Colonoscopies are the most effective way to detect polyps in the colon. Left untreated, polyps may become cancerous, leading to potentially fatal colorectal cancer. Colorectal cancers generally have no pain or other side effects until the cancer has progressed to an advanced stage, making early detection essential. Your doctor will recommend screening for colon cancer when you turn 45 years of age, or younger if you have a family history of cancer.

Most polyps that are detected during your colonoscopy can be removed during the procedure. Small or flat polyps will removed immediately and sent to be tested for any cancer cells. If a large polyp is discovered during your procedure, your doctor is trained to perform a procedure called Endoscopic Mucosal Resection (EMR), which allows him to remove even large polyps immediately rather than having to schedule a second procedure for surgical removal of the polyp.

Preparing for Your Procedure

Providing a clear field of vision is critically important for a successful colonoscopy. You will need to restrict food intake for up to 3 days prior to your procedure, move to a totally clear liquid diet for 24 hours prior to your procedure, and begin a regimen of over-the-counter laxatives the day before and prescription laxatives the evening before and morning of your procedure.

If you take over-the-counter or prescription medications, you may need to stop or delay taking them for a period of time before your procedure.

You will be sedated for the procedure, so you will need to be sure that you have someone to bring you to and take you home after the procedure. You will not be allowed to drive yourself.

After the procedure, you will be in recovery for a short time while the sedation wears off. Your doctor will review any immediate results with you while you are in recovery, and you will be allowed to go home. You may be groggy for the rest of the day, and can eat a small meal when you get home. You will be able to resume normal activities the next day.

See below to read some frequently asked questions about colonoscopies, how to prepare and what to expect.

Colonoscopy Q&A

What is a colonoscopy, what does it test for and why should I get one?

A colonoscopy is a procedure that examines the entire colon – all 5 feet of it. During the procedure, your doctor inserts a small flexible tube with a camera attached and weaves it all through your colon looking for polyps, tears and other areas of irritation that might cause any number of gastrointestinal problems. During a colonoscopy, the doctor looks for causes of abdominal distress, including diverticulosis, inflammatory bowel disease, bleeding, change in bowel habits, abdominal pain, and other obstructions. Most importantly, a colonoscopy is the most effective way to identify and remove pre-cancerous and cancerous polyps.

Your doctor may also order a colonoscopy after abnormal x-rays or CT scans to get a better view into the colon.

If we find a polyp, we will generally remove it during the colonoscopy and have it examined for cancerous cells. If we find a large polyp, your doctor may use a different procedure, called Endoscopic Mucosal Resection (EMR) to remove it immediately. Some doctors will have a patient with a large polyp schedule a surgical procedure to have it removed, requiring general anesthesia and a longer recovery time.

If left undetected and untreated, colon polyps can grow and can become cancerous. Polyps generally do not hurt and show no signs of development until they are at a very advanced stage. Colonoscopies are the most effective way to check for and remove polyps in the colon. Colonoscopies can also look for irritations in the lining of the colon that may be the cause of other gastrointestinal distress such as chronic diarrhea or gas.

Because colon cancer rarely exhibits any symptoms until it is in advanced stages, it is recommended that everyone get a screening colonoscopy at the age of 45, younger if there is a family history of colon cancer.  Your doctor will let you know when it’s time for your screening.

Will it hurt?

No, you are fully sedated during the colonoscopy so you will not feel anything. When you wake up, you might feel some mild discomfort in the rectal area, but that usually a result of the preparation and excessive bathroom use rather than the procedure.

At what age should I get a colonoscopy?

New guidelines recommend that patients at average risk for colorectal cancer begin screening at age 45. If you have a family history of colon cancer, your doctor will generally recommend you get your first colonoscopy by age 40 or younger, depending on the familial relationship and the age of onset.

I had a screening colonoscopy a year ago, so I’m done right?  I don’t have to get one ever again?

Not so fast. If a polyp was found, we may recommend that you have a screening colonoscopy every two years.  If no polyps were found, you’re probably good for 5 to 10 years. But, no it’s not ‘one and done’. Colon cancer is very stealthy so it is important to check back to be sure there are no new polyps. Your doctors will let you know how often you should have the procedure repeated based on your health and risk factors.

