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How to prepare for your first colonoscopy (and be happy about it)

Color portrait of Sachi Fujimori By Sachi Fujimori

When Lisa K. turned 56, she got calls from her two sisters. Along with birthday wishes, she received loving reminders that she was due for a colonoscopy. “I wasn’t surprised,” Lisa says. “We’re all so close, and I would do the same for them.”

The procedure, in which a scope is used to examine the lining of your colon, isn’t something most people look forward to. But like mammograms and dental checkups, colon screening can catch problems at a stage when they’re much easier to treat.

Although colon cancer is the third leading cause of cancer deaths in the U.S., it has a 92% survival rate when treated early. For people like Lisa who have a family history of colon cancer, colonoscopies can also bring some relief from health fears and anxiety. “It’s such a small inconvenience for a result that could save your life,” Lisa adds.

The procedure itself is usually simple, with little discomfort, especially with sedation. But people may find the home prep in the days before the procedure inconvenient or disagreeable. The tips below can help you avoid surprises and make the prep process go smoothly.

1.    When you should get your first colonoscopy.

The new recommended age for your first colonoscopy is 45. Just last year, the American Cancer Society lowered the age from 50, due to rising rates of colon cancer among younger adults. As a result, Aetna now covers preventive colonoscopies for anyone 45 and over. If no problems are found, your next scheduled screening will be in 10 years.

There are exceptions to these guidelines. If you have a family history of colon cancer, your first screening will be at age 40, or 10 years earlier than your youngest relative’s age at diagnosis.

2.    How to prepare for your first colonoscopy.

Before your procedure, your colon will need to be clear of all food particles. That means avoiding solid foods the day before and drinking a liquid laxative that will send you to the bathroom more than usual. If you’re accustomed to fasting or juice cleanses, the prep experience will be similar.

It’s a good idea to take your prep day off work. While you won’t have to begin the laxatives until evening, fasting can sap your energy and makes some people light-headed.

Stay-at-home mom Kate Leehane, 41, made sure her husband was available to watch their two kids, 8 and 11, on her prep day. Then she set up a comfortable station near the bathroom with her favorite magazines and books. “I didn’t try to get anything accomplished except reading as I was doing the cleanse,” she says.

Your doctor or pharmacist will give you detailed instructions about how to use the laxatives, when to time your last meal, and what you can drink to deal with any hunger pangs. Kate recommends wearing loose pants so you can quickly use the toilet and drinking the liquid laxative chilled, with a straw, to help it go down faster.

3.    How to manage colon prep when you have a health condition.

Healthy adults can usually manage colonoscopy prep without much trouble. But if you have a chronic condition, you may be worried about managing your blood sugar or taking your medication. Be assured that many patients just like you get through their prep without any issues. However, it’s important to discuss your concerns with your doctor before you make your colonoscopy appointment.

Conditions like diabetes, for instance, can make fasting harder. Gelatin desserts (such as Jell-O) and certain beverages can help you manage your blood sugar. Scheduling your colonoscopy for the early morning can also cut down the time you’re unable to eat. Patients with heart conditions or kidney disease may be given alternative laxatives that are easier on the system.

4.    What  to expect at your appointment.

Most people are drowsy or asleep during their colonoscopy. As you lie on your back in a hospital gown, you’ll be given a sedative (not general anesthesia, which is much stronger) through a breathing mask. Within seconds, you’ll be “asleep” and won’t feel anything during the exam.

The doctor then inserts a scope — a thin tube with a tiny camera — into your rectum to examine the lining of your colon. About 30 minutes later, you’ll wake up in the recovery room, likely feeling no different than before.

Because some people take longer to fully recover from sedation, a friend will need to meet you at the doctor and accompany you home. Many people can eat right away ― and are eager to do so ― while others may want to test their digestive system with something light, such as crackers or toast.

Michelle Newman is an old hand at colonoscopies. She undergoes the procedure every few years because her father died of colon cancer in his 50s. “I’ve had small polyps removed and biopsied in the past, and they always come back benign,” she says. “Other than the prep, the procedure is over and done within a few minutes. It’s always so worth it.”

5.    What are polyps?

Polyps are small growths in the colon lining. Any polyps found during a colonoscopy will be removed and sent for biopsy. Most polyps are benign, but some can become cancerous over time. Just as removing suspicious moles can prevent future skin cancers, removing polyps in the colon can prevent future colon cancers. “The procedure is both diagnostic and therapeutic, which is pretty rare to find in medicine,” says Amit Patel, MD, an assistant professor at Duke University School of Medicine and a spokesperson with the American Gastroenterological Association.

If no polyps are found, you won’t need another colonoscopy for 10 years. If polyps are found or you have a family history of colon cancer, you’ll undergo exams more frequently ― possibly every one to three years.

6.    What are the alternatives to colonoscopies?

Other, more convenient screening methods are available that don’t require fasting or laxatives. A stool test checks for the presence of blood and DNA changes that may indicate cancer. These at-home kits give you all the tools you need to mail in a small sample to a lab for testing.

Stool tests should be done every one to three years. If your results come back positive, you’ll need to follow up with a colonoscopy. If you prefer to avoid a colonoscopy in the short term, however, a stool test will give you some peace of mind. “The best test is the one that gets done,” declares Sophie Balzora, MD, of NYU Langone Medical Center and a spokesperson with the American College of Gastroenterology.

Read more about alternatives to colonoscopy.

Carrie Trippe Peck, a colon cancer survivor at 45, advises everyone she meets not to delay their screening. “Yeah, it’s probably not the first thing you want to do, but it’s not worth losing your life to colon cancer,” she says. “The procedure itself is snap, and you get a fantastic nap.”

About the author

Sachi Fujimori is a writer and editor based in Brooklyn who focuses on writing about science and health.  A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl.