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Colonoscopy Q&A

What is a colonoscopy, what does it test for and why should I get one?
A colonoscopy is a procedure that examines the entire colon – all 5 feet of it. During the procedure, your doctor inserts a small flexible tube with a camera attached and weaves it all through your colon looking for polyps, tears and other areas of irritation that might cause any number of gastrointestinal problems. During a colonoscopy, the doctor looks for causes of abdominal distress, including diverticulosis, inflammatory bowel disease, bleeding, change in bowel habits, abdominal pain, and other obstructions. Most importantly, a colonoscopy is the most effective way to identify and remove pre-cancerous and cancerous polyps.

Your doctor may also order a colonoscopy after abnormal x-rays or CT scans to get a better view into the colon.

If we find a polyp, we will generally remove it during the colonoscopy and have it examined for cancerous cells. If we find a large polyp, Dr. Haque may use a different procedure, called Endoscopic Mucosal Resection (EMR) to remove it immediately. Some doctors will have a patient with a large polyp schedule a surgical procedure to have it removed, requiring general anesthesia and a longer recovery time.

If left undetected and untreated, colon polyps can grow and can become cancerous. Polyps generally do not hurt and show no signs of development until they are at a very advanced stage. Colonoscopies are the most effective way to check for and remove polyps in the colon. Colonoscopies can also look for irritations in the lining of the colon that may be the cause of other gastrointestinal distress such as chronic diarrhea or gas. 

Because colon cancer rarely exhibits any symptoms until it is in advanced stages, it is recommended that everyone get a screening colonoscopy at the age of 50, younger if there is a family history of colon cancer.  Your doctor will let you know when it’s time for your screening.

Will it hurt?
No, you are fully sedated during the colonoscopy so will not feel anything. When you wake up, you might feel some mild discomfort in the rectal area, but that usually a result of the preparation and excessive bathroom use rather than the procedure.

At what age should I get a colonoscopy?
Most doctors recommend that their patients get their first colonoscopy at the age of 50. If you have a family history of colon cancer, your doctor will generally recommend you get your first colonoscopy by age 40 or younger, depending on the familial relationship and the age of onset.  

I had a screening colonoscopy a year ago, so I’m done right?  I don’t have to get one ever again?
Not so fast. If a polyp was found, we may recommend that you have a screening colonoscopy every two years.  If no polyps were found, you’re probably good for 5 to 10 years. But, no it’s not ‘one and done’.  Colon cancer is very stealthy so it is important to check back to be sure there are no new polyps. Dr. Haque and your primary care doctor will let you know how often you should have the procedure repeated based on your health and risk factors.

There is no history of colon cancer in my family. Do I still need to be screened?
Not having a family history does not let you off the hook. Your health may depend on it.

It is recommended that everyone has a screening colonoscopy at age 50 and then regularly thereafter even if there is no family history of colon cancer. Your lifetime risk of developing colon cancer is approximately 6%. Your risk is higher if there is a family history, especially if the family member developed the disease before the age of 50.

That said, there are a number of contributing factors to the development of colon cancer that have nothing to do with heredity. Risk factors include obesity, cigarette smoking, inflammatory conditions in the colon such as Crohn’s, colitis and ulcerative colitis, and excessive alcohol consumption. Your doctor will review your medical and social history and make recommendations at to when and how often you should have a colonoscopy.

I have a family history of colon cancer. Should I get screened before I turn 50?
You are smart to be concerned. Your risk of developing colon cancer is roughly doubled if one (1) first degree relative (parent, sibling or child) had colon cancer or polyps after age 50, and is higher if the cancer or polyps were diagnosed at a younger age or if more members of your family are affected. Certain inherited disorders, for example, polyposis syndromes and hereditary non-polyposis colorectal cancer, can also increase your risk of developing colon cancer.

Because of the increased risk, your doctor may recommend you get your first screening colonoscopy as early as 30 years old – younger if your family member or members developed it early – and may also recommend more frequent screenings. 

The doctor found a polyp. What does that mean and what happens next?
First of all, don't panic.  Finding a polyp does not automatically mean you have cancer.

A polyp is an area of irregular cell growth. It can be a flat area with minimal extension beyond the colon wall or it can grow up and out like a small balloon or sack. One of the great things about a colonoscopy is that small polyps can be removed during the procedure and sent to the lab for testing right away. Even some large polyps can be removed at the time of the procedure using a technique called Endoscopic Mucosal Resection (EMR). Dr. Haque is one of the few gastroenterologists in Southern Maryland trained to perform EMR.

Once the polyp has been removed, it will be tested to determine whether it is benign, pre-cancerous or cancerous. And don’t worry, most are benign. Your doctor will discuss the post-procedure treatment for any polyps found and tested when you wake up and will discuss any required follow up treatments with you and your primary care doctor.

And remember; early detection is key to treating any cancer, and colonoscopies are the most effective way to detect and treat colorectal cancers. That is why getting a screening colonoscopy by age 50 is so important.

