What to Expect at Your First Colonoscopy

What is the somewhat uncomfortable event your spouse will insist you go to about every 10 years? Here’s a hint: It’s not your high school reunion. It’s way more important than that. It’s your colonoscopy.

According to the American Society for Gastrointestinal Endoscopy, colon cancer is the third most commonly diagnosed cancer and the third leading cause of cancer-related death in both men and women in the United States. Nearly 137,000 people are diagnosed each year and more than 50,000 die. The good news is that many cases are prevented each year through improved screening and prevention.

The best method for screening is a colonoscopy. During the procedure, the doctor looks at the inside of your colon. The colon is a length of intestine about 5 feet long and about 3 inches in diameter. It absorbs water from wastes, creating stool. In addition to examining your colon for signs of cancer, the doctor is able to remove polyps, or growths of tissue that develop on the lining of the colon or rectum. Colon cancer usually begins as a non-cancerous polyp. Remove the polyp. Decrease the risk. It’s a two-for-one deal: screening and prevention.

Colonoscopies are recommended once every 10 years starting at age 50. If you have a family history of colon cancer, your primary care doctor may recommend screening earlier and more often. Often, the first colonoscopy is the hardest, because you don’t know what to expect. Let’s give you an idea of what you are getting into and how useful it is.

First you will get a referral to a specialist called a gastroenterologist or to a surgeon who performs colonoscopies. This is the person who will perform your colonoscopy. Together with his or her team, the gastroenterologist will recommend one of a number of ways to prepare for your colonoscopy. There are solutions to drink and other methods for cleaning your colon so the doctor can actually see the lining. Share your concerns openly, so your doctor can help you choose the best method of preparation for you. You’ll also need to make plans to get a ride home and take the rest of the day off from work on the day of the procedure.

During a colonoscopy, you'll wear a gown. Sedation is usually recommended. It is combined with an intravenous pain medication to minimize any discomfort.

You'll begin the exam lying on your side on the exam table, usually with your knees drawn toward your chest. The doctor will insert a colonoscope into your rectum. The scope—which is long enough to reach the entire length of your colon—contains a light and a tube (channel) that allows the doctor to pump air into your colon. The air inflates the colon, which provides a better view of the lining of the colon. When the scope is moved or air is introduced, you may feel abdominal cramping or the urge to have a bowel movement.

The colonoscope also contains a tiny video camera at its tip. The camera sends images to an external monitor so the doctor can study the inside of your colon. The doctor can also insert instruments through the channel to take tissue samples (biopsies) or remove polyps or other areas of abnormal tissue. The whole process will take about 20 minutes to an hour.

After the exam, it takes about a half hour to begin to recover from the sedative. Residual effect from the sedative may take a while to wear off. That’s why you can’t drive. If your doctor removed a polyp during your colonoscopy, you may be advised to eat a special diet temporarily. You may feel bloated or pass gas for a few hours after the exam, as you clear the air from your colon. Walking may help relieve any discomfort.

Being proactive about your personal health reduces your risk for colon cancer. We hear from patients every day that the peace of mind gained is absolutely worth the prep and procedure. It’s way, way better than a surgery to remove cancer or ongoing cancer treatment. When you’re done with your colonoscopy, you can have confidence that you have taken an important step to ensure your health and wellbeing for the next 10 years. 

Tanya Cowder, MS, RN, CNOR, is the senior director of perioperative and interventional services at Southwestern Vermont Medical Center, part of Southwestern Vermont Health Care, in Bennington. This column was written as a part of Southwestern Vermont Medical Center’s observance of Colorectal Cancer Awareness Month, which is celebrated each March. For answers to questions about colorectal cancer screening, call 802-447-5551.