Why a Colonoscopy Is Important and Why You Shouldn't Be Afraid to Have One

Colonoscopies: Don’t Delay A Test That Could Save Your Life

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You just turned 50 and go to your doctor for a check-up. Suddenly, she suggests that you’re due for the dreaded colonoscopy. All you know is that you're terrified of medical facilities, anesthesia, and strangers watching while you have something stuck in your behind. It’s natural to feel apprehensive, but the test is a crucial tool in maintaining good health. Let’s explore exactly what happens when you go and why it's crucial that you don't wait to have one.

Colon cancer might be more common than you think. In fact, the number of people dying from colorectal cancer, or CRC, has increased enough in recent years to justify a change in the guidelines. In the past, people were advised to get tested at age 50, but now that age has lowered to 45. Unfortunately, many still resist colonoscopies. As a result, up to 75% of patients diagnosed with CRC are not seen by a healthcare provider until the disease has advanced. (Hayman & Vyas, 2021).

The U.S. Preventive Services Task Force updated the guidelines based on these eye-opening statistics:

• 1 in 23 men and 1 in 25 women will be diagnosed with colorectal cancer (CRC) in their lifetime.

• CRC is the 3rd most diagnosed cancer among men and women.

• The American Cancer Society estimates cases for 2025 will be about 107,320 new cases of colon cancer (54,510 in men and 52,810 in women) and about 46,950 new cases of rectal cancer (27,950 in men and 19,000 in women).

• While the overall rates of CRC have decreased by about 1% each year, this is mainly in older populations who are more likely to get screened.

• In people under 50, the diagnosis rates increased 2.4% each year between 2012 and 2021, and the rates of death due to CRC have also risen steadily, about 1% per year since the mid-2000s.

Why are younger people more likely to die from CRC than older populations?

Studies indicate that older adults are more likely to undergo screenings. When you get regular screenings, your doctor has a better chance of detecting and removing any polyps. A polyp is a small growth of tissue found along the colon's lining. Most of them are benign and can be removed during the colonoscopy. The process is painless and occurs while you are sedated. Polyps don’t usually cause symptoms, so you probably won’t know you have one unless you get a colonoscopy. If you are asymptomatic and not undergoing screening, there is a much higher risk that a polyp could develop into cancer without you knowing. If not caught in time, this could prove fatal. The best way to decrease the risk of colon cancer is to get tested.

That being said, not many people know that the guidelines have changed. Now that they have, your insurance should pay for you to have the test done at 45 instead of waiting to turn 50, and it's highly suggested that you do so.

Remember, early detection of CRC can significantly increase the chances of successful treatment, making the inconvenience of a colonoscopy well worth it.

Multiple factors increase your risk of developing CRC:

• Older age-although this population tends to find the disease earlier due to regular screening, the risk of CRC still increases with age.

• Smoking

• Diabetes

• Family history of CRC (If you do have a family history, consider getting screened before 45)

• Inflammatory Bowel Disease (Crohn’s, Ulcerative Colitis)

• Lack of exercise

• Obesity

• Radiation to the pelvic or abdominal area

• Poor diet, eating a lot of fatty foods and meat, and not enough fruits and vegetables

Even if you don’t have any of the risk factors above, you are still considered “average risk” and should take your first test by 45.

There are multiple options for screening, but which test is best?

Do you really need a colonoscopy if you’re healthy and don’t have any risk factors?

If you are over 45, you are considered “average risk.” For the average-risk adult, multiple options are available. Let’s look at the alternative options:

1. At-home stool tests: A growing number of at-home stool tests are becoming available that assess your stool DNA or blood. They are convenient and non-invasive, and most do not require dietary or medication restrictions beforehand. However, since they are designed for healthy individuals with low to average risk, they may not be suitable for everyone. These at-home kits are not recommended if you have any abnormal symptoms or risk factors. Also, while the kits are simpler and less bothersome, they are not as sensitive as a colonoscopy; they can sometimes yield a false positive, and if you receive a positive result, you will need to follow up with a colonoscopy anyway.

2. Virtual Colonoscopy or CT Colonography: This is a computed tomography (CT) scan of your abdominal organs to identify any changes or abnormalities in the colon or rectum. It is a non-invasive procedure that uses X-rays to visualize your internal structures. However, the patient must take prep the night before to cleanse, just like a traditional colonoscopy. Polyps cannot be removed, and tissue samples can’t be taken, requiring a colonoscopy as a follow-up if any abnormalities are noted. Another con is that the test is less accurate than a colonoscopy, despite going through the prep.

3. Colonoscopy: Often called the 'gold standard' of CRC screening tools, it is a safe and effective procedure. The doctor can directly visualize the inside of the colon, enabling detection, removal, or biopsy of any abnormalities. This method is the best way for your doctor to examine the rectum and colon and to fix minor irregularities if they exist. If a mass is found, it can be biopsied immediately, unlike other tests where you'll need to schedule and wait for a colonoscopy and then wait for biopsy results, which can take a week.

4. Robotic colonoscopy: This new advance gives a more in-depth view of the colon with minimal pain, sedation, and procedure time than a traditional colonoscopy. However, they are not widely available.

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   https://commons.wikimedia.org/wiki/File:CSIRO_ScienceImage_11130_CSIROs_colonoscopy_simulator_developed_using_the_latest_computer_gaming_technology.jpg

   
   

Colonoscopy Steps

1. The preparation: A patient must fast the day before. You can have clear liquids like broth and water. You must also take a prep the day and night before. This is usually a drink and several pills that will completely empty your stomach and intestines before the test, making sure there's no stool blocking the scope and camera. The prep is usually a combination of pills and drinks. It depends on what your practitioner prefers.

