients also experience nausea. Try slowing down how fast you are drinking the solution. For those who tend to struggle with the taste or consistency, try drinking it through a straw. You can also bite into a small wedge of lime or lemon, or you can chew gum or ice between drinks.
After you finish the last of the prep solution and check in for your appointment, you'll often be greeted by the front desk team and then escorted back by a healthcare team member. They will review things like your medical history and medications and see how the colon prep treated you. There is a risk that you may have to come back and repeat the test at a later time if the colon prep was not adequate.
Another critical thing they will do is establish your intravenous therapy or IV. The IV is the route in which they will give you the medication to help make the procedure a little bit more comfortable. Some people don't do any sedation at all, but it is totally appropriate to opt for it. There are several different ways that sedation could be done for the procedure. A lot of that depends upon how the procedure is scheduled with your healthcare team. Then, you will end up going back to the procedure room where they will review the nature of the procedure before starting the colonoscopy. Afterwards, there's a bit of a recovery period, and then you're able to head back home. Because of the sedation, we don't want people driving, consuming alcohol or making any critical decisions for 24 hours.
We still don't have a perfect recipe for preventing polyps, but maintaining a healthy diet and exercise can protect you. It is important to be aware of any symptoms and then follow through with screening. Best of luck as you take this important first step. — Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota.
