Why people hate colonoscopy

Hate colonoscopy?

If the thought of having a colonoscopy makes you cringe, you’re not alone.

Despite being dreaded, colonoscopy saves lives. Colonoscopy is the most effective test for the detection and prevention of colon cancer, the 2nd leading cause of cancer death in United States. In a study published in the New England Journal of Medicine in 2012, removal of polyps during colonoscopy led to a 53% reduction in colorectal cancer death. Colorectal cancer detected during screening colonoscopy is easier to treat than cancer diagnosed through other means.

So if colonoscopy prevents colon cancer, why do so many people hate it?

Why People Hate Colonoscopy: Fear of bowel preparation

By far, the most unpleasant aspect of colonoscopy is the bowel preparation. Patients are worried about being on clear liquid diet for colonoscopy, hunger, using the bowel cleansing agents, and adverse reaction to the bowel cleansing agents.

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 hunger pangs, you can have honey, hard candies, gelatin, popsicles, fruit ices and sorbet while still being on clear liquid diet for colonoscopy.

Though rare, adverse reactions to bowel cleansing agents have been reported. You will have diarrhea, so stay near a toilet. Use a soft toilet tissue. For anorectal irritation or discomfort, use baby wipes, Vaseline, Desitin or hemorrhoidal agents. If you have nausea or start vomiting, stop drinking for 30-45 minutes until the symptoms subside, then you may resume. Some people require anti-nausea medications.  You may call your provider at anytime if you feel very uncomfortable or sick.

For an infographic on 10 tips for making a colonoscopy preparation more tolerable, click HERE.

Why People Hate Colonoscopy: Fear of sedation

Patients are usually worried about not getting enough sedation during colonoscopy and feeling pain as a result. Some are worried about getting too much sedation and not being able to wake up after the procedure.

Colonoscopy can be done without sedation; with minimal sedation; with moderate sedation; with deep sedation or with general anesthesia.

If you are worried about too much sedation or adverse effects of sedation, you can have colonoscopy without sedation or minimal sedation

Most colonoscopies are done with moderate or conscious sedation using midazolam (versed) and fentanyl.

If you are worried about too little sedation, have chronic pain syndrome or if you’re on multiple pain pills, you can have colonoscopy with deep sedation. Deep sedation often requires monitored anesthesia care with propofol.

Why People Hate Colonoscopy: Fear of the colonoscope

Patients are worried about having a tube through their anus into the colon. What is the size of the number? Is it flexible? Will I have pain from the tube? Are the scopes clean? Will I get infected?

Colonoscopy is usually performed with the use of the colonoscope.  Different versions by different manufacturers exist. Manufacturers include Olympus, Fujinon, Pentax to name a few. The Olympus adult colonoscope is 12.8mm in diameter and the pediatric colonoscope is 11.5mm in diameter.

The tip is very flexible and can bend up and down to 180 degrees each and can bend either right and left to 160 degrees. The amount of tube inserted to reach the cecum (start of colon and completion goal) is dependent of a person’s unique colon (size, redundancy, presence of diverticulosis, previous abdominal surgeries, the technique used (water immersion versus water exchange versus air insufflation) and the expertise of the physician.

The colonoscope is manually cleaned and then sterilized using a machine called an automated endoscope reprocessor (AER). According to the Food and Drug Administration, AER are designed to kill microorganism in and on reusable endoscopes by exposing their outside surfaces and interior channels to chemical solutions.

Be rest assured that the tube is small, flexible, and sterilized. You will not feel it when a polyp is removed or when biopsies are taken.

Why People Hate Colonoscopy: Fear of the physician

Patients are worried about the competency and effectiveness of their physician. Will my physician miss colon polyps? Will I have complications like a tear in my colon?

Google your physician: Even though there is poor correlation between physician online rating and quality of care, online information about your physician is still helpful. Is she board certified? Where did he train? How does she perform on quality measures such as completion rates (cecal intubation rate), complication rates, and the ability to detect pre-cancerous polyps (adenoma detection rate)?

Talk to your physician: Express your colonoscopy fears to your physician and work together to address them. Colonoscopy can be personalized to address your fears.

Don’t let your fear of colonoscopy deprive you of its life saving potential.

To learn more about what determines a good colonoscopy, read The 3 P’s of colonoscopy: Factors that determine the outcome of colonoscopy.