Your checkup was going great. You discussed your health changes, recent lab work and even what you did to celebrate your birthday. You thought the visit was wrapping up. Then your doctor brings up the topic you’ve been dreading most: Scheduling your first colonoscopy screening.

If the word “colonoscopy” fills you with fear, dread or embarrassment, you’re not alone. According to the Centers for Disease Control and Prevention, about 25% of adults have not been screened as recommended for colorectal cancer. And for those who are up to date on their screenings, chances are they weren’t exactly thrilled about getting a colonoscopy.

We hear you. A colonoscopy isn’t high on anyone’s list. But there’s a huge reason why doctors continue to sing the praises of colonoscopies. Simply put, a screening colonoscopy is an incredibly effective way of finding colon and rectal cancers early, when they’re most treatable.

Here’s even better news: A single colonoscopy can often provide peace of mind for years to come. In fact, many people can go up to 10 years between colonoscopies.

What is a colonoscopy and why might I need one?

A colonoscopy is commonly used for colorectal cancer screenings. During the procedure, a specially trained doctor checks the lining of your colon for inflammation, swelling and unusual tissue growths. Sometimes these growths, called polyps, can become cancerous.

As a screening tool, colonoscopies look for cancer or precancer in people who don’t have symptoms of the disease. So, if there are no visible signs of colon cancer, why do you need the screening?

It’s because early stage colorectal cancer often has no symptoms. So, by using a colonoscopy to look at your insides – where the disease starts – we can find and treat cancerous and precancerous cells early on. That’s why it’s so important to follow colorectal cancer screening guidelines – they save lives.

If colon cancer is found and treated before it has a chance to spread, the five-year relative survival rate is about 90%, according to the American Cancer Society (ACS). But, less than half of colon and rectal cancers are found at an early stage.

Colonoscopies are also used as a diagnostic tool when people are having strange symptoms.

Signs that you may need a diagnostic colonoscopy

Screening colonoscopies are considered preventive care for people who don’t have any symptoms of colorectal disease. But a doctor may recommend a diagnostic colonoscopy to help identify the cause of symptoms like:

  • Persistent abdominal pain, cramps or gas
  • Frequent indigestion
  • Changes in your bowel habits such as chronic constipation or diarrhea
  • Poop that’s consistently not a normal stool color or has an unusual appearance
  • Blood in your stool
  • Unexplained weight loss

A diagnostic colonoscopy can help detect a range of conditions – which may or may not be cancer. Other conditions and diseases that colonoscopies can detect include diverticulosis or diverticulitis, intestinal infections and inflammatory bowel disease. Insurance coverage for diagnostic colonoscopies usually differs from screening colonoscopies for most plans. So, you should call your insurance provider to get more information about your specific plan coverage.

When to get your first colonoscopy screening

The latest guidance from the United States Preventive Services Task Force and the ACS recommends colorectal cancer screenings start at age 45 for all men and women. If you have certain risk factors for colon or rectal cancer, your doctor may suggest you start screenings earlier.

Since the recommended screening age was recently lowered, make sure to check with your insurance provider about any coverage changes.

Who needs a screening colonoscopy? Why might I need one before age 45?

Risk factors can include a family history of colorectal cancers, Lynch syndrome or other hereditary colorectal cancer syndromes, existing gastrointestinal conditions like Crohn’s disease, obesity and previous radiation treatments to the belly or pelvis area. Lifestyle factors such as smoking, drinking a lot of alcohol, poor diet without enough colon-healthy foods and low levels of exercise have also been linked to increased cancer risks.

So, talk with your primary care doctor about your individual risk factors to determine if screenings should start at 45 or earlier. Also, make sure to let your doctor know of any changes in your family’s history of the disease or your own personal health.

How often you should get a colonoscopy

Many people only need a colonoscopy every 10 years. But how often you need to have a colonoscopy will depend on your overall health, age, individual risk factors and your results from any previous screening.

When you can stop getting colonoscopies

Routine colonoscopies are generally recommended for everyone until the age of 75. Between ages 76 and 85, you should talk with your doctor about the risks and benefits of screening, as well as consider your personal preferences and overall health when deciding whether to continue screenings. After 85, screenings aren’t recommended as the potential risks can outweigh the potential benefits.

Colonoscopy FAQ

Is a colonoscopy my only cancer screening option?

The short answer is: No. There are other screening options, including a stool test known as the fecal immunochemical test (FIT test). The FIT test, which you do at home and send in for analysis, looks to see if there’s hidden blood in your stool, something that can be a sign of colon cancer.

If you’re healthy and don’t have a family history of colon cancer, you may be able to start with the FIT test. But if the test comes back positive, your doctor will likely recommend a follow-up colonoscopy.

What kind of doctor does a colonoscopy?

Most often, colonoscopies are performed by a gastroenterologist – a doctor who specializes in preventing, diagnosing and treating digestive disorders. But general surgeons and internal medicine doctors, like primary care physicians, can also perform colonoscopies if they’ve been specially trained.

What happens during a colonoscopy procedure?

Before the colonoscopy procedure starts, you’ll lie on your side on a table in the exam room. Your doctor or a nurse will give you medications to help you relax and keep you comfortable for the duration of the procedure – you may even fall asleep.

When the procedure begins, your doctor will gently ease a thin, flexible, hollow, lighted scope into your colon (which is also called your large bowel or large intestine). There’s a camera attached to the end of the scope so your doctor can look for abnormalities like colon polyps that may become cancerous.

Your rectum and your entire colon are examined during the procedure, and your care team will continuously monitor you to make sure you’re doing okay.

