The colonoscopy process: everything you ever wanted to know (and some things you didn’t)

While undergoing my latest colonoscopy prep and screening process last month, I learned that some things have changed even from just a couple years ago.  Whether you’ve had a colonoscopy before but it’s been a while, or if you’ve yet to have one, hopefully this “what to expect” post will be helpful.

IMPORTANT ALERT!

First off, a huge thing that’s changed recently is that, even if you have no history of disease or other known risk factors, the new recommended age for a first colonoscopy is no longer 50, it’s now 45. I don’t get the sense that this has been well communicated to the public at large, so it’s important to spread the word - when it comes to colonoscopies, 45 is the new 50!

The depressing reality is that this change in recommendation is due to the cold hard fact that there continues to be an alarming increase in younger adults being diagnosed with colon cancer, and oftentimes it’s already too late.

The good news is when colon cancer is caught early via a colonoscopy, it can be highly treatable and often curable!  

So for you lucky ducks with no known risk factors, go get yours at 45!  And for the rest of us that have a darn good reason to get them even younger, follow your doctor's advice for how often to do it, and don’t procrastinate!  For me, with my history of severe Ulcerative Colitis, this means every two years, and I make sure to be as punctual as possible.  

#REALTALK

Let’s just go ahead and get this out of the way….colonoscopies suck.  There’s no use pretending otherwise.  Including the prep day, the entire experience is about 24 hours of various  forms of mild torture.  However, compared to undiagnosed colon cancer or autoimmune disease, or other debilitating acute or chronic issues that can make your life miserable for way longer than 24 hours, it’s a process that’s obviously worth going through.

THE DREADED PREP PROCESS: WHAT TO EAT/DRINK

The day before your procedure, you’ll stick mostly to a liquid diet including water, clear juices, black coffee, teas, clear broths, and popsicles/italian ice (that aren’t red or purple in color).

One thing about my most recent prep that really excited me was learning that now a little bit of low residue solid food can be eaten the day before for breakfast and lunch!  This is a huge change as before the rule was liquids-only for the entire day.  So the day before my colonoscopy last month, I had a little food that was specified on the “approved low-residue list.”  This included some coconut yogurt and a scoop of peanut butter in the morning, then scrambled eggs and another scoop of peanut butter for lunch, before sticking to clear liquids for the rest of the day.  Double and triple check your prep instructions to make sure you know what you may eat, if anything.

I totally felt like I was doing something wrong by eating ANY solid food, but it all worked out okay!  I definitely kept it to small amounts and can imagine that eating a large amount would only make the evening events harder, but even just being able to eat the small amounts helped remove that sickly/weak feeling that I’d get each time prior from not having nourishment.  I also never really drink juice, so even the small amounts I drink on colonoscopy prep day typically make me feel sick to my empty stomach, and this time the little bit of solid food helped to counter that.

THE DREADED PREP PROCESS: THE CLEANSE

The actual “cleansing” process will vary depending on which prep solutions (which can be one of numerous prescriptions or an over the counter cocktail) you are instructed to use, but this is generally how it goes (read your doctor’s instructions thoroughly for your specific method).  My instructions always start with taking a stool softener pill early in the evening, I guess just to start loosening things up, pun intended.  Then for the prep solution, most prescribed ones are a 2 dose method, with the first dose being in the evening, typically around 6pm or so.  That’s when you take your first dose of the prep solution, which generally is a bottle of goo.  The bottle of goo is a thick, salty-ish liquid that usually has an artificial flavor added such as cranberry or orange.  It’s not the worst thing in the world, but DO NOT expect it to taste like juice or be even remotely enjoyable.  The instructions will then tell you to follow with a certain amount of clear liquids in a certain time frame.  Follow the instructions exactly as it’s super important to drink enough so that you don’t get overly dehydrated once the action starts.

A quick note about the prep prescription - for the last decade plus, my doctor has given me a prescription for the prep solution, and having had numerous prescribed preps, I’ve always found them to get the job done well.  When I saw him for my pre-colonoscopy appointment he warned me that a lot of health insurance providers are no longer covering these types of prep and will now only cover the gallon sized demon-sent-from-hell concoction known as “GoLytely” (world’s most ironic name, by the way).  I have mentioned in earlier posts that there is no way I could ever, past, present, or future, get down a whole gallon of this stuff, so this wasn’t an option for me.  He said I could pay out of pocket for the regular prescription, or he could give me a list for a variety of over-the-counter methods.  Trying to keep things as low stress as possible, I decided to begrudgingly bite the bullet and pay out of pocket for my usual stuff (which cost me $130, UGH!) since I KNOW that it works and didn’t want to have to deal with worrying about the effectiveness of the over-the-counter stuff.  Why in the world healthcare insurance companies would stop covering these easier prep solutions for such an important screening procedure is beyond my understanding….but that’s a post for another day.