There is no history of colon cancer in my family. Do I still need to be screened?

Not having a family history does not let you off the hook. Your health may depend on it.

It is recommended that everyone has a screening colonoscopy at age 45 and then regularly thereafter even if there is no family history of colon cancer. Your lifetime risk of developing colon cancer is approximately 6%. Your risk is higher if there is a family history, especially if the family member developed the disease before the age of 50.

That said, there are a number of contributing factors to the development of colon cancer that have nothing to do with heredity. Risk factors include obesity, cigarette smoking, inflammatory conditions in the colon such as Crohn’s, colitis and ulcerative colitis, and excessive alcohol consumption. Your doctor will review your medical and social history and make recommendations at to when and how often you should have a colonoscopy.

I have a family history of colon cancer. Should I get screened before I turn 45?

You are smart to be concerned. Your risk of developing colon cancer is roughly doubled if one (1) first degree relative (parent, sibling or child) had colon cancer or polyps after age 50, and is higher if the cancer or polyps were diagnosed at a younger age or if more members of your family are affected. Certain inherited disorders, for example, polyposis syndromes and hereditary non-polyposis colorectal cancer, can also increase your risk of developing colon cancer.

Because of the increased risk, your doctor may recommend you get your first screening colonoscopy as early as 30 years old – younger if your family member or members developed it early – and may also recommend more frequent screenings.

The doctor found a polyp. What does that mean and what happens next?

First of all, don't panic. Finding a polyp does not automatically mean you have cancer.

A polyp is an area of irregular cell growth. It can be a flat area with minimal extension beyond the colon wall or it can grow up and out like a small balloon or sack. One of the great things about a colonoscopy is that small polyps can be removed during the procedure and sent to the lab for testing right away. Even some large polyps can be removed at the time of the procedure using a technique called Endoscopic Mucosal Resection (EMR).

Once the polyp has been removed, it will be tested to determine whether it is benign, pre-cancerous or cancerous. And don’t worry, most are benign. Your doctor will discuss the post-procedure treatment for any polyps found and tested when you wake up and will discuss any required follow up treatments with you and your primary care doctor.

And remember; early detection is key to treating any cancer, and colonoscopies are the most effective way to detect and treat colorectal cancers. That is why getting a screening colonoscopy by age 45 is so important.

What else does a colonoscopy check for?

When people hear ‘colonoscopy’ they normally think of colon cancer. And while it is a great tool for early detection and prevention of colon and other colorectal cancers, a colonoscopy is also effective in the diagnosis and/or evaluation of various GI disorders, including diverticulosis, inflammatory bowel disease, rectal bleeding, changes in bowel habits, abdominal pain and obstructions.  It is also normally ordered in response to an abnormal x-rays or CT scans to provide a closer ‘inside’ look at the problem.

Everyone complains about how unpleasant it is to prepare for a colonoscopy. What do I have to do and how bad is it?

Yes, the preparation process can be very challenging for some people. We don’t make you stop eating and ask you to drink this terrible tasting stuff to be mean; we just want to do as much as we can to ensure a good outcome.

The most important part of a successful colonoscopy is that the doctor has excellent visibility into the colon. That means your entire digestive tract must be empty, and sadly, the only way to ensure that is to eliminate solid food and completely empty your bowels. This process takes up to 3 days and requires the use of very strong laxatives and other means to evacuate the colon.

To prepare for your colonoscopy, we will ask you to eliminate some foods (corn, beans, nuts and seeds) 3 days prior to the procedure. You will not be able to eat any solid food for 24 hours before the procedure. You will be able to drink clear fluids and broth, and in fact we want you to drink lots and lots of fluids to help flush out your system.

The night before your procedure, we will put you on a regimen of prescription liquid laxatives – the dreaded mixture that you have to drink. You will drink one bottle of the mixture the night before your procedure and one the morning of your procedure.

