Content warning: mentions cancer and death
If I had a dollar for every time a patient came into my office and said they “want to be checked for cancer,” well…I probably wouldn’t be writing this blog post! There is no single universal test for cancer, but common things happen commonly. Colorectal cancer is the second most common cause of cancer deaths when men and women are combined (cancer.org). Screening for colorectal cancer should be on your list to be “checked for cancer.”
For those at average risk, screening for colorectal cancer should begin at age 45 (cdc.gov). If you want to know more about colorectal cancer incidence, risk factors and screening methods, then check out last week's blog post here. I am at increased risk for colorectal cancer, because my father died from complications of colon cancer when he was only 45. So though I’m only in my thirties, I’ve already had my first screening colonoscopy, which is the gold standard screening method for individuals at high risk. Alternative screening methods are NOT appropriate for high risk individuals, but are an option for individuals at average risk. Let's talk about my experience with my first screening colonoscopy.
Before the colonoscopy procedure
I received clear verbal and written instructions detailing when to start the prep, what was required and what should be avoided to successfully complete the prep. I was given written instructions well in advance so that I could purchase what I needed (my prep medications were available over the counter and did not require a prescription). A nurse called a day or two prior to the procedure with a specific time to present to the hospital on the day my colonoscopy procedure was scheduled. Prep instructions were reviewed once again, and I had the opportunity to ask questions.
The prep wasn’t as bad as I expected based on what others have said. Most people don’t like to have watery diarrhea, but that’s essentially all the prep is - self-induced diarrhea.
Here's what I needed for my prep* (please note that your prep could differ):
4 dulcolax (bisacodyl) 5 mg tablets - commissions earned
8.3 oz (238 gram) Miralax (polyethylene glycol) powder
64 oz Gatorade NOT RED OR PURPLE COLORED (this is so that it doesn’t “dye things weird” or give the false appearance of blood) - commissions earned
clear fluids to drink/eat (clear means you can see through them)
- examples are juices without pulp, gatorade, water/flavored water, clear broth buillon, Jell-o not red or purple colored and without fruit/toppings, black coffee/tea/iced tea)
- AVOID milk/dairy products including coffee creamer, orange/tomato juice, alcohol, red/purple liquids
First things first, DO NOT PLAN TO GO ANYWHERE OR DO ANYTHING PRODUCTIVE! Seriously. You won’t want to be away from home (or your preferred bathroom for that matter) for any period of time. No, I never felt as if I was going to have an accident, but once I started the prep, I had the urge to relieve myself about every 15-20 minutes throughout the day, but NOT the night, Thank God. Who wants to lose sleep?! I wondered if I’d be on the commode all night, and I’m happy to report that was NOT the case.
Once I initiated the prep (at NOON - but this can vary based on the time of your procedure) with the 4 tablets of bisacodyl 5 mg, then I mixed the entire 8.3 oz bottle of Miralax with 64 oz Gatorade. I combined it in one large pitcher and stored it in the refrigerator. Miralax is a preferred prep method, because it’s tasteless and dissolves easily. I did not have to suck on a lemon prior to drinking my prep solution or drink it through a straw as suggested in case of trouble tolerating the drink. 6 hours after taking bisacodyl (6 pm), I had to drink 8 oz of the Miralax/Gatorade prep solution every 15 minutes until half (32 oz) was gone. Finally 5 hours later (11 PM), I finished the remaining 32 oz over the next hour - 8 oz every 15 minutes. So the prep was finished by midnight. Thankfully, the urge to relieve myself abated not long after and I was able to sleep most of the night without having to use the bathroom.
I also drank other clear (not red or purple) liquids throughout the day. My “meals” were chicken broth - I would dissolve one chicken bouillon cube in a cup of boiling water as directed using an electric tea kettle, and eat it like a soup (commissions earned). I ate jello for dessert (did I say no red or purple?) - commissions earned. I’m not a big fan of either of these things any other time, but I was happy to have them during my colonoscopy prep.
