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

Colonoscopies: Don’t Procrastinate With 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 may be much more prevalent than you realize.  In fact, the rate of people dying from colorectal cancer, or CRC, has increased enough in recent years that the guidelines have changed.  Before, people were instructed to get one at age 50, but that has decreased to 45. Unfortunately, there is still a widespread lack of acceptance for colonoscopies.  Due to this, up to 75% of patients who are diagnosed with CRC aren’t seen by a healthcare provider until the disease is advanced (Hayman & Vyas, 2021).

The U.S. Preventative Services Task Force changed this.  Here are some 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 #3 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 the older populations that are more likely to get screened.

• Additionally, older adults have seen decreased rates of death from CRC. 

• 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-2000’s. 

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

A couple of reasons.  First, older adults are more likely to get screened.  When you get regular screenings, there is a greater chance that the doctor will find what’s called a polyp if it’s there.  A polyp is a small growth of tissue found along the colon's lining.  Most of them are benign and will be removed during the colonoscopy.  The process is painless, and you won’t even know it happened when you wake up.  Polyps don’t usually cause symptoms, so you probably won’t know you have one unless you get a colonoscopy.  However, if you have blood in your stool, a change in bowel habits, abdominal pain, or bleeding from the rectum, these could be an indication of a polyp that has progressed and/or cancer, in which case you should get checked sooner rather than later. 

On the other hand, if you’re asymptomatic and not being screened, there is a greater risk that any polyp could develop into cancer without your knowledge. 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 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

• Smoking

• Diabetes

• Family history of CRC-in fact, it is recommended that if you do have a family history, you start getting screened before 45. 

• Inflammatory Bowel Disease, like Crohn’s or 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. 

Multiple options, but which test is best?

So, what about other tests?  Do you really need a colonoscopy if you’re healthy and don’t have any risk factors? Let's look at the options:

1. At home stool tests: If you are over 45, you are considered “average risk.” For the average-risk adult, multiple options are available. A growing number of at-home stool tests are becoming available.  These tests either 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 CT scan of your abdominal organs to detect changes or abnormalities in the colon or rectum. It doesn’t require any sedation or invasive procedures.  However, the patient must take a prep and cleanse the night before, just like a traditional colonoscopy. Since polyps can’t be removed and tissue samples can’t be taken, you may need a colonoscopy as a follow-up if any abnormalities are noted. Another con is that the test remains less accurate than a colonoscopy, despite going through the prep. 

3. Colonoscopy: Often referred to as the 'gold standard' of CRC screening tools, it is a safe and effective procedure.  During this test, a small flexible tube with a camera at the end is inserted into the rectum.  The doctor can directly visualize the inside of the colon, allowing for the detection, removal, or biopsy of any abnormalities. This approach is the best way for your doctor to inspect the rectum and colon and fix any minor irregularities if present. If a mass is found, it can be biopsied immediately, as opposed to the other tests, where you would have to schedule and wait for a colonoscopy and then wait for the results of the biopsy, 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. 

   
   
   
   

   

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

   
   

Colonoscopy steps: 

1. The prep: A patient must fast the day before.  You can have clear liquids like broth and water.  You must also take a prep that will completely (and I mean completely) empty you before the test, ensuring that there is no stool in the way of the scope and camera. The prep is usually a combination of pills and drinks.  It depends on what your practitioner prefers.

   
   

   Oftentimes, patients report that the prep was the most challenging part, but not to the point that they don’t have more tests in the future. Just plan ahead to stay close to an available bathroom at all times after starting to take it because once it starts to work, that is imperative! 

   
   

   Of note, unfortunately, under rare circumstances, there are some individuals for whom the prep doesn't work. If you are one of these individuals, you may need to return for another colonoscopy with a different preparation.

2. What happens 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 had room to see you there on that day. 

   
   

   The staff will check you in and bring you to your preoperative room, where you will completely undress and put on a gown like the one pictured above. 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.).

Side note: I know many people are terrified of the IV, but remember: it’s usually a quick stick, and then it’s over.  If you take some big breaths right before and know that it’s not the worst thing in the world, it will help. Also, once the IV is in, that’s where all the good medicine will go!

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 performs the test, and a technician assists him with the equipment and any samples that may need to be collected. There is always a nurse who will document and sometimes assist as well. There may be an anesthesia provider, usually a nurse anesthetist, which means you will be getting propofol. 

4. Different forms of sedation: If there is no anesthesia provider, another RN will medicate you. With this form of sedation, you may not remember the procedure once it’s over, but you’re less likely to stay still while the test is performed, and you’re more likely to wake up with nausea and a headache due to the medications used. If you are moving around, the test will take longer or may need to be canceled until you can do it with anesthesia. 

   
   

   Neither of these situations is likely with an anesthesia provider administering the medication. There are many situations where anesthesia is used. Often, if people admit they drink regularly or take any drugs, or if they have high anxiety, the provider will request anesthesia. Ultimately, you can request to have an anesthesia person for sedation because you feel you have “increased medication requirements.” If you think you need this and inform your doctor well before the procedure, this request can usually be accommodated. 

   
   

   Sometimes, if an anesthetist isn’t administering the medication, it's because someone (insurance) didn’t want to pay, or there just wasn't anyone available, even if you’re at the hospital. In many cases, the doctors and nurses prefer it if anesthesia were there. Not only do they provide a better sedative experience, but they are also trained to handle any tricky medical issues if they arise.

5. Anesthesia: Many people are embarrassed by the thought of “all these people” looking at your most private parts, especially when you’re being “violated” while sleeping. However,  there’s nothing to be embarrassed about.  Don’t forget that the staff in the room may perform up to 15 procedures in just one day.  They are all trained and used to seeing people having this done.  

   
   

   If you get propofol, your arm may initially feel achy when it enters the IV. That’s because it’s thick and contains a preservative that can make it uncomfortable at first, but it works very fast. You will be asleep in less than 20 seconds. Some folks are nervous about receiving this type of anesthesia, but it’s very safe. Your anesthesia provider will be by your side the whole time with all of her attention. You really just take a nap and wake up when it's over.

6. The test: After you're asleep, the doctor uncovers your bottom the tiniest bit and inserts a tiny, 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’d ever had.  

7. After the test: That’s it!  You will be wheeled out to recovery; the doctor will speak to you once you’re a little more awake and tell you what she found. After that, you can have your IV taken out, and you can 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, I hope you will keep up with your screenings. They are relatively easy and potentially life-saving tests that insurance should cover. If you are over 45 and haven’t had one, please consider doing so. 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