What happens if a colon polyp is found during a colonoscopy?

If your doctor finds a colon polyp during your colonoscopy, they’ll remove it – usually with a looped wire that slips inside the tube. If needed, your doctor may take other tissue biopsies as well. The polyps or tissues samples are then sent to a laboratory for testing.

All shapes and sizes of colon polyps can be safely removed during a colonoscopy. However, large polyps may require more than one treatment for complete removal.

What does a colon polyp look like?

A colon polyp typically looks like a raised surface or bump protruding from the wall of your large intestine. Colon polyps come in two different shapes – flat and mushroom-like.

  • Sessile polyps lie flat against the colon lining. This can make them more difficult to find during a colonoscopy.
  • Pedunculated polyps look like mushrooms growing up from the colon lining. They attach to the surface by a long, thin stalk.

Colon polyps are usually smaller than the size of a pea but can grow to the size of a golf ball. And as the polyps get bigger, so does the risk of colorectal cancer. That’s why doctors like to remove suspicious-looking polyps as soon as they can.

What does a cancerous colon polyp look like?

Generally, you can’t tell for sure if a colon polyp is cancerous with the naked eye. That’s why any polyps or tissues removed during a colonoscopy are sent to a laboratory for testing. Samples need to be looked at under a microscope.

Does a colonoscopy hurt?

No. Most people don’t find a colonoscopy painful, but some do feel a little discomfort such as pressure or cramping as the scope moves through their colon.

The type of pain medication and sedation used during the colonoscopy procedure can have an impact on your experience.

Are you asleep for a colonoscopy procedure?

That depends on your doctor’s recommendations and your preferences. One of the most common choices is moderate sedation, also called conscious sedation, which includes a mild sedative and pain killer.

Another sedation option is propofol. This medication provides a deeper level of anesthesia and is given by an anesthesia team present during the procedure. This can be a good option if you’re anxious about the procedure or had an uncomfortable experience in the past.

When you make your appointment, you can share any sedation and medication preferences with your care team. HealthPartners and Park Nicollet offer a wide range of sedation options, and your doctor or care team can help you choose the one that’s right for you. Medications can also be adjusted during the procedure to keep you comfortable.

How long does a colonoscopy take?

From the time you arrive for your screening to the time you’re discharged, you can plan on everything taking about two hours. But the colonoscopy procedure itself typically takes about 20-45 minutes. The amount of time depends on how well your at-home preparation worked, the length of your colon and how many polyps are found and removed.

Your doctor may discuss some of the results of your colonoscopy before you leave. If you had a biopsy or polyp removed and sent for testing, you should receive your results within 7-10 days. You’ll receive a letter in the mail, or if you have an online MyChart account with us, you’ll see your results there.

How do you get ready for a colonoscopy?

For a colonoscopy to be successful, your colon needs to be clean. That means you need to take steps to clean it out before the procedure.

Before your procedure, you’ll get very specific colonoscopy prep instructions, which may include a combination of prescription and over-the-counter medications. Most of the instructions will be about diet, such as what you can and can’t eat before a colonoscopy, and when to stop taking certain medications.

Usually this prep work is what people fear the most about a colonoscopy. Perhaps you’ve heard about the bad tasting liquids, that you can’t eat anything for days and that you’ll be in the bathroom all day and night.

In truth, colonoscopy prep has gotten much easier in recent years – and better tasting. The disgusting colonoscopy prep liquids have been replaced by a variety of options that are easier to swallow. There have been other tweaks to the process, including how frequently you need to drink the prep liquid. So while making your intestines squeaky clean is no one’s definition of fun, it probably won’t be as bad as everything you’ve heard.

What are the possible colonoscopy complications or risks?

Like any procedure, a colonoscopy does carry some risk. But colonoscopy complications are rare, and your care team is specially trained to address any issues that can arise. Possible risks include a perforation of the colon lining, bleeding where a biopsy was taken or a polyp was removed, a missed diagnosis if a polyp couldn’t be seen during the procedure, an allergic reaction to sedation medication, and postcautery syndrome.

What happens after a colonoscopy?

The recovery after a colonoscopy usually happens quickly. Immediately after your colonoscopy procedure, your nurse will take you to a recovery room. You’ll probably be monitored for about 30 minutes before you’re discharged with specific care instructions.

If you were sedated during the exam, you’ll probably feel sleepy for a few hours. You may also feel a little gassy or bloated but walking around can help with that. As for what you can eat after a colonoscopy, the good news is that you can return to your regular diet.

It’s not uncommon to see a little blood in your first bowel movement following your colonoscopy. This can happen if your doctor had to take a tissue sample or remove a polyp. But contact your doctor if you continue to see blood or there’s a lot of it, or if you are experiencing stomach cramping, fever or vomiting.

If you have more questions, you can read this handout on what to expect during and after a colonoscopy, or call the clinic where you’ll be having your colonoscopy.

The bottom line: It’s time to get your rear in here

Colonoscopies save lives, helping identify colon cancer in the early stages when it’s still easy to treat. And while it may be small comfort, everyone will need a colonoscopy at some point. There’s no reason to be scared or embarrassed.

If you’re still not comfortable with the idea of colonoscopy, talk to your doctor. Other screening options, such as a FIT test, may be an option based on your overall health and family history. The FIT test can provide valuable information about the health of your colon and help determine if a colonoscopy is necessary.

The most important thing is that you get screened for colorectal cancer if you’re over the age of 45 – or sooner if recommended by your doctor. So don’t delay, schedule today.