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Colonoscopy Myths: Fact or Fiction? Women's Medicine Collaborative Experts Weigh In

3/20/2013

March is Colorectal Cancer Awareness Month  


WMC ColonoscopyIt’s been said time and again: colonoscopies, the main screening tool for colorectal cancer (cancer of the colon and rectum), can save lives. According to experts at the Women’s Medicine Collaborative, this procedure – which allows a physician to examine the lining of the colon for abnormalities – not only finds precancerous polyps that can be removed before they turn into cancer, but can also help identify and diagnose colorectal cancer early, when treatment works best.

However, there is still some confusion and fear when it comes to colonoscopies. Many people avoid their colonoscopy because they think the test – and the preparation beforehand – is unpleasant and uncomfortable, or they may not understand exactly what the procedure involves and why it is so necessary.

Silvia Degli Esposti, MD, director of the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative, tackles three of the most common colonoscopy myths and explains whether they are fact or fiction.

Myth #1: You should ask to be completely sedated and given full anesthesia during a colonoscopy so you don’t remember anything.  

Degli Esposti says this is false – and is both costly and medically unnecessary for most patients. The use of full anesthesia usually is recommended only for those considered at high risk because of age, illness, or a prior history of complications with sedatives. However, there has been a recent trend of healthy, low-risk patients opting toward full sedation for colonoscopy because they’re nervous about the idea of being awake during the procedure. Others believe that full anesthesia wears off quickly and doesn't cause the same grogginess as other sedatives.

“We tend to forget that there are always risks with anesthesia,” Degli Esposti says. “For low-risk people who are generally healthy and do not need anesthesia for a colonoscopy, taking these risks is simply unnecessary.”

And expensive. Because an anesthesiologist or nurse anesthetist is needed for full sedation, patients are charged an additional fee for their services, which is often not covered by medical insurance. A 2012 study in the Journal of the American Medical Association reported the extra sedation provided during a colonoscopy to low-risk patients added an average of about $500 to an insured patient's bill in 2009, and $150 to a Medicare bill.

Degli Esposti says the majority of patients receive what is called “conscious sedation,” or a combination of drugs for relaxation that also block any pain or discomfort. “Although they are semi-conscious during the procedure, most patients don't remember much afterward. It’s like being in a dream-like state,” she says, adding that conscious sedation is endorsed by three gastroenterology societies for uncomplicated cases and can be administered by the gastroenterologists themselves.

An alternative some patients might consider is a “virtual” colonoscopy done via a CT scan or MRI. These procedures don't require sedation and take only 10 minutes compared to 30 to 60 minutes for a conventional colonoscopy. The downside is that not all health insurance (including Medicare) covers these procedures, and they're not as widely available as the conventional exams. Also, if the virtual procedure reveals any abnormalities, patients will still have to undergo a regular colonoscopy procedure to diagnose them.

MYTH # 2: The prep is horrible!  

Degli Esposti says this is partly true, adding that the biggest complaint about having a colonoscopy is the preparation beforehand, when patients must drink a solution that clears the bowel of all solid matter. The large amount of solution gently cleanses the bowel over a period of several hours, which is why patients cannot just sip the solution; instead, they must drink eight ounces every 15-30 minutes. The fluid does not absorb into your body (it carries no calories), nor will the frequent trips to the bathroom cause patients to become dehydrated.

Degli Esposti recommends mixing Miralax powder in Gatorade or flavoring the liquid prep solution with one to two tablespoons of pre-sweetened powder such as Kool-Aid or Crystal Lite. Many people find that drinking the solution quickly at an ice cold temperature is helpful, as is drinking through a straw.

A more recent option is split-dose preparation. Half of the solution is taken the evening before and the rest is taken the morning of the procedure. These patients are scheduled for an afternoon colonoscopy. This has been shown to improve colon cleansing and many find split-dose preparation more tolerable.

MYTH # 3: I don’t really need a colonoscopy unless I have symptoms.  

Degli Esposti says this is completely false. “Colorectal cancer is called the ‘silent killer,’” she says. “We can’t feel a polyp in our colon. A colonoscopy is the only way to detect, remove and analyze any polyps, preventing colon cancer from developing.”

The American Cancer Society and the American College of Gastroenterology recommend that all adults have this screening test beginning at age 50. Degli Esposti says patients with unusual symptoms, such as rectal bleeding; those who have a family member with colon cancer; or African American individuals may need colonoscopies sooner and should talk to their physician.

  

For more information about colonoscopy and preparation options, please visit the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative.