Wednesday, November 20, 2019

Craptastic! The low down on what to expect for your colonoscopy

This September I turned 50. There are many wonderful things about hitting the big Five-O, but the “welcome to 50” colonoscopy is not one of them. As I am the kind of person who needs lots of information about things, I took to Google to search for other people’s experiences with the prep and the procedure. I wanted to know what to expect and how to make the best of the “prep” everyone says is horrible.

There was precious little information out there, and a dearth of detailed information. The lack of information on what to expect each step along the way is largely why people are so nervous and fearful about the procedure. So, in my traditional way of doing things, I will write the information I wished I was able to find prior to my colonoscopy adventure.

The initial consult

The journey begins with a consult with a gastrointestinal doctor, who my primary doctor referred me to. They actually called me with an appointment day and time, which I had to change. This is typically a quick face to face appointment where your vital signs are taken, questions about your medical history, medications, and bowel habits are asked, and a brief discussion takes place about what to expect for the procedure and what bowel prep regimen you will use. You are then scheduled for the colonoscopy at a future date, and given your instructions for the bowel prep, in a handout. Be sure to ask questions at this visit, in as much detail as you need, because you won’t really get another chance until the day of your procedure.

Anesthesia or no anesthesia?

You are given an arrival time around 1 hour before your actual procedure so they can get you ready.
The procedure itself is typically done in an outpatient endoscopy clinic setting or the endoscopy unit of a hospital. My doctor was in a freestanding clinic. The lobby was designed to look like a tropical Zen garden, which was interesting and soothing.

Most people elect anesthesia, which really means you are sedated for the procedure with an anti-anxiety drug that makes you feel a little loopy and groggy and that relaxes you and another that essentially gives you amnesia, so you don’t remember anything. Yet you are awake and able to converse with the doctors the entire time, you just won’t remember it. You are not really “asleep” or “knocked out”, although I’m sure some people probably do doze off if the meds are strong enough for them to do so. With this option, you have an IV, Oxygen in your nose, a little gadget on your finger to measure your oxygen levels, an EKG, and a blood pressure cuff, and you are given all drugs to sedate you prior to the start of the procedure in your IV.

After the colonoscopy, which takes 20-30 min or so, you have to stay an hour or so to recover. Then you cannot drive or work for the rest of the day, so someone has to pick you up and take you home.

I opted out of the anesthesia. She seemed surprised, but also said more and more people, especially women, are opting to undergo the procedure without any sedation. Everything I could find on the internet (which wasn’t much) and talking to others who had no anesthesia, led me to believe it’s not painful. Uncomfortable at times, maybe, but I had all my kids without pain medication and know I react horribly to any kind of anesthesia and am super sensitive to drugs of any kind, so a few minutes of discomfort was far better for me than being down for a day or two to recover from the drugs.

I loved my GI doctor. She was easygoing, funny, and had a great bedside manner. She did her procedures on Tuesdays, so I had no choice of day, but I could choose the time. Choose carefully, as your last prep is usually about 4 hours prior to your arrival time to the appointment and you’ll spend most of those 4 hours on the toilet. If you are doing a single prep, it may be 6-8 hours prior. If you don’t want to lose much sleep, choose a later time of day. I chose 10:15, not realizing that was the arrival time. When I later received an appointment confirmation I learned my procedure was actually at 11:15.

My plan was to work from home in the morning prior to my colonoscopy, and then either work from home or go to the office afterwards, depending on how I felt.

The “prep”

Preparation for your colonoscopy will probably begin with a somewhat restricted diet for a few days prior. Even if it doesn’t, it’s a good idea to avoid difficult to digest foods like nuts, seeds, whole grains, fruits, veggies, and leafy greens. I had to avoid them for 3-4 days prior. Stick to soft, easy to digest foods and don’t eat a ton. Everything you put in for those several days prior will come forcefully out on prep day, remember that.

The day before you are usually allowed a simple breakfast of scrambled eggs, crackers, or mashed potato (no skin) in a small amount, after which you are only allowed clear liquids until after the colonoscopy. I actually forgot to eat breakfast, but I’m glad I did. I think fasting from solid food for 36 hours probably helped a lot.

Pro-tip on clear liquids and hydration before and during your prep:

Hydrate, hydrate, hydrate! You are allowed only clear liquids. Think anything you can see through including jello, Popsicles, juice, tea and coffee, etc. You cannot have milk or cream in your tea/coffee, however. You can also have sugary drinks, so unless you are diabetic, I recommend drinking lots of water, but also drinks that have calories and electrolytes in them like a sports drink. Avoid red and purple colored beverages, though. You will lose tons of fluid, so start hydrating days before, and drink as much as you can the day before and the morning of your procedure all the way until you are told to stop liquids by your doctor.