What else does a colonoscopy check for?
When people hear ‘colonoscopy’ they normally think of colon cancer. And while it is a great tool for early detection and prevention of colon and other colorectal cancers, a colonoscopy is also effective in the diagnosis and/or evaluation of various GI disorders, including diverticulosis, inflammatory bowel disease, rectal bleeding, changes in bowel habits, abdominal pain and obstructions.  It is also normally ordered in response to an abnormal x-rays or CT scans to provide a closer ‘inside’ look at the problem.  

Everyone complains about how unpleasant it is to prepare for a colonoscopy. What do I have to do and how bad is it?
Yes, the preparation process can be very challenging for some people. We don’t make you stop eating and ask you to drink this terrible tasting stuff to be mean; we just want to do as much as we can to ensure a good outcome.

The most important part of a successful colonoscopy is that the doctor has excellent visibility into the colon. That means your entire digestive tract must be empty, and sadly, the only way to ensure that is to eliminate solid food and completely empty your bowels. This process takes up to 3 days and requires the use of very strong laxatives and other means to evacuate the colon.

To prepare for your colonoscopy, we will ask you to eliminate some foods (corn, beans, nuts and seeds) 3 days prior to the procedure. You will not be able to eat any solid food for 24 hours before the procedure. You will be able to drink clear fluids and broth, and in fact we want you to drink lots and lots of fluids to help flush out your system.

The night before your procedure, we will put you on a regimen of prescription liquid laxatives – the dreaded mixture that you have to drink. You will drink one bottle of the mixture the night before your procedure and one the morning of your procedure.

And yes, you should plan to spend a lot of time in the bathroom during this process. You might also want to stock up on soft toilet tissue and baby wipes.

We will give you full instructions on how and when to prepare for your procedure. We know it isn’t pleasant, but remember, this is all to ensure your doctor has clear field of vision into your colon so that no polyps – small or large – are missed during the exam.

So other than spending a lot of time in the bathroom, what else can happen during preparation?
Funny you should ask. What most people hear about is the preparation and how hard it can be to drink all the mixture. Because people react to laxatives differently, you may have some other results beyond just having to use the bathroom. Reactions can include

  • Hunger and tummy grumbling
  • Light headedness (if this happens, drink a clear fluid with calories such as a soda, juice or broth or treat yourself to some green or yellow jello. You should not have any red colored juice or jello prior to your procedure.)
  • Nausea and vomiting up of the mixture (drinking ginger ale can help!)
  • Diarrhea, which can be immediate, extreme and painful at times
  • Bloating and gas with flatulence
  • Rectal bleeding and blood in the stool or toilet*

* Rectal bleeding is often the result of a previously undetected hemorrhoid that is torn open from the increased bathroom usage. Small to moderate amounts of blood in the stool or in the toilet are normal but you should call your doctor’s office or go to the Emergency Department if the bleeding is excessive and doesn’t stop after you have evacuated your bowels.

These side effects are normally short lived and will dissipate as soon as your procedure is done. And then you can treat yourself to a nice meal!

I’m curious. Why can’t I have red juice or jello before the procedure?
One of the things we look for in a colonoscopy is irritation in the colon wall which is generally seen as a red area. Red juices and jello use food dye to get the red color which can then stain the wall of the colon and mask any irritation. 

Seriously the preparation sounds dreadful. Is there any other way to check for colon cancer? 
Yes, there are alternative methods to examine the colon, but none are considered as accurate at colon cancer and polyp detection as a colonoscopy. It is important to note that these alternative procedures do not allow for the immediate therapeutic removal of polyps and they are not guaranteed to identify all polyps. If a polyp is found, you will still need to go through the regular colonoscopy to remove them.

The alternative procedures include:

A flexible sigmoidoscopy with barium enema - The sigmoidoscopy examines the lower portion of the colon and is often used in conjunction with the barium enema, which takes an x-ray of your colon after you have ingested barium, a contrast agent that lets the doctor see any markers or abnormalities in your colon. This procedure still requires you to evacuate your colon by using laxatives and an enema. 

Computerized tomography (CT) - Sometimes referred to as a ‘virtual colonoscopy’, a CT takes pictures and image of your colon but from the outside of your body. You still need to totally empty your colon the day before using laxatives and/or enemas, and the CT exposes you to radiation which has its own risks for cancer development. 

Fecal Occult Blood Testing (FOBT) – Stool is tested and examined for minute amounts of blood loss (possibly from polyps or cancer) by way of a chemical reaction resulting in a color change of the stool. While FOBT is not a test to examine the colon, it is recommended annually to individuals over age 50. If occult blood is found in the stool, a follow up colonoscopy will be necessary.

It is important to remember that these alternative screening techniques are not as thorough as a colonoscopy and often will result in the patient requiring a colonoscopy to confirm or treat the results. Consequently, the current standard of care is for patients for whom it is medically appropriate to just have a regular colonoscopy.