Ready For Your First Colonoscopy?

It’s a milestone many adults don’t want. Your first colonoscopy procedure often brings a mix of anxiety and dread – and that’s just for the lead-up to the exam.

“For people who are hesitant, I think the first thing to help them acknowledge that you're not alone,” said Dipen Maun, MD, a colon and rectal surgeon with Franciscan Health Indianapolis and Mooresville. “These concerns are, unfortunately, very common. And many people worry about the preparation, the procedure, or maybe taking time off away from work or family. But screening for colon cancer is one of the most powerful things you can do to protect your long-term health."

Dr. Maun and Amy Long, RN, an endoscopy nurse navigator with Franciscan Health Indianapolis, explain how adults in their 40s and 50s should prepare for their first colonoscopy and what to expect with their colonoscopy exam.

Key Takeaways: What To Expect In A Colonoscopy Procedure

• Colonoscopy prep often begins the day before the procedure and includes temporary diet changes and medications to help with bowel cleansing and help your doctor to locate colorectal polyps.
• During a colonoscopy procedure, you are sedated. A long, flexible tube called a colonoscope, which has a tiny camera, a light and small channels if procedures are needed, is inserted in the body to inspect your colon and rectum.
• Any abnormal growths such as colorectal polyps typically are removed during the colonoscopy procedure. Samples of the tissues are then diagnosed in a lab.

Why Should Adults Have A Colonoscopy?

“People really need to get a colonoscopy because colorectal cancer is the second leading cause of cancer-related deaths in America,” Long said. “Early detection is the key here. It can take 10 to 20 years for a small polyp to become cancer. So if they can find that polyp in the beginning and remove it, then you don't have to worry about it growing.”

What Is The Recommended Age For A First Colonoscopy?

For most adults, 45 is the age when you should expect your first colonoscopy. These guidelines have changed in recent years, noting the earlier occurrences of colon cancer.

Other factors, such as race and a family history of colorectal cancer, may lead to that first colonoscopy happening earlier in life.

“What we have learned is that if you've got a family history of colorectal cancer, you need to start and get a colonoscopy for yourself 10 years before your family,” Long said. “So say, your father had colorectal cancer at 50, you need to be screened at 40.”

How Do I Prepare For A Colonoscopy?

Preparing for your first colonoscopy may mean a mix of temporary diet changes and medications to help with bowel cleansing, to allow your physician to better able to find any polyps in the colon.

“One of the most important parts of the colonoscopy, if not the most important part, is the actual colon preparation, which occurs the night and morning before,” said Dipen Maun, MD, a colon and rectal surgeon with Franciscan Health Indianapolis and Mooresville. “I do want to stress that this is extremely important, because if the prep is poor, there'll be residual stool coating large intestine, and the doctor won't be able to see or examine the lining nearly as well as they'd like to. And this will lead to potentially missed things.”

Colonoscopy prep solutionsYour doctor will prescribe a preparation protocol that is often taken the night before and morning of the colonoscopy procedure.

Often these involve a laxative solution but may also include prescription medications.

“There's different kinds of prep,” Long said. “The physician that's going to do your procedure will order your prep. They will pick what is best for you.”

What to eat and drink

“Typically, the day before there's a special diet,” Dr. Maun said. “That diet really focuses on just very, very clear liquids so that we're not adding additional roughage into the body.”

The American Society for Gastrointestinal Endoscopy advises on preparing for a colonoscopy:

• A day before the procedure, limit foods to clear broth, tea, gelatin desserts, ginger ale, sherbet and clear fruit juices.
• Avoid recommended desserts and liquids that are red or purple.
• Avoid dehydration by drinking more fluids than usual.

“Typically, what your prep time will look like, the day before your procedure, you can't have any solid food or dairy products the whole day,” Long explained. “So when you wake up, no solid food or dairy. You will have your clear liquids that day. They will give you a list of what you can have and what you cannot have. And then you will be given times of when to start the actual prep.

