Last week, I took an important step in protecting my health: I underwent my very first colonoscopy. Here’s what you need to know if it’s time for yours.
I went into my first colonoscopy with a great deal of anxiety. I’m a hypochondriac, so even the thought of being screened for cancer can make an anxious day worse. We hypochondriacs worry when there should be nothing to worry about, after all.
The stories I read from my classmates — all of whom have reached the magic age of 50 — did not help. Some gave far too much detail about the horrors of the day before.
Of course, everyone assured me that the procedure itself is a piece of cake. I shouldn’t worry about a thing, they said. You’re out like a light and won’t even know it was happening, they insisted.
The prep day worried me.
So I wanted to give you a delicately detailed walkthrough of what you can expect.
Preparing for prep day
Your gastroenterologist or the endoscopy center you’ll use will send detailed instructions ahead of the procedure.
They know you will have a lot of questions since it is your very first colonoscopy, but they give you several pages of information that answers most of them!
A couple of days before the scheduled procedure, you will make a few simple changes to your diet. You’ll avoid a handful of high-fiber foods, nuts and seeds. You’ll also receive specific instructions about the medication you take. Some must be stopped days ahead of the procedure. Others must be halved leading up to the big day.
You’ll also receive instructions for the liquid concoction you’ll drink the day before. Each endoscopy center will provide their own recipe. Some might be more complicated than others. But you’ll want to go at least two days before your procedure and shop for the various supplies. You can find most of what you need at a pharmacy like CVS or Walgreen’s.
In my case, I needed Gatorade Zero — I’m a type 2 diabetic, and regular Gatorade is loaded with sugar. The recipe I received called for a 64-ounce bottle. No one near me — pharmacies or grocery stores — sold anything larger than a 32-ounce bottle. So I purchased a 64-ounce jug of apple juice, drank it a couple of days before and used the cleaned-out container for the concoction.
I noticed something interesting, however: When I poured the contents of the two 32-ounce Gatorade bottles into the 64-ounce bottle, there wasn’t enough room. That leads me to believe the 64 ounces of apple juice may not be 64 ounces. But that is a fight I’ll consider for another day.
If you need that large an amount of Gatorade, find a container larger than 64 ounces. That way, you can mix the Gatorade and the other ingredients you’ll need and not have to worry about running out of room in the jug.
Mix up the concoction
Now those other ingredients. My doctor’s recipe called for a 238-gram container of Miralax powder. If you’re wondering how much that is in doses, you’ll want to sit down. I read the label: that’s the equivalent of 14 doses. You’ll consume all 14 doses in roughly a 12-hour period or less.
So yes, ahead of that first colonoscopy, you’ll be in the bathroom a few times during the day!
You also purchase infant gas drops that you add to the concoction. You also buy Dulcolax tablets. If 14 doses of Miralax weren’t enough inducement, you’ll pop a few of those tablets over the course of the day as well.
I mixed the ingredients two days before the procedure and chilled it in the refrigerator. I suspect it’s much easier to take when it’s colder.
Again, follow your doctor’s recipe. If you change the ingredients, it might effect the procedure. And I’m guessing you probably don’t want to go through it more often than you have to!
If you can’t find an ingredient or you aren’t sure, call your doctor’s office! They can talk you through a Plan B that won’t jeopardize the procedure.
And believe me: you won’t come up with a question they haven’t already heard many times before. As embarrassing a concept as this may feel to you, this is what they deal with every single day. They know it’s uncomfortable for you and they want to help you as much as they can. Keep that in mind!
Make arrangements for transportation
This is something many people likely don’t consider ahead of time. You will receive general anesthesia, which means you won’t be able to drive after the procedure is over. They will require you to have an adult with you. That person will take you to the endoscopy center, stay there through the procedure, then take you home.
You won’t be allowed to call Uber or a similar ride-hailing service. You’ll need a family member or close friend. (And you’ll likely find out who your friends really are!)
In my case, I called a medical transport service that charged me $99 to pick me up, wait through the procedure in the parking lot, then take me back home. My other option would have been to call my parents to drive 100 miles to do so. By they’d have had to come the day before and then be around for “prep day.”
I figured I might not be the best company that day, given the circumstances.
The day before
The instructions for my first colonoscopy called for me to take two Dulcolax tablets at noon. You start drinking the chilled concoction in 8-ounce increments every 15 minutes when you have your first bathroom visit or at 7 p.m., whichever comes first. I’ll let you in on a little secret here: your first bathroom visit will likely come before 7 p.m.
They base the timing for your prep on the time of your procedure. So pay close attention to the instructions: they’ll map out the times you should start your procedure. It may not necessarily follow the same timeline mine did. I scheduled my procedure for 10:30 a.m. the following day, so they set the timeline based on that time.
Back to the story: You drink those 8-ounce doses of the concoction until half of it is gone. Well, I’m no math genius, but I’m at least smart enough to know that half of a 64-ounce drink is 32 ounces, and four 8-ounce glasses takes care of that 32 ounces.
So after the fourth glass, I was done for a while.
I visited the bathroom several times that day and into the evening.
