March is Colorectal Cancer Awareness Month
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
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
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
For more information about colonoscopy and preparation options, please
visit the Center for
Women’s Gastrointestinal Medicine at the Women’s Medicine