colonoscopy questions answered

All your colonoscopy questions answered provides answers to commonly asked questions about colonoscopy. Questions like what is a colonoscopy? Why do I need a colonoscopy? What are the benefits and risks of colonoscopy? What are the alternatives to colonoscopy? How do I spot a complication after colonoscopy? How do I shop for a colonoscopy? When should I get a screening colonoscopy? How often should I get a colonoscopy? How do I prepare for colonoscopy? Where is colonoscopy performed? Who performs a colonoscopy? Will I be put to sleep during colonoscopy? Will I feel pain during colonoscopy? Will my insurance cover my colonoscopy? What is the cost of colonoscopy? And lots more.


What is a colonoscopy?

Colonoscopy is a procedure that utilizes a flexible tube with light and camera at the end to look at the inner lining of a person’s large intestine (colon) through a video monitor. During the procedure, the physician has the ability to take a small piece of tissue from the colon (biopsy), remove a polyp (polypectomy), mark a specific spot (tattoo), treat a blockage, or stop a bleeding. Any tissue or specimen removed during colonoscopy is sent to the pathologist for analysis. Pictures are taken during the procedure and a colonoscopy report with pictures is generated. For a video on what to expect during colonoscopy, click HERE.


Why do I need a colonoscopy?

These are some of the reasons for having a colonoscopy:

  • Screening and surveillance of colorectal polyps and cancer.
  • Evaluation and treatment of gastrointestinal bleeding.
  • Evaluation of abnormalities seen on imaging studies such as X-ray or CT scan.
  • Evaluation of change in bowel habits like unexplained diarrhea.
  • Evaluation of unexplained abdominal pains.
  • Evaluations of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • Management of complications of surgery like strictures, leaks, fistula.
  • Removal of foreign body from the colon.
  • Excision and ablation of colorectal lesions such as angiodysplasias.
  • Relief of colorectal obstruction.


What are the benefits of colonoscopy?

Colonoscopy saves lives.

  • It can detect colorectal cancer leading to treatment and cure.
  • It can prevent colorectal cancer by removing precancerous polyps before they grow into cancer.
  • It can used to diagnosed several gastrointestinal diseases like colitis (infectious, ischemic, inflammatory, drug-induced, microscopic, segmental colitis associated with diverticular disease), diverticular disease, gastrointestinal bleeding (hemorrhoids, colitis, diverticulosis, angiodysplasias, dieulafoy lesions, solitary rectal ulcer syndrome, cancer).
  • It can be used to stop hemorrhage (bleeding) using several tools like hemoclip, injection of vasoconstrictors, electrocautery, coagulation therapies, sprays, ablation).
  • It can be used to relieve obstruction or blockage through dilation (stretching out) or placement of stents.
  • It can be used to block leaks and fistula.
  • It can be used to remove foreign bodies.
  • It can be used to perform fecal microbiota transplantation (fecal transplant).


What are the risks of colonoscopy?

Like all procedures, colonoscopy is associated with certain risks. Serious adverse events are rare.   Some of the risks of colonoscopy are:

  • Breathing problems from sedation (anesthesia).
  • Sneezing and running nose from oxygen given via nasal cannula.
  • Heart problems from anesthesia or the procedure.
  • Bleeding (hemorrhage).
  • Perforation (tear in the colon).
  • Missed polyps.
  • Abdominal discomfort or pain.
  • Infection.
  • Gas explosion (very rare; when electrical energy is used).
  • Spleen rupture.
  • Death.

For more information on complications of colonoscopy, click HERE.


How do I spot a complication after colonoscopy?

Click HERE to find out how to spot a complication after colonoscopy.


Are there alternatives to colonoscopy?

Yes. Though colonoscopy is unique in its ability to diagnose and treat at the same time or prevent colon cancer though removal of precancerous polyps, other tests are available.

Alternatives to screening and diagnostic colonoscopies include:

  • Stool tests: guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), FIT-DNA test (cologuard).
  • X-Ray.
  • Barium enema.
  • CT scan.
  • MRI.
  • CT colonography.
  • Capsule colonoscopy.

Alternatives to screening colonoscopy can be found HERE.


When Should I get a screening colonoscopy?

When and how often to screen for colorectal cancer depends on your family history.

  • Average risk individuals without family history of colon cancer should start at age 50.
  • African-Americans should start at age 45 according to the American College of Gastroenterology.
  • Individuals with one first degree relative with history of colorectal cancer or adenomatous polyps before the age of 60 or two or more first-degree relatives at any age should start screening at age 40 or 10 years earlier than the age of the affected relative.
  • Individuals with a first-degree relative with a history of colorectal cancer or polyp at age 60 or older or two second-degree relatives with colorectal cancer should start screening at age 40.
  • Individuals with familial adenomatous polyposis should start screening at age 10 to 12.
  • Individuals with Lynch syndrome should start screening at age 20-25 or 10years younger than the youngest affected immediate relative.

To learn more about the American Cancer Society recommendations for colorectal cancer early detection, click HERE.


How often should I get colonoscopies?

How often you get colonoscopies depend on your clinical condition (history of ulcerative colitis or Crohn’s disease, colon polyps, colorectal cancer) and your family history.

For the Multi-society Task Force on Colorectal Cancer guidelines on surveillance colonoscopy after screening and polypectomy, click HERE.


How do I prepare for colonoscopy?

The colon needs to be prepared for colonoscopy. It has to be cleaned out so that the physician can properly see the inner lining of the colon. This is called bowel preparation.

The adequacy of bowel cleansing is scored during colonoscopy using several bowel preparation scales. Adequate bowel prep is one that can detect polyps 5mm in size or more.

Inadequate bowel prep is associated with a reduced chance of detecting pre-cancerous polyps. It leads to longer procedure time and aborted procedure. Ultimately, it leads to higher healthcare cost.

Click HERE for a video on the costs of inadequate bowel prep.

There are many medications approved by the Food and Drug Administration as bowel cleansing agents. These include Colyte®, GoLYTELY®, NuLYTELY®, TriLyte®, HalfLytely®, MoviPrep®, SUPREP®, OsmoPrep®, and Prepopik®.

Regardless of the bowel cleansing agent used, the split dose regimen has been proven in multiple studies to be the most effective way to use the medication. In the split dose regimen, half of the bowel cleansing agent is taken the evening before the colonoscopy. The 2nd half is taken 4-5 hours before the scheduled colonoscopy.

Bowel preparation is often the most unpleasant aspect of colonoscopy. Certain tricks can improve a patient’s experience of bowel preparation:

  • Chill the bowel cleansing liquid. A cold cleansing liquid is easier to swallow than a warm one.
  • Improve the taste of the cleansing agent by adding flavor with lemon juice, lemon slices or sugar free flavor enhancers like Crystal Light®.
  • Use a straw to drink the bowel cleansing agent to reduce exposure of the taste to the tongue.
  • Suck on a menthol candy like Halls® cough drops while drinking the bowel cleansing agent. This has been shown in studies to improve taste and bowel preparation.

For frequently asked questions about bowel preparation, click HERE.


More colonoscopy questions answered ….


How do I shop for colonoscopy?

Click HERE for colonoscopy shopping list.


What is a high quality colonoscopy?

Read The 3 P’s of colonoscopy: Factors that determine the outcome of colonoscopy.

Watch a VIDEO on what makes a high quality colonoscopy.


Will I be put to sleep for colonoscopy?

Colonoscopy can be done the following ways:

  • Without sedation.
  • With minimal sedation.
  • With moderate sedation.
  • With deep sedation.
  • With general anesthesia.


Will I feel pain during colonoscopy?

It depends. If deep sedation or general anesthesia is used, you won’t. If minimal or no sedation is used, you may feel bloated or have some cramps depending on your pain tolerance and the skill of your doctor.

You will not feel pain when a biopsy is taken.


More colonoscopy questions answered ….


Who performs a colonoscopy?

Colonoscopy should be performed by a trained professional. It is usually performed by a gastroenterologist or a colorectal surgeon.


Where is colonoscopy performed?

Colonoscopy can be performed in the hospital, the outpatient department of the hospital (HOPD), an ambulatory surgery center (ASC) or appropriate office.


Will my insurance cover my colonoscopy?

Yes. Whether you have a co-pay or deductible depends on what kind of colonoscopy you are getting (screening or diagnostic), your insurance carrier (Medicare, PPO, HMO, Medicaid) and what was done during colonoscopy.  The Affordable Care Act eliminates co-pays for preventive services including colorectal cancer screening. Unfortunately, you may have co-pay if a polyp is removed during your screening colonoscopy.


What is the cost of colonoscopy?

The cost of colonoscopy vary greatly depending on where you live (zip code) , where it is done (hospital, ambulatory surgery center, HOPD, office),  and what is done during the colonoscopy (biopsy, polypectomy, etc.). On average, colonoscopy cost over $1000. For the cost of colonoscopy in your area, click HERE.