Remember that I said I’d be delicate? It’s worth noting that I have a condition called irritable bowel syndrome. That means I sometimes suffer an upset stomach during periods of stress and that occasionally, I might experience that outside of periods of stress. In my case, I figured my prep day would be a bad IBS day times about 50. In reality, it was a bad IBS day times about five.
I expected it to be far worse than it turned out to be. In fact, I felt relieved that I was able to spend plenty of time outside the restroom without being in a panic.
My instructions called me to drink the second half, eight ounces at a time, in 15-minute increments beginning at 11 p.m. I feared this would keep me up all night. Admittedly, I had to get up at about 2:30 a.m. and again at about 6 a.m. Otherwise, I slept fine.
I can’t stress this enough.
You will read horror stories about prep day. I read a Facebook post from a classmate who claimed he was convinced he passed a piece of a toy he swallowed when he was in kindergarten. And that was one of the less-disturbing stories I came across.
Those stories, while entertaining, caused a lot of anxiety.
That anxiety, it turned out, was unfounded.
To put it another way, it reminded me of an important lesson: Don’t believe everything you read!
It may have been “horrible” for them. But as someone with a good deal of experience in the area of IBS, I can tell you it was not the horror story some made it out to be.
The big day
Back in 2000, Katie Couric famously took cameras along for her first colonoscopy. You have to admire, I suppose, her transparency. Granted, she lost her husband, Jay Monahan, to colorectal cancer in 1998, so it became personal for her.
But I asked in advance to make sure I would not be awake for my first colonoscopy.
“There’s nothing in there I want to see,” I told the nurse. I could have quoted a late uncle who expressed a similar thought: “That is a cavern into which I do not wish to peer.”
When you arrive, they check you in and take you to a pre-op room. It’s a ward of patients but each “room” is separated by walls and a curtain, so you do have privacy. A nurse gives you one of those infamous hospital gowns and tells you to leave the back unbuttoned. You remove everything except your socks, put the gown on, and get back into bed under the covers. They connect an IV, monitor your blood pressure and oxygen and ask lots of questions.
Your gastroenterologist will stop by to say hello before the procedure. He’ll answer any initial questions. Mine was very calming and reassuring. He promised he’d take “very good care” of me and I must say, he did.
At the appointed time, the nurses will wheel you into the exam room. They’ll have you turn onto your left side. (That’s fine: that’s how I sleep most of the time anyway.) They’ll tell you the procedure itself will take only about 20 minutes. You will have been in the exam room before your first colonoscopy at least twice that long!
They’ll mention they’re about to give you the anesthesia. In my case, it was propofol. That’s the good stuff. It seems like I was only awake for about another 15 to 30 seconds. The next thing I knew, I woke up, already back in the prep room.
My first colonoscopy was over. No pain, no discomfort.
The doctor stopped by a few minutes later and told me everything went well. They removed three small polyps. They’re supposed to let me know within a few days if there was anything to be concerned about. The doctor said he was confident there is not.
They even gave me a detailed report that included photos of the polyps. I’ll spare you that detail. Not that they look bad; I wouldn’t have known that they were out of the ordinary. It’s just the idea of where the camera was located at the time.
Depending on the lab results, I should return either in three years or five years. Since I have a system that produces polyps, they prefer to have you return in five-year increments just to keep a watchful eye on things.
One piece of good news
One of the horror stories I read about people having their first colonoscopy is the time after the procedure. My dad even told me this.
They have to pump an amount of air into your colon so they can get a good look. That air, of course, must go somewhere. So they expect you to pass that air.
In fact, the nurse stays in the room with you while you pass gas to make sure you pass enough of it before they’ll let you leave. As I recoiled at the horror of such a thing, my dad told me I shouldn’t feel bad about it; they’ll be other people around me in the same predicament.
Suddenly, I felt like I’d be in a scene from a Mel Brooks picture!
I sheepishly asked the nurse about it. She immediately relieved that bit of anxiety.
“Oh, no, that’s old!” she said. “We’re able to pump out the gas they put in before it’s over.”
It’s all about prevention.
Naturally, I asked a lot of questions. Colon cancer is a relatively slow-moving cancer. That’s why the screening is so important.
My endoscopy center said that at least half of the time, they’ll find at least one polyp during a first colonoscopy. You want them to find those polyps. That’s how cancer starts. Not all polyps will become cancer. I’ve read figures that state less than 30% of polyps will eventually develop into cancer.
But you want to be screened and you want them to remove the polyps in case any of them fall into that smaller percentile. When they do that, the risk is gone. You don’t feel the removal. There’s no pain.
And if they do find the polyps, coming back in three to five years will make sure no new ones will have appeared that could cause a problem.
The prep day isn’t the greatest. But overall, it’s a pain-free way to prevent a deadly form of cancer.
So you can bet I’ll be advocating people 45 or over schedule that first colonoscopy and follow through.
If I can get through it as easily as I did, you definitely can. And you should.
So if you’re at least 45 years old and you haven’t made that call, do so before this week comes to a close. Any procedure that can prevent cancer is a procedure that is well worth your time!