Liquid stools started about an hour after initiating the prep. The first few hours into the prep, I experienced mild abdominal discomfort, mild headache, runny nose and just felt worn out in general. I felt a little lightheaded in the shower and had to cut it short, so use caution. But once I got into the routine of the prep ( and had my first “meal”), I felt better.
THE GOAL OF PREP IS NOT ONLY TO MOVE STOOL, BUT ALSO TO WASH THE WALLS OF THE INTESTINES. This is why sticking to clear liquids is so important.
Although the preparation for the colonoscopy wasn’t as bad as I anticipated, it was indeed “worse than the procedure.”
The day of the colonoscopy procedure
I continued to drink/eat clear liquids until 2 hours prior to the arrival time for my colonoscopy procedure.
FYI: if your colonoscopy procedure will be done under generalized anesthesia, you will need a driver to take you home afterwards.
The actual colonoscopy procedure was a breeze. I was in and out, from checkin to checkout, within two hours! After check-in, my vital signs were taken and a urine sample was provided to rule out pregnancy since I'm a woman of child bearing age. Medications were reviewed. I was asked about my prep, the time of my last meal and bowel movement (clear liquid is what they want). After changing into a gown and getting an IV, I was seen by the anesthesiologist and gastroenterologist that would perform the colonoscopy procedure. We had a discussion about risks of the procedure. Risks (bleeding, infection, tear, from being under general anesthesia) are RARE and the benefits outweigh the risks in my opinion.
Once in the operating room (OR), I participated in the “timeout” where everyone ensures it’s the right patient and the right procedure. I got into a left side lying position and place my slightly bent right leg over my straight left leg - this position was found to increase polyp detection among other benefits (sciencedaily.com). Once I put the oxygen mask on, I remember my vision blurring within minutes. Then I woke up in a recovery room about an hour later! The worst part in my opinion was getting the IV and ripping off the bandaid after the IV was removed. Seriously! The colonoscopy procedure itself was quick and painless, in and out of the OR within an hour (less time than it takes to get your car detailed or hair colored). I felt no different than I had prior to the procedure. That’s all it takes to screen for and potentially prevent one of the most common cancers?! I was amazed, grateful and relieved.
After the colonoscopy procedure
After the procedure, the gastroenterologist will check on you and discuss findings. If any polyps were removed, they will be sent to the pathology lab for testing. Results can take up to a couple of weeks. Your level of risk, the results of the colonoscopy and the findings if any will determine when you should repeat testing (so you may not know until pathology results are available rather than immediately following the procedure). If you’re uncertain, then ask! This is important. A "clean" colonoscopy will not likely be "one and done," so be sure to understand when you should follow up in the future if indicated.
In general, average risk individuals with negative colonoscopies can expect to repeat in 10 years. High risk individuals can expect to return in 3-5 years. Individuals diagnosed with colorectal cancer may require another colonoscopy in 6-12 months as part of an ongoing treatment plan.
Other than having someone drive to escort you home and being advised to "take it easy" (avoid operating heavy machinery including driving or making any serious decisions the rest of the day after being under anesthesia) there are no dietary restrictions. There is no recovery period. More solid stools should resume soon after you resume your typical diet.
Takeaways and Conclusion
Prep takes one day and the procedure another (you may miss two work days) - try to schedule close to days you already have off, such as just before the weekend or a holiday break if applicable
Prep wasn't bad - no accidents and able to sleep through the night
Procedure was quick and painless
Minimal restrictions "post-op" and no recovery period
Again, colonoscopy preparation and procedures can vary. Be sure to discuss particulars along with risks, benefits and alternatives with your provider as they apply to your specific situation. While preparing for and undergoing a colonoscopy procedure takes preparation and is more risky and time consuming than less invasive alternatives, screening for and potentially preventing one of the most common cancers is worthwhile and a productive way to spend a couple of days! If you were to be diagnosed with colorectal cancer, treatment would certainly be more inconvenient.
What questions do you have for me?
**This post contains affiliate links. I earn commissions from clicks that result in products purchased.
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