“Most likely, there'll be two times. You'll be given, for instance, five o'clock that evening and then you'll do another prep. So then the next day, when it's colonoscopy day, you won't have anything so many hours before the procedure because of the anesthesia or your sedation that will be involved.”

Colonoscopy prep effects

Preparing for a colonoscopy can involve what may be an uncomfortable night before.

“This doesn't hurt at all, but it can be very frustrating as you're running into the bathroom over and over again,” Dr. Maun said. “Sleep is unfortunately pretty limited that night. And this is without a doubt the most uncomfortable part for many people. But once you get through it, it's really kind of smooth sailing.”

What If I Am On Other Medications?

Speak with your doctor about any medications you take, to determine if they could interfere with the colonoscopy or the preparation.

Do I Need To Take Time Off Work?

“You wouldn't want to work the day of your procedure,” Long said. “Because of the sedation, you can't drive yourself home. You will be kind of down and out for the day. If you're going to be sedated, you can't do any physical or mental task for the remainder of the day following your procedure. So, if you had it done on a Friday and you don't work Fridays, that works for you.”

How Long Does A Colonoscopy Take?

A colonoscopy may take 30-60 minutes. While the prep leading up to it is much more time-consuming, the actual procedure itself is quite fast.

What Should I Expect With My Colonoscopy?

Day of the colonoscopy

“Typically 60 to 90 minutes before, the operating room or the procedure room staff will do a bunch of basic checklists, take your medical history, sign some consent forms,” Dr. Maun said. “An IV is placed in your arm. You'll be changing to a hospital gown, and then you'll be wheeled back into the procedure room.

“It is very common to receive some sort of sedation for the procedure. It could be a moderate or it could be a deep sedation. Both ways are completely safe and designed to maximize the comfort of the procedure so that you'll have very little or zero recollection of the entire experience.”

During the procedure

“Once you're in the procedure, you'll lie on your left side with your knees bent,” Dr. Maun said. “Your body's really completely covered except for the backside. The doctor will then insert a colonoscope, which is a very long, flexible tube. It's fairly narrow. On the end of it, it has a tiny camera and a light, and also has a bunch of small channels so that the doctor can do some procedures if necessary. The doctor will then insert the colonoscope through the rectum, through the entire large intestine, and then, while withdrawing the scope, very thoroughly examine the colon, to look for things that don't belong.

“The whole idea of this is to examine the lining and look for polyps. Imagine that a polyp is like a little growth and it's a seed for a future cancer that can grow, and this can happen anywhere throughout the entire large intestine. Finding these polyps and removing them, we can reset that potential cancerous process and prevent a colon cancer from developing.”

If something abnormal is found

“If something is found, such as a polyp, the doctor can remove it, and that's called a polypectomy,” Dr. Maun said. “If there's a growth that's found that can't be removed, the doctor can take a biopsy. And even if there's some bleeding from something, the doctor can actually control that during a colonoscope. It's a very functional test, and the whole procedure typically last 20 to 40 minutes.”

In the recovery room

“At the very end, you'll be brought into a recovery area, probably spend 30 to 60 minutes recovering,” Dr Maun said. “You'll need someone to drive you there and drive you home because of the sedation and can resume all your normal activities the next day.”

Are There Complications Of A Colonoscopy?

“Most likely all they're going to experience afterwards would be gas because sometimes they put air in the colon so that they can inflate it, if you will, to see the lining, to notice any kind of polyps that are there,” Long said. “So you might be a little gassy after your procedure.”

Dr. Maun adds: “You may have a little bit of bloating or some mild cramping. But most times, patients have no symptoms at all.”

When Do I Need To Return For My Next Colonoscopy?

Most adults will return every 10 years for their next colonoscopy.

“So it's about every 10 years, unless you were told by your doctor, ‘We did find a polyp. I want to bring you back in five,’” Long said.

Despite the temporary discomfort of colon prep and the exam, screening for colon and rectal cancer is worth it.

“What is really unique about a colonoscopy is that it doesn't just only detect polyps and cancer, it's actually used to prevent it,” Dr. Maun said. “It's one of the most impactful tests that you can receive that both detects and prevents colon cancer.”