And yes, you should plan to spend a lot of time in the bathroom during this process. You might also want to stock up on soft toilet tissue and baby wipes.

We will give you full instructions on how and when to prepare for your procedure. We know it isn’t pleasant, but remember, this is all to ensure your doctor has clear field of vision into your colon so that no polyps – small or large – are missed during the exam.

So other than spending a lot of time in the bathroom, what else can happen during preparation?

Funny you should ask. What most people hear about is the preparation and how hard it can be to drink all the mixture. Because people react to laxatives differently, you may have some other results beyond just having to use the bathroom. Reactions can include:

• Hunger and tummy grumbling
• Light headedness (if this happens, drink a clear fluid with calories such as a soda, juice or broth or treat yourself to some green or yellow jello. You should not have any red colored juice or jello prior to your procedure.)
• Nausea and vomiting up of the mixture (drinking ginger ale can help!)
• Diarrhea, which can be immediate, extreme and painful at times
• Bloating and gas with flatulence
• Rectal bleeding and blood in the stool or toilet*

* Rectal bleeding is often the result of a previously undetected hemorrhoid that is torn open from the increased bathroom usage. Small to moderate amounts of blood in the stool or in the toilet are normal but you should call your doctor’s office or go to the Emergency Department if the bleeding is excessive and doesn’t stop after you have evacuated your bowels.

These side effects are normally short lived and will dissipate as soon as your procedure is done. And then you can treat yourself to a nice meal!

I’m curious. Why can’t I have red juice or jello before the procedure?

One of the things we look for in a colonoscopy is irritation in the colon wall which is generally seen as a red area. Red juices and jello use food dye to get the red color which can then stain the wall of the colon and mask any irritation.

Seriously, the preparation sounds dreadful. Is there any other way to check for colon cancer?

Yes, there are alternative methods to examine the colon, but none are considered as accurate at colon cancer and polyp detection as a colonoscopy. It is important to note that these alternative procedures do not allow for the immediate therapeutic removal of polyps and they are not guaranteed to identify all polyps. If a polyp is found, you will still need to go through the regular colonoscopy to remove them.

The alternative procedures include:

A flexible sigmoidoscopy with barium enema - The sigmoidoscopy examines the lower portion of the colon and is often used in conjunction with the barium enema, which takes an x-ray of your colon after you have ingested barium, a contrast agent that lets the doctor see any markers or abnormalities in your colon. This procedure still requires you to evacuate your colon by using laxatives and an enema.

Computerized tomography (CT) - Sometimes referred to as a ‘virtual colonoscopy’, a CT takes pictures and image of your colon but from the outside of your body. You still need to totally empty your colon the day before using laxatives and/or enemas, and the CT exposes you to radiation which has its own risks for cancer development.

Fecal Occult Blood Testing (FOBT) – Stool is tested and examined for minute amounts of blood loss (possibly from polyps or cancer) by way of a chemical reaction resulting in a color change of the stool. While FOBT is not a test to examine the colon, it is recommended annually to individuals over age 45. If occult blood is found in the stool, a follow up colonoscopy will be necessary.

It is important to remember that these alternative screening techniques are not as thorough as a colonoscopy and often will result in the patient requiring a colonoscopy to confirm or treat the results. Consequently, the current standard of care is for patients for whom it is medically appropriate to just have a regular colonoscopy.

Also called an Upper Endoscopy, this procedure looks for causes of esophageal and stomach irritation, including heart burn and acid reflux. While you are under sedation, your doctor will insert a thin, flexible lighted tube with a camera down your throat and into your stomach, providing visibility of your digestive tract as far down as to the top of your small intestines. The camera transmits the images to a screen that the doctor can see in real time, providing opportunity to examine any suspicious irritations in your throat, esophagus or stomach.

EGDs are often used to look for ulcers or other sources of gastrointestinal bleeding and irritation that might prohibit a patient from undergoing abdominal surgery, such as gall bladder removal. They are more effective than x-rays or ultrasounds because they let the doctor actually see the inside of your digestive tract.

EGDs also allow the doctor to provide therapeutic treatment while performing the endoscopy. During the procedure, the doctor can remove suspicious polyps, take samples for testing or treat bleeding issues.