So, the real “prep” is anything but pleasant. It is a mega dose of laxatives usually provided in a packet that you mix with water in a specific ratio and must drink in a certain time frame, usually 30-60 minutes. It’s either in one dose, or two doses separated by a number of hours, depending on which type of prep your doctor prescribes for you. The timing relative to the time of your procedure will depend on the type of prep the doctor recommends for you and what time your colonsocopy is scheduled for.

My doctor prescribed Plenvu, which is a 2 dose prep. It’s relatively new. It was about $60 at CVS. It requires you to drink a lot less of the icky tasting mixture than most other preps, but its concentrated. None of them taste good and none of them are pleasant from what I’ve gathered.

Dose 1:

Starting around 5 pm the night before, I was to mix Pouch A with 16 oz of water in the provided container, shake it up, and drink it in 30 minutes. It was supposedly mango flavored. It was essentially a mega dose of salt water. It tasted disgusting. I sipped it. After about 45 min I had only managed to drink half of it. It made me queasy, gave me shivers, and I felt a little spacey in the head. I took to the internet and started to read the reviews of this particular prep. I quickly learned that was very common. Some people reported vomiting, but feeling queasy, cold and shaky, and generally crappy (pun intended) seemed to be the norm. NONE of this was discussed in my visit with the doctor.

Pro-Tips for getting the drink(s) from hell down:
  • Make it as cold as possible. I added ice and it helped a lot.
  • Use a straw, it avoids getting the full on disgusting taste in your mouth
  • Sip it slowly, don’t chug it. It seems the faster you drink it the more likely you are to throw it up or feel queasy
  • Chase each sip with a tasty clear liquid. It helps with hydration and kills the salty aftertaste. Something sweet helps.
  • Stir it frequently. The powder will settle out of the water a bit which makes the last few ounces super concentrated if you don’t keep stirring it before each sip.
  • Most everything I could find on the internet written by medical professionals said if you feel nauseous or vomit to take a break from the drink for 20-30 min, and then sip it slowly. Taking longer to drink it is preferred to not drinking all of it.
  • If you feel queasy, or think you will (chances are high you will!), have some peppermint or ginger handy (teas, candies, aromatherapy oil), an anti-nausea medication, either a homeopathic, an over the counter one, or a prescription one - ask your doctor. You could also try lemon or lime flavors or even suck on a lemon or lime wedge between sips (pretend it’s Tequila?)

After about 60 minutes, my normally very low blood pressure was 140/93 (I run 100/60), I had a headache and felt lousy. If you have high blood pressure, talk to your doctor about preps that have super high levels of salt (most do) and if you should adjust your medications.  My BP was likely higher than normal because of all the salt. I still had about 2 ounces of the salty solution left to drink after 90 minutes but I just couldn’t do it. I never finished it.

About 30 min into drinking, I had my first trip to the bathroom. Over the next 4 hours, I made several quick trips to the bathroom, and passed mostly brown liquid. I had no cramping, but very little “warning”, so stay close to the bathroom!

Pro tip for comfort:

Purchase a diaper cream and flushable wipes prior to starting your prep. Use the diaper cream often to protect your skin. Having hours and hours of frequent, liquid stools is very irritating to your skin. Toilet paper can be uncomfortable, too. The cream will protect your bum from the discomfort of the irritated skin. Your derriere will appreciate it. We have a bidet and it was a godsend. Others have reported sitting in a warm bath or taking a warm shower helps, too, but depending on how frequently you are needing to have bowel movements, how quickly they sneak up on you, and how liquid they are, you might not make it to the toilet from the bath.

After about 4 hours, things settled down and I was able to have a good nearly 6 hours of sleep.

Dose 2:

My alarm was set for 5 am, but I woke up on my own around 4. I had to pee and had another liquid stool. I made myself some tea, mixed my second “prep” drink, this time two envelopes of powder mix into the 16 oz container with water, and brought that with my laptop to the bathroom. Everything I read said once the second drink starts to work, you spend the next few hours in the bathroom, so I figured I might as well be productive. Guess where I wrote this blog post. :-)

I started drinking it a little before 5 am, alternating with my tea. I put lots of sugar in my tea! I found the second drink to be marginally more palatable as it was a sweet berry flavor. It didn’t taste quite as salty to me as the first one. It took me about an hour to drink ¾ of it, all of my tea, and a bottle of Bai coconut water, and during that time I had about 6 trips to the toilet, about every 10 minutes. They were quick, painless, and essentially liquid in nature. The cat kept me company while I camped out in the bathroom.

