The Straight Poop About Colonoscopies

March is Colon Cancer Awareness Month, and what better way to celebrate than to read this vivid account of what actually happens before, during and after a colonoscopy?

Warning - there will be discussion about bowel movements in this posting. If you don't like to read about bowel movements, you probably want even less to talk about them, which is precisely the reason why more preventable colon cancers aren't prevented. So suck it up and read on!


A little background first. I have colon cancer. I was diagnosed in January 2005, at 38 years old, when one of two polyps found during a colonoscopy was determined to be malignant. Because the cancer was contained in the polyp, it was considered Stage 0. Had I not had the colonoscopy, it likely would have spread to other vital organs nearby. That's what happened to my mom at age 67. She fought cancer for two years before she died. I've had 5 colonoscopies, and have been the designated driver for a good 15 others between my wife and my dad.

So let's start with why one would even have a colonoscopy. Isn't that an "old-person's" test? Often it is. Doctors usually suggest having one around age 50.  But if you have a family history, it's usually a good idea to get checked at least a decade before your youngest relative was diagnosed. And if you have a significant change in bowel habits, bleeding, unexplained weight loss, or abdominal pain, your doctor might order a colonoscopy so they can see what's going on inside your large intestine (aka colon).

It's pretty common to be uncomfortable with the procedure. Anecdotally, it's right up there with the dreaded Digital Rectal Exam for prostate health on the least favorite procedures for men, and ladies, I'm sure there some stuff that goes on a the gynecologist's office that you detest or fear at least as much. Still, the problem with the colonoscopy is that the prep involves much more than dropping one's shorts/ hiking one's skirt while your doctor (hopefully) lubricates his/her (hopefully) gloved hand.

Colonoscopy prep involves being on a clear liquid diet for a day, and then topping it off with drinking a solution or downing a series of pills that will give you the worst case of diarrhea you've ever had - at least I hope it's the worst case for your sake. This is the rumbling, grumbling, "OMG how can there be anything left in me! Outta my way"explosive kind of diarrhea. And it's no fun. But it doesn't last that long. If you learn nothing else from this post, learn this: get some cream called Nupricanal from your local pharmacy. It's an over-the-counter med. You're going to wipe it on your very sore butt and find instant relief.

Here's my typical prep day:

6:30 Wake up, drink yellow Gatorade for breakfast. Nothing red or purple, as these colors can look like blood in the colon.
7:30 Go to work
9:30 Snack - lemon jello. Jello is liquid - don't ask.
12:00 Lunch - clear broth and a glass of yellow gatorade.
3:00 Snack - frozen lemonade
5:00 Go home
6:00 Start Prep by taking 4 horse-tranquilizer sized Osmo Prep (sodium phosphate) pills with 8 ounces of water
6:15 Repeat the pills and water every 15 minutes for an hour
7:00 Wonder what all the fuss is about
8:00 start a second round of Osmo Prep, this time 4 pills and 8 ounces of water every 15 minutes 3 times
8:17 realize what the fuss is about - Gotta Go!
Repeat trip to bathroom seven more times before 11:00. Apply Nupricanal each time. Wash hands thoroughly.
11:00 crawl into bed

Next day
5:00 Wake up
5:10 - One last time in the bathroom
5:40 - Nope, this is the last time
6:00  - Get driven to Dr's office
6:10 - Really? How can there be anything left?

And then we can start the procedure. But before we talk about that, let me just say a couple words about prep. There are easily a dozen methods of bowel prep used. The goal is the same, clean that 4 ft tube called a colon as thoroughly as possible so the GI doc can get a good look at it from the inside. The biggest challenge with the prep is the volume of liquid you have to drink. My prep uses pills and while it does require me to down a full gallon of water, at least it's water (or Gatorade if you prefer). There are other preps out there on the market that are all liquid and that will claim to have a refreshing fruit flavor. There's even one called GoLightly - I am not shitting you, if you'll pardon the pun. That's like calling a jack hammer the Tap-Tap Machine.

The point is you can ask your doc ahead of time what kind of prep they are going to require you to use. If you are easily nauseated and your doc says it's GoLightly and that's final - I'd strongly consider finding another doc. Not every patient can tolerate the pills, so it may not be an option for you, but ask up front. You can even call and ask the nurse before you schedule an appointment.

So, back to Day Two of colonoscopy fun. I hope you asked for an early appointment, because the sooner we get this over with the happier you'll be. The worst part is behind you. Your job now is pretty simple. They call your name, take you into a pre-op area, get your vitals, and before you can say "what's in that tank over there" you're in la-la land. It varies from practice to practice, but chances are you're in the kind of "twilight sleep" that they put moms in back when I was born so they'd forget the whole labor thing and want to have a baby again.

A nurse and a tech will roll you on your side, tuck your knees up and expose your ass to all the people in the office building next door. Then the doc will come on, blocking their view and will stick a thin, flexible tube in what some people prefer to think of as a one-way opening. The doc will also blow some air in there because that helps him round the corners and see all that freshly cleaned colon wall using the camera at the end of the tube. It also makes for a lively scene in the recovery room - more on that in a sec.

If he finds a polyp, he'll probably remove it by lassoing it with a little wire and snipping it off. That area will be sore for a couple days and may bleed a little. He'll send the tissue off to the lab and in a couple days you'll know whether it's cancer or not. "Not" is the better answer.

The whole process takes about 10 or 15 minutes. Then you go to a recovery area where somebody who must love you a whole lot will be called in to wait with you until you fart. That air the doc blew in there has to go somewhere, right? That's a sign that the plumbing is working. Once you're stable enough to dress yourself, you can go home.

You probably won't remember whatever the doctor or nurse told you about the procedure, which is OK, because the person who waited for you to fart listened to that while pretending not to listen to the other 4 patients farting. After you nap off the remaining anesthesia you'll fart some more, eat solid food, and text your co-worker to say it wasn't that bad.

Congratulations, you're no longer a colonoscopy virgin!