Preparing for Your Procedure

With any endoscopic procedure, having a clear field of vision is important to a successful outcome. That means having nothing in your upper digestive tract, from your stomach down to your small intestine. You will have to stop eating and drinking the night before your procedure. Some procedures may require the use of a laxative to empty the bowels as well.

If you are taking over-the-counter or prescription medications, you may need to stop them or delay them for some period of time prior to your procedure. Your doctor will review your medication list and walk you through the preparation requirements in advance of your procedure.

Because you will be placed under sedation for the procedure, you will remain under observation for at least an hour after the procedure. You will not be allowed to drive yourself home. The procedure itself only takes 20 minutes or so, and the doctor will review the immediate results with you as soon as you wake up. Once home, you will be groggy but will be able to eat that day and resume normal activities the next day.

EMR is a procedure that lets your doctor remove abnormal tissue from the digestive tract with a minimally invasive endoscopic procedure rather than by a more invasive surgical procedure. EMRs can be performed on lesions and polyps found in the upper and lower digestive tracts. EMR is particularly useful in removing cancerous or pre-cancerous lesions and to assess whether a cancer has grown past the duodenum – the lining of the digestive tract.

EMR uses a long flexible tube equipped with a light, camera and other instruments. The patient is under sedation and tube is inserted either through the mouth and throat or through the anus, depending on the area of the digestive tract being examined. During the procedure, your doctor is able to see the inside of the area being examined and can remove lesions or polyps or collect tissue for further analysis and testing.

Preparing for Your Procedure

Preparation for an EMR will depend on the area being scoped. If your procedure is being performed on the upper digestive tract (esophagus, stomach or upper part of the small intestines), you will be required to stop eating and drinking the night before the procedure in order to totally empty your stomach and provide your doctor a clear viewing field.

If your procedure is to examine the colon, you will need to undergo a regimen of fasting and laxatives to ensure your colon is empty along with your stomach. Your doctor will explain the preparation procedures required based on the type of EMR you are receiving.

Your doctor will also discuss any need to stop or delay of medications that may be required prior to your procedure.

You will be sedated during the procedure, so you will stay in recovery until the effects of the sedation begin to wear off. You will not be allowed to drive yourself home, so be sure to have someone available to take you to and from the procedure. The doctor will review the immediate findings when you come out of sedation, and will have you schedule an appointment to review any results of tests that are sent out for review.

You will want to take it easy for the rest of the day after you get home, but can enjoy a light meal. You should be able to resume normal activities the next day.

What is Esophageal Dilation?
Esophageal dilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your esophagus [swallowing tube]. Doctors can use various techniques for this procedure. Your doctor might perform the procedure as part of a sedated endoscopy. Alternatively, your doctor might apply a local anesthetic spray to the back of your throat and then pass a weighted dilator through your mouth and into your esophagus.

Why is Esophageal Dilation Done?
The most common cause of narrowing of the esophagus, or stricture, is scarring of the esophagus from reflux of stomach acid occurring in patients with heartburn. Patients with a narrowed portion of the esophagus often have trouble swallowing; food feels like it is “stuck” in the chest region, causing discomfort or pain. Less common causes of esophageal narrowing are webs or rings (which are thin layers of excess tissue), cancer of the esophagus, scarring after radiation treatment or a disorder of the way the esophagus moves [motility disorder].

How Should I Prepare for the Procedure?
An empty stomach allows for the best and safest examination, so you should have nothing to drink, including water, for at least six hours before the examination. Your doctor will tell you when to start fasting.

Tell your doctor in advance about any medications you take, particularly aspirin products or anticoagulants (blood thinners such as warfarin or heparin), or clopidogrel. Most medications can be continued as usual, but you might need to adjust your usual dose before the examination. Your doctor will give you specific guidance. Tell your doctor if you have any allergies to medications as well as medical conditions such as heart or lung disease. Also, tell your doctor if you require antibiotics prior to dental procedures, because you might need antibiotics prior to esophageal dilation as well.