So back to the prep process - you drink the first dose of goo and the follow up liquids, and then….you wait.  Sometimes the bowels get stimulated rather quickly, and sometimes it takes hours.  It’s a good idea to take a little walk (without straying too far from the bathroom - just in case) after your first dose to help things move along.  Some warm tea at this point is a good idea too.

Excuse the graphicness here, but, the more you know…. Solid material may come out at first, but then you'll experience very watery diarrhea throughout the night time after time until the job is done.   

Sometime in the middle of the night when your instructions say to do so, you will take the second dose (set an alarm so you don’t miss it!).  You will be low-level miserable and exhausted by now, but again, it’s very important to drink enough liquids post-second dose to avoid dehydration.

Do not expect to sleep much and do expect to be visiting the porcelain throne many, many times throughout the night.  Remind yourself that you can sleep (and eat!) tomorrow, and that this is only a few measly hours of your precious life and it is ABSOLUTELY ALL WORTH IT.

THE PROCEDURE DAY

Give yourself plenty of time in the morning to be up and functioning before you need to leave for your appointment because your bowels may still be churning.  Once you arrive for your procedure, there will, of course, be paperwork, then a nurse will get you all set up with a gown and an IV.  The anesthesiologist will likely pay you a visit to discuss the process then you’ll be wheeled into the procedure room where your doctor, anesthesiologist, and nurses will be waiting for you.

At this point I recommend cracking a few jokes to distract from the fact that in a couple minutes these folks will literally be up you a$$.  But seriously, try to enjoy your medically induced nap.  

When you wake up it will all be over with, a nurse will bring you something to drink and then the doctor will come review the results with you.  You will even get to take home pictures of the inside of your colon - who doesn’t love that?!  Then you’re all done and you can go home to eat and sleep!  

Congratulate yourself - you’ve done a big part of what it takes to make sure you live a long and healthy life!

SOME HOT TIPS!

After undergoing many colonoscopies over the last 22 years, I’ve come up with a list of tips to make the process a little easier.

1. Schedule your procedure in the morning - the later in the day it is, the longer you have to go without eating and sleeping much.  The earlier you schedule it for, the earlier you get to go home.
2. Don’t gorge yourself in the days prior to prep day.  Though it’s tempting to have one really big “last meal” before your prep day, know that this will only create more of that which will have to come out, and that just means more harsh and unpleasant trips to the bathroom on prep night.
3. Don’t gorge yourself in the meals post-colonoscopy.  Again, it will be tempting to make up for lost time with a big meal after the procedure, but your colon has just been through a lot, and smaller meals will go over much better.  For me, eating too much too fast post-procedure leads to severe gas pain.  Definitely not what you want at that point!  Also limit fiber and harder to digest foods for a day or so as they can provoke gas pain, too (I actually made this mistake on my most recent one, and I certainly won’t forget it next time!) - after that you can fully return to your hopefully extremely healthy, fiber-filled lifestyle!
4. Chug the goo.  As mentioned earlier, the prep meds are pretty gross.  I’ve tried taking just little sips at a time and I’ve tried mixing them with other liquids.  Unless your specific prep instructions say to do otherwise, I recommend cracking that bottle open, chugging it down as fast as you can, and then chasing it with some juice.  Expect to gag a bit, but this makes the process faster and therefore reduces the suffering!
5. Take the second dose of goo early - if my instructions say to take it 5 hours before my procedure time, I take it 7 hours before.  This gives a little extra time to make sure all has been cleared out before having to leave the safety and comfort of the bathroom to head to the procedure facility.  The last thing you want at this point is an urgent need to go while in transit, and giving yourself these extra couple of hours will help avoid that situation.

So there you have it!  Remember that all of the above reflects my personal experience - you should do as your own doctor instructs re: your colonoscopy prep, but don’t be afraid to ask questions/get clarification on instructions as needed.  

It’s always good to know what to expect, so I hope this has helped you feel more prepared and confident for when your colonoscopy time comes.

Bottom line, colonoscopies are unpleasant, but just do it anyway.  Your healthy future is so worth a little temporary discomfort!