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Everything you wanted to know about colonoscopy but were too embarrassed to ask

By Renée Bacher

Fifty thousand people die of colorectal cancer each year. It's the third most common type of non-skin cancer and second most fatal cancer (lung cancer is first), yet is largely preventable and highly treatable when caught early.

But there's something about the "back door" region that is taboo, even when it comes to discussing a routine — and recommended! — screening for this common cancer killer.

Almost everyone will have a colonoscopy at some point. Colonoscopy is a standard screening test for colorectal cancer, and is usually recommended for all adults starting at age 50, or younger for those at high risk.

For the question-shy, or just the curious, here's everything you wanted to know about a colonoscopy but were too embarrassed to ask.

What, exactly, are they going to do to me during a colonoscopy?

During colonoscopy, a gastroenterologist (a doctor who specializes in treating the digestive system) inserts a long, flexible tube (called a colonoscope) into your rectum. The colonoscope, which has a light and camera on its end, inflates your colon with air, allowing the doctor to snake the tube through the entire length of your colon. The images captured during its voyage are projected onto a screen, enabling your doctor to see any inflamed tissue, bleeding or growths (polyps) on the surface of the colon.

How does colonoscopy help prevent colon cancer?

Some types of polyps are benign, but others may eventually become cancer or may already be cancer. Because colon cancer is a relatively slow-growing cancer, regular colonoscopy screenings allow your doctor to detect and remove polyps before they turn cancerous or catch any cancerous polyps before they have a chance to grow and spread.

Your doctor will most likely remove any questionable polyps or early-stage lesion during your procedure and send them to a lab for testing. If the screening reveals a problem, diagnosis and treatment can occur promptly, when it is most effective, ideally before any potential cancer has spread.

Do I have to stand and bend over during the procedure?

No. During the colonoscopy, you will lie on your left side on an examination table. Most people choose intravenous (IV) pain medication and light sedation to keep them comfortable yet lucid enough to change positions if the physician needs it for better angling of the scope.

Will it hurt?

Experiences vary from patient to patient. Some people report experiencing mild discomfort for a very short period during the procedure. But for most a colonoscopy is painless. In fact, many people go to sleep from their IV pain medication and have no recollection of the procedure afterwards.

Do I have to have sedation during the procedure?

Sedation is optional but highly recommended to help you relax and lessen your awareness of any cramping.

How long does it take?

Colonoscopy takes about 30 to 60 minutes to complete. You will need to remain at the doctor's office for an hour or two after the procedure until the sedative wears off. Because of the sedation, you will need to have someone drive you home after.

I'm embarrassed because I have hemorrhoids. Will the doctor be able to see them?

Yes. But gastroenterologists see and treat hemorrhoids routinely. We promise, yours won't be the first — or the last — they'll ever see!

What's with that horrible prep everybody talks about? I'm afraid it will make me nauseous. Is there anything else I can take, like herbal remedies or over-the-counter laxatives?

Typically, you must follow a clear liquid diet for one to three days before your colonoscopy to clear out the colon, finishing by drinking a strong, liquid laxative prescribed by your doctor (called "the prep," for short).

Prep drinks have a reputation for their unpleasant (some say, horrible) taste. Some people find drinking the prep through a straw lessens the taste (the straw bypasses some taste buds). Many prefer to drink the prep chilled. There are many different flavors and brands of laxatives, so be sure to ask your doctor about your choices.

Do not substitute the prep for herbal remedies or over-the-counter laxatives. It is crucial that you take only what your doctor prescribes and follow the directions exactly to make sure your colonoscopy is safe and accurate.

How soon will I get the results?

Usually, it takes a couple of days to get the results of your colonoscopy back from your doctor.

Will the procedure constipate me?

No. If anything, it's a fresh start. Your colon will be squeaky clean from your prep.

Will I feel pain in my rectum afterwards? What about after my first bowel movement?

You shouldn't feel any pain after the procedure, nor from your first bowel movement. Sometimes the rectum is irritated from frequent wiping during your prep. You may want to use wet cloth wipes or apply ointment to the area after wiping when you are using the prep.

Will I pass gas afterwards?

Hopefully! During the procedure, your colon will be pumped with air to allow the colonoscope to move through more easily and get a good look at your intestinal walls, and that air needs to come out sometime. When it does, however, you should be alone (or with a loved one), behind the privacy of a closed curtain in your doctor's office.

How often do I need to have this done?

If your colonoscopy is normal, you won't have to get your next one for another 10 years. If polyps or bleeding were found, you may need to be checked more frequently. Talk to your doctor about how often you should have a colonoscopy.

Renée Bacher has written for The Times Magazine, The Wall Street Journal and Parents magazine, among other publications.

Published on November 29, 2011.

See also:

• A colonoscopy saved my life: Tonya Dennis' story
• How you can prevent colon cancer
• Build a cancer-fighting diet
• Talk to others in our colon cancer community