Also about an hour into the second round, I started to feel a bit queasy, lightheaded, and shaky. Not as bad as the first time, but not pleasant. My heart rate was actually low, probably because of the dehydration. I normally have a resting HR of around 56 (I’m a runner) but it was in the 40’s. This happened with the first round and only lasted a few hours. It took me about 90 minutes to completely finish drinking the prep.

The bowel movements by the time you are well into the second round of prep become essentially all liquid and frequent, about every 5-10 minutes for me. For a while I literally just sat on the toilet while it poured/dripped out of me essentially non-stop for maybe 20-30 min. It feels like you are peeing out your butt. There is literally little to no warning, so if you are not planning to sit on or very near the toilet for a few hours, you might want to wear an adult incontinence brief or a sanitary pad to avoid “accidents”. It just runs out of you with no effort. When your bowel movements are all liquid, yellow, and fairly clear, your prep has been successful. You are “clean”.

You still need to finish drinking all the prep drink though, to be sure your entire colon is cleaned out. I literally easily lost the equivalent of all the fluids I took in within an hour or two of drinking them, and then some. I also got a low grade headache and dizzy when I stood up because of the fluid loss and dehydration. It was about that same time I ended up sitting on the toilet for a good 20-30 min because I was running like a faucet. It was at this time I was most grateful for the heated toilet seat but really wished it was padded!

I should point out that at no time did I have any discomfort or diarrhea cramps. The discomfort was all in trying to stomach the prep drink and dealing with the side effects of it and the dehydration. I drank a TON, and still ended up dehydrated. The saltiness of the prep does help make you want to drink though, so that helps with the hydration.

About 3 hours after I started drinking the second prep, the bowel movements let up significantly and I was able to shower, get dressed, have one last cup of tea and a glass of water, before 8 am when I was not allowed to have any more liquids, and get a little work done. I had two more small, pure liquid (watery) BM’s before I left my house at 10 am. By then, I was wicked thirsty and getting hungry again.

Overall, despite the horrible taste and how I felt after the first dose, the second dose was less offensive in every way, and I would probably opt to use this prep again in the future. That said, if we can send people into space, why the hell can’t they make a prep that is entirely in pill form or that tastes GOOD and doesn’t make you feel like you are going to puke?

The Actual Colonoscopy

I left my house at 10, having had nothing to drink since 8 am per instructions. I reminded my husband to keep his phone with him and on vibrate in case he needed to come get me unexpectedly, but since I was opting for no anesthesia, I was allowed to drive myself there and home. I was so thirsty and getting even more hungry.

Why arrive so early? Well, they have to check you in, have you sign papers, make copies of your insurance cards, give you your ID bracelet and then you wait. Everyone in the waiting area was discussing how terrible the prep tastes. It was a pretty jolly group, actually.

About 45 min before my scheduled time I was brought into a large room with curtained “bays” with a stretcher in each bay. Everyone having procedures was brought into this room. There I met an aide who had me put my clothes in a bag, change into the fashionable hospital johnny and she gave me slipper sox to keep my feet warmer. She also gave me a warm blanket. My belongings were put under the stretcher and were with me the entire time. Then the nurse asked a bunch of questions like when I last ate, what I ate, what kind of prep I did, when did I last drink, what I drank, if I had any medications, allergies, etc. She took my vital signs and started an IV. This is absolutely necessary if you are having anesthesia, because they inject the sedative and amnesia drug via the IV, but they also require it for those not having anesthesia so they have access in an emergency.

The anesthesiologist came in to tell me I’d sleep through the entire thing. I told her nope, I wouldn’t because I wasn’t having anesthesia. She looked at me with some combination of horror and disbelief. As if to say why would you ever do something so foolish when we have perfectly fantastic drugs? She asked the nurse if it was true, as if I didn’t know what I was talking about. I don’t know what it is about anesthesiologists, but I’ve yet to meet one who didn’t think I was insane for saying no to anesthesia. Not when I gave birth and not for this. Mind you, my chart had “NO ANESTHESIA” written on it in big letters, starred, and highlighted, so I don’t know how she missed it when she looked right at it.