   
   

Oftentimes, patients say that the prep was the hardest part, but not so much so that they have any lasting effects. However, plan to stay close to a bathroom after starting to take it because once it starts to work, it works fast!

Unfortunately, under rare circumstances, some individuals don't respond to the prep. If you are one of these individuals, you may need to return for another colonoscopy with a different preparation.

2. Once you get to the facility: You will go to a medical facility—either a hospital, an outpatient surgical center, or a GI center. The latter two are freestanding facilities not attached to a hospital. Only healthier patients should be treated at these. However, if you are at a hospital, this could just be because your practitioner was only available to see you there on that day.

The staff will check you in and bring you to a preoperative room, where you will completely undress and put on a gown like the one pictured below. The nurse or nurse anesthetist will start your IV, take your vital signs, and ask you some basic preoperative questions (e.g., what you ate today, what medicines you have taken, etc.).

Pic: https://commons.wikimedia.org/wiki/File:Hospitalgownspatients.jpg

3. What happens next? You will be wheeled to your exam room on a stretcher. The rooms are typically small, and several people will be present. The doctor will perform the test, and a technician will assist with the equipment and any samples that may need to be collected. A nurse will be present to document and offer assistance and sedation if needed. There may be an anesthesia provider, usually a nurse anesthetist, who will give you propofol for deep sedation.

4. Different forms of sedation: In many situations, anesthesia is used to provide deep sedation for patient comfort and to facilitate a quicker and easier procedure. However, this will add to the cost of the procedure, and insurance may be an issue. In some situations, anesthesia might be necessary for certain patients. If people admit to drinking alcohol regularly, taking drugs, or suffering from high anxiety, the provider may request anesthesia or go to a facility that offers anesthesia. Ultimately, you can request to have deep sedation with anesthesia if you feel you have increased medication requirements or if it’s something you feel strongly about. If you need this and inform your doctor well before the procedure, this request can be accommodated.

   
   

If there is no anesthesia provider, an RN will administer medication to you. This form of sedation may not offer as deep a sedation. There is an increased risk that you might remember the procedure, you’re less likely to stay still during the test, and you’re more likely to wake up with nausea and a headache from the medications. If you are moving around, the test will take longer, or it may need to be canceled until you can do it with anesthesia. However, most patients do very well with this level of sedation and report no memory of the test or issues during and afterward.

Occasionally, when an anesthetist is not responsible for administering medication, it is due to factors such as insurance refusals to reimburse or the unavailability of qualified personnel, despite being within the hospital setting. In numerous instances, medical professionals such as doctors and nurses favor the availability of anesthesia. This preference is due not only to the enhanced sedative experience it offers but also because they are adequately trained to manage complex medical issues should they occur.

5. Anesthesia: Although many individuals may feel embarrassed at the prospect of undergoing a colonoscopy, particularly when sedated, there is no need for such feelings. It is important to remember that the medical staff in the procedure room may perform as many as fifteen procedures in a single day. They are all professionally trained and experienced in assisting patients through this process.

If you are treated with propofol, your arm will initially feel achy when it enters the IV. The medication is thick and contains a preservative that can cause initial discomfort, but it works very fast. You will fall asleep in less than 20 seconds. Some people feel nervous about receiving this type of anesthesia, but it’s very safe. Your anesthesia provider will stay with you the entire time, giving you her full attention. You can relax and take a nap, then wake up when it's finished.

6. The test: Once you are asleep, the doctor will gently part your buttocks and insert a small, lubricated scope. It always goes in easily and is very small, so it’s not as invasive or uncomfortable as you might think. Once in, you are covered back up with your blankets. The only thing the people in the room are looking at is what the camera sees: the inside of your colon, which doesn’t look like anything too exciting for the most part. The test usually takes around 30-60 minutes while you sleep comfortably. Once done, the scope is removed, and the medication stops. Most patients wake up comfortably and often report that it was the best sleep they’ve ever had.

6. After the test: That’s it! You will be wheeled to recovery; the doctor will speak to you once you’re awake and tell you what she found. Your IV is taken out, and you go home with your ride. The medicine, propofol, will start wearing off almost immediately. It doesn’t leave you nauseous or with a headache. If you did receive the other sedation, and you are feeling unwell, there are medications the RN can give you to help with that.

Now that you have read about the risk of CRC and the process of a colonoscopy, please consider getting one when the time comes. They are easy and potentially life-saving tests that insurance should cover. Call your healthcare provider to address this if you are over 45 and haven’t had one. It could save your life!

References: 

Webpages:

American Cancer Society. (n.d.). Colorectal cancer. https://www.cancer.org/cancer/types/colon-rectal-cancer.html

American Cancer Society. (n.d.). Key statistics for colorectal cancer. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html

Mayo Clinic. (n.d.). Colon polyps. https://www.mayoclinic.org/diseases-conditions/colon-polyps/symptoms-causes/syc-20352875

Mayo Clinic Health System. (n.d.). Colorectal cancer myths and facts. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/colorectal-cancer-myths-and-facts

Verywell Health. (n.d.). Colonoscopy: The gold standard for colorectal cancer screening. https://www.verywellhealth.com/colonoscopy-gold-standard-11685291

Journal Article:

Hayman, C. V., & Vyas, D. (2021). Screening colonoscopy: The present and the future. World Journal of Gastroenterology, 27(3), 233-239. https://doi.org/10.3748/wjg.v27.i3.233