Young daughter: Dad, why do they call it a colonoscopy (koe-lun-OS-kuh-pee)?
Dad: I’m not sure. Something about exploring the colon with a scope? Hmm.. let me check. Quite literally, it means, “Examination of the hill.” …and yes, that seems odd.
Young daughter: Shouldn’t it be called a colonosco-poo instead?
Dad: Doh!…and you think my Dad jokes are bad?
In the 1960s, researchers in Japan developed the colonoscope, a rectally-inserted tube with a camera on the end which allowed for visualization of polyps within the entire large intestine. Today, a colonoscopy is the most accurate test for cancer of the colon and rectum, proven to detect the disease early and save lives.
About 4% (1 in 25) of people develop rectal or colon cancer in their lives, the second highest type of cancer-causing deaths. According to the American Cancer Society, there is greater risk for those of African-American and Ashkenazi descent, as well as those who have a family history of colon cancer. Lack of exercise, smoking, drinking even moderate levels of alcohol, becoming obese, frequently eating red meat and cooking at very high temperatures each raise your risk of colon cancer.
Getting a colonoscopy significantly reduces your risk of dying from rectal or colon cancer. If detected early, 5 year survival rates are about 70-90%, otherwise, they drop to 14%. Modern colonoscopies also can remove <1mm-sized pre-cancerous polyps, providing added protection. Larger polyps can be removed in separate surgeries.
Colon and Rectum Cancer Screening
Beginning at age 45, the American Cancer Society recommends men and women follow one of these testing schedules for screening:
- Flexible sigmoidoscopy every 5 years, or
- Colonoscopy every 10 years, or
- Double-contrast barium enema every 5 years, or
- CT colonography (virtual colonoscopy) every 5 years
- Yearly guaiac-based fecal occult blood test (gFOBT)
- Yearly fecal immunochemical test (FIT)
- Stool DNA test (sDNA) such as Cologuard every 3 years
Of note, Cologuard works by detecting abnormal DNA and traces of blood in the stool. It can detect 92% of cancers but only 42% of large precancerous polyps. Cologuard is better at detecting cancer than FIT (92% vs 70% for FIT), but the baseline false positive rate of 12-14% is significantly higher and that rate increases as people age.
Routine colonoscopies generally are not recommended after age 75 because the likelihood of impacting life expectancy becomes less than the risk of the procedure.
Colonoscopy Preparation Risks
Five days prior to your appointment, leading medical centers ask you to begin preparation for a colonoscopy by changing your diet. For the procedure to be successful, your colon must be free of solid waste matter. You must stop eating raw foods and vegetables. During the 2-3 days before your visit, you further reduce your diet to avoid seeds, nuts and high fiber foods.
One day before your procedure, you switch to a clear liquid diet. Colored drinks may impair your examination, similar to how purple lollipops change the color of your tongue. To reduce hunger cravings, our colonoscopy-experienced editors recommend chicken broth combined with Vietnamese vegetable powder for added flavor.
As part of your liquid diet, you will receive instructions on how to mix in 1.5 containers of laxatives to your favorite clear sport drinks to clean everything out. Expect to make about 20 trips to the toilet in the 24 hours before you reach the hospital. What they don’t tell you is that the hardest part is reaching the hospital without soiling yourself. Bring towels for the ride and a change of clothes.
Colonoscopy Procedural Risks
During the procedure, unless you request otherwise, you will be sedated and wake up in the recovery room. You will require an escort to take you home because the anesthesia will take a few hours to fully wear off.
About 1 in 200 people who undergo a colonoscopy experience a serious complication. Perforation of the colon occurs in about 1 in 2000 procedures, bleeding in 2.6 per 1000, and death in 3 per 100,000, with an overall risk of serious complications of 0.35%.
Low-risk populations with an absence of symptoms should not undergo colonoscopies. The risks of complications outweigh the benefits of the procedure. For example, the odds of developing colorectal cancer between the ages of 20 and 40 in the absence of specific risk factors are about 1 in 1,250 (0.08%).
The rate of complications varies with the practitioner and institution performing the procedure, and other variables. Before undergoing a colonoscopy, ask your medical provider for their statistics and for those of your specific surgeon. Inquire if they use recent advances such as the GI Genius which uses AI to improve the detection of cancer. Also, if curious, you can watch this 40 minute narrated video of an actual colonoscopy.
Alas, even with following the preparation instructions perfectly, over 25% of colonoscopies need to be redone within 1 year because the quality of the preparation was not ideal and did not allow for full examination. This statistic comes from Mass General Hospital, conveniently provided to patients after the procedure if they must go through it again!
More detailed information about the prep process can be found in this helpful FAQ.
If your procedure goes well, you may still feel some discomfort for a few days as your digestive tract refills and forces out trapped gasses. In part, this is because your colon was inflated like a balloon during the examination to make it easier for the colonoscope to travel through it.
Although it is normal to experience mild cramping after your colonoscopy, call your healthcare professional immediately or go to your nearest emergency room if you experience any of the these symptoms:
- Fever or chills
- A large amount of blood with bowel movements
- An inability to pass gas
- Trouble breathing, chest pain, or leg swelling
- Persistent or severe abdominal pain, swelling, or hardening
- Nausea and vomiting
In the end, undergoing colon and rectal screening is important to protecting your health. Consult with your primary care physician and seek to get checked at least every five years. For prep, start a few hours early to give yourself the best chance for a clear examination the first time.
In return for taking care of your health, reward yourself with laughter by giving RotoWipe as a prank gift. Explain that your hospital gave you one and it worked great for colonoscopy prep. 😉 Or discover some new euphemisms for pooping. Or, if you are a Dad, consider getting some novelty toilet paper for your house simply because “Poop jokes aren’t my favorite, but they are a solid #2.”