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Preparing for a Colonoscopy: Managing Expectations and Easing Anxieties

The bottom line is that anxiety is natural, but there is no need to fear a colonoscopy. Screenings save lives.

For those approaching or over age 50, the very word can elicit waves of anxiety and dread.  

Colonoscopies help prevent colorectal cancer by finding precancerous lesions and removing them before they have an opportunity to develop into cancer. Often referred to as the “gold standard” for screening, colonoscopies can both find cancer and remove potentially precancerous growths called polyps in the same procedure. Because most cases of colorectal cancer start as polyps, colonoscopies help stop colorectal cancer before it even starts. 

Colorectal cancer is the second most common cause of cancer death in the U.S. when men and women are combined. However, regular screening can find colorectal cancer when it is small, hasn’t spread and might be easier to treat.  

Regardless, many people are anxious or fearful before a medical procedure, especially if they’re worried their doctor may find cancer. The bottom line: it’s worth it. If you’re at an average risk, you only have to have a colonoscopy once every 5 to 10 years. And screening saves lives. 

“That’s what the whole purpose is,” says Dr. Ankur Parikh, DO, associate director, precision medicine at Jefferson Health. “If you can remove it before it has a chance to evolve into colon cancer, or if you happen to find a colon cancer and you haven’t had any major symptoms, chances are it’s probably going to be more of an early stage.” 

Risk Factors for Colorectal Cancer 

Age is a strong risk factor for colorectal cancer. Though young people can get colon cancer, your risk increases as you get older. It is much more common among people over 50 years old. 

The American Cancer Society (ACS) has guidelines for colorectal cancer screening and recommends people at average risk for colorectal cancer begin screening at age 45. In the most recent guideline update, ACS lowered the age to start screening because studies show rates of colorectal cancer among people younger than 50 are on the rise. ACS experts have determined that screening starting at 45 could help save more lives. 

If you’ve had close family members — like a parent, sibling, or child — who have had polyps or colon cancer, you are at a higher risk of developing colorectal cancer. If you’ve had multiple family members with colorectal cancer — especially on one side of the family — it may mean that colorectal cancer is hereditary in your family.  

“A lot of it has to do with family history,” Dr. Parikh notes. “So, a first-degree relative — if your parent, brother or sister had colon cancer at a younger age, then you will need to have a colonoscopy as well at an earlier age.” 

What About That Prep 

Anyone who has undergone a colonoscopy knows that the prep is generally considered the most difficult part of the procedure. The good news? Once you’re done with the prep, the rest is easy. 

To get ready for a colonoscopy, full bowel prep is required. Your doctor will give you specific directions on how to prepare. Generally, all solids must be emptied from the stomach and bowel by following a clear liquid diet for 1-3 days before the procedure. You should not drink beverages containing red or purple dye. A few examples of what you can drink include: 

  • Fat-free bouillon or broth 
  • Strained fruit juice 
  • Water 
  • Plain coffee or tea 
  • Sports drinks, such as Gatorade 
  • Gelatin 

Switching to a soft-food diet at least 48 hours before the colonoscopy may make your preparation easier. Soft foods include: 

  • Scrambled eggs 
  • Smoothies 
  • Vegetable purees and soups 
  • Soft fruits, like bananas 

Foods to Avoid 

During this time, you also need to avoid foods that can be hard to digest or get in the way of the camera during your colonoscopy. These include: 

  • Fatty, fried foods 
  • Tough meats 
  • Whole grains 
  • Seeds, nuts, and grains 
  • Popcorn
  • Raw vegetables 
  • Vegetable skins
  • Fruit with seeds or skins 
  • Broccoli, cabbage, or lettuce
  • Corn
  • Beans and peas 

A laxative may also be required the night before a colonoscopy to loosen stool and get your bowels moving. “In the past, a lot of people have been worried about the volume of fluid they have to drink,” Dr. Parikh says. “Now they’re often splitting up the preps, where it might be the night before and then the morning of, assuming it’s not a morning colonoscopy. And there’s also different formularies now that contain electrolytes, making them smaller in volume and easier to take in.” 

The Procedure  

During a colonoscopy, you will lie on your side on an examination table. The procedure can be done with conscious sedation, often referred to as “twilight,” or deeper sedation referred to as general anesthesia. You are given a pain reliever and a sedative intravenously (in your vein). You will feel relaxed and somewhat drowsy, ensuring the colonoscopy will not hurt. “A lot of times, patients will wake up from the sedation and ask, ‘when are we going to do this?’ and they’re told that they already had the procedure,” Dr. Parikh says with a smile. 

The doctor will then insert a long, flexible, lighted tube with a camera called a colonoscope, or scope, into the rectum and slowly guide it into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. The small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The doctor will examine the entire colon searching for anything abnormal and remove polyps. Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again. 

After the procedure is done, you’ll wait for about an hour to allow the sedative to wear off. You’ll be advised not to drive for the next 24 hours, until its full effects fade. Some patients may experience cramping or bloating after the procedure. Not to worry, your body will naturally dispel the carbon dioxide used during the procedure. If your doctor removes tissue or a polyp during a biopsy, they’ll send it to a laboratory for testing. Your doctor will tell you the results when they’re ready, which is normally within a few days. 

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From the Experts, Healthy You