The day I turned 45, I received a sweatshirt from my parents, a homemade pen pot from my 5-year-old daughter and an ominous auto-generated email from my health care provider. It was about my butt.
“Happy birthday,” the email read. Then it told me I should come in and let a gastroenterologist scope my colon for signs of cancer.
The letter wasn’t much of a shock to me. I knew that the American Cancer Society had recently lowered the recommended screening age for average-risk adults from 50 to 45. I also knew why the procedure was important.
Colon cancer is the third-most common cancer among men and women in the U.S. And early detection is critical. If you spot it before it spreads, the 5-year relative survival rate is about 90%, according to the American Cancer Society. But unfortunately, fewer than half of colorectal cancers are found this early. That’s why we need colonoscopies starting at 45.
So I scheduled my colonoscopy. It was annoying, but harmless. Here’s what it was like — and what you can expect too.
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Exploring the options for colon cancer screening
Before I received the email telling me I was due for my colonoscopy, I’d already had the talk with my doctor. “You’re getting pretty close to the magic age,” he told me. I’d seen blood after wiping, and I asked him about it. “It’s almost time to get a camera up there and see what they find,” he replied.
During that talk, my doctor told me a troubling stat: People born around 1990 have 2 times the risk of developing colon cancer and 4 times the risk of developing rectal cancer compared with adults born around 1950. This is according to data published in the Journal of the National Cancer Institute. But at the same time, he told me not to worry. A colonoscopy is an effective means of detection. It would be a “piece of cake,” he told me.
For good measure, he told me about some of the colonoscopy alternatives. One, a test called Cologuard®, looks at DNA in fecal matter. This is a relatively simple test. You just submit a stool sample and wait for the results.
The downside of Cologuard is that if you receive a positive result, you still need a colonoscopy. Also, a negative test doesn’t necessarily rule out early-stage cancer.
If you get a colonoscopy and the result is negative, you don’t need another one for 10 years, according to the U.S Preventive Services Task Force. But with Cologuard, you should retest every 1 to 3 years.
I weighed the options and decided to stick with the scope. I told my doctor to put me in touch with a gastroenterologist. Soon I was receiving phone calls daily until we had a date on the books.
The colonoscopy diet
Preparing for a colonoscopy turns out to be harder than the colonoscopy itself. After our call, a nurse from the gastroenterology office followed up with an email of instructions.
It said I’d need someone to drive me to and from the appointment. Because I’d be taking anesthesia, I’d be woozy after the procedure.
Aside from that, most of the email focused on how I should eat — or not eat — during the days leading up to the big event. The hard part would be the final 36 hours. My goal, it said, was to completely empty my colon.
“People don’t realize the colon is full of stool most of the time,” says Aline Charabaty, MD. She’s the assistant clinical director of the division of gastroenterology at Johns Hopkins School of Medicine. I reached out to her after the procedure to get clarity on my experience. “We can’t see the lining of the colon if stool is left behind.”
To that end, I was to fast on nothing but liquids. I was instructed to drink 8 ounces of clear fluids each hour I was awake. Thankfully current medications were okay, so I could continue with my daily dose of Singulair® for allergies. But that didn’t do much for my appetite.
The full excavation
Cleaning the bowels requires more than just skipping meals. The advice varies slightly among health care providers, but laxatives are a must. Dulcolax® (bisacodyl) is common. But my doctor gave me a gallon of a Gavilyte/Colyte solution, which tasted like Alka-Seltzer®. Thanks to that, I spent a ton of time on the toilet.
There’s no need for gory details, but let’s just say it was uncomfortable. My legs grew tired from sitting on the bowl. I texted updates to my friends to stave off boredom. I probably shared too much detail.
By the end of the cleansing period, I was zonked. I hadn’t eaten in 24 hours, and despite drinking so much fluid, I was probably fighting dehydration. (Diarrhea that’s not linked to a laxative is one of the 4 signs you might have IBS.)
The colonoscopy procedure
I arrived at the medical office 2 hours before the colonoscopy. Then about 30 minutes before the procedure, I was admitted to pre-op. Throughout this time, half a dozen nurses asked me to confirm my name. They said they did this to make sure they were giving a colonoscopy to the right guy.
During pre-op, I removed my clothes and climbed into a hospital gown. A nurse explained that a conscious sedation cocktail of midazolam and fentanyl would help me relax and block pain. I’d be sleepy, but awake. (There are varying levels of sedation, so talk to your gastroenterologist if you’d prefer to be completely under.)
After the sedation cocktail, they wheeled me into the operating room to meet my doctor. He was all business. He introduced himself, administered my medicine and told me to lie on my side. Then he got to work.
I couldn’t see what the doctor was doing, but there was a monitor set up in front of me. On it, I could watch a feed from the camera snaking through my bowels. As the doctor pushed into my colon, I saw the scope advance slowly down a long corridor until it couldn’t go farther. Every now and again, the doctor remarked on how well I’d cleaned my colon. And then he saw a polyp peeking out from the colon wall.
Polyps are small clumps of cells that form inside our colons as we age. It’s common to find them during colonoscopies, says Dr. Charabaty. Doctors aren’t sure why they form, but usually they’re nothing to worry about. Most are benign. Still, they do need to be tested. Some are precancerous. These are called adenomas.
But my polyp wasn’t unusual. In fact, the doctor found 3 of them. He removed them all using a little lasso fixed to the end of the scope. After the procedure, he sent them to the lab for biopsy. Fortunately, the test came back cancer-free.
In all, the procedure itself lasted no more than 10 minutes. It wasn’t nearly as bad as I’d feared. And afterward, I went for Vietnamese food. It was one of the best-tasting meals of my life.
(If you leave the hospital with a prescription in hand, check out the Optum Perks mobile app on your phone. Use it to find discounts you can redeem right at the pharmacy.)
Colonoscopies should begin at 45 for average-risk people: A Cancer Journal for Clinicians (2018). “Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society”
Colon cancer is the third-leading cause of cancer-related death in the U.S.: American Cancer Society
Early detection leads to a 90% survival rate for colorectal cancer: American Cancer Society
Levels of sedation: American society of Anesthesiologists