If you are having anesthesia, the anesthesiologist will come by and ask you a few questions, answer any that you have, and let you know, very briefly, that they will give you “something” to “knock you out” or “put you to sleep” and you won’t feel a thing.

She went on her merry way and the doctor came shortly thereafter to take my stretcher and me into the procedure room herself! She was not the best driver, which she kidded about along the way! In the room there were 2 nurses and the doctor. If you have anesthesia, there will also be a nurse anesthetist. In addition to the blood pressure cuff and pulse oximeter on my finger, they hooked up 3 EKG electrodes to my arms. I didn’t need the oxygen since I wasn’t having the anesthesia. Upbeat pop music was playing and we easily fell into conversation.

The procedure itself took about 20 minutes. None of it was painful. The colonoscope is a tiny camera and light at the end of a long, flexible tube, about the size of a finger. At times, there was pressure and discomfort, especially while the advance the scope in the beginning all the way to the end of your colon, sort of like when you feel super bloated and have a stomach ache, or if you’ve ever been pregnant, feeling the baby flip around and push against your belly, but it didn’t last long. I think it’s mostly because they inject air through the scope so they can see, so you feel distended and gassy and the scope just feels weird as it moves around the bends. At one point the nurse pushed on my belly to help it round a bend, and that actually made it feel much better.

Once they were all the way to the end of the colon they slowly back the scope out and that’s when they take a good look around, and that’s what takes the most time. This part was more comfortable. I watched on the TV screen and found it quite interesting. She showed me my appendix, the inside of my small intestine (very cool), and the rest of the journey was all the same looking. She did find and remove 2 polyps. That was also fascinating. I didn’t feel a thing! She kind of used a lasso and lopped them off. And then it was done. A little pressure at the very end, but nothing compared to childbirth and a hell of a lot shorter! Not bad at all!

I did find this video and website by a GI doctor in the UK that talks about colonoscopy that’s pretty interesting, if you want to see what the colonoscope looks like and hear a little about the procedure from a woman who is a colon cancer survivor. .


I was wheeled into the recovery area, which was just the other end of the big room I started in, and encouraged to let out the air. If you massage your belly and move around a bit it helps. You feel distended and gassy for a bit afterwards, but that didn’t last too long. They offered me something to drink and some toast, gave me a paper with pictures of my colon (what a conversation piece one of those would be on the wall!), and information on polyps. Those were sent to pathology to be tested and she said since I had polyps, I should have my next one in 5 years instead of 10, just to be safe, since polyps grow slowly, and although most are benign, they are what can grow into cancer in some people.

The nurse took one set of vitals, then since I was driving myself home and didn’t have anesthesia, I got dressed and they walked me out to the front door and sent me on my merry way, with parting chocolates! Female MD’s are the best! I was so happy to be able to drink again, I was so thirsty! I also ate some eggs and a little bit of oatmeal when I got home. They advise a soft, “easy” first meal or two so as not to upset your system too much with something hard to digest. I wasn’t as hungry as I thought I would be. It took a few hours before the bloating and gas discomfort subsided completely, but I worked the rest of the afternoon and felt perfectly fine.

Final Thoughts

All in all, I think people fear colonoscopy because it’s a mysterious procedure and because it’s not talked about in detail by those who’ve had them, or by the doctors and nurses who perform them and work with the people who have them all day, every day. Because it involves your backside and it’s an invasive procedure, people are anxious and fearful it will hurt, embarrassed because it’s “down there”, think they have no “signs” so they couldn’t possibly have cancer and thus don’t need to do it, or simply aren’t given the option to do it without anesthesia, which feeds the fear it’s painful.

The prep sucked, and I don’t look forward to doing it again, but that said, after talking with others who did different kinds of prep, none of them were “good”. I didn’t have to drink a gallon of the icky stuff in 2-3 hours. I wasn’t up all night and got several hours of solid sleep, and it worked great. I liked the split dose and now that I have experience with it, I know the tricks to make it as manageable as possible. I would do this variety of prep again, if for no other reason than I now know what to expect with it.

I think it’s important to keep in mind the purpose of the prep is to clean out your entire bowel system so the doctor can see everything clearly. This is a cancer screening, just like mammograms, prostate exams, and skin checks, it's just more invasive because it’s your colon, so keep in mind all the hassle of the prep, no matter how often you have to do it, is way better than treating colon cancer. SO many people avoid colonoscopies because the mere thought of it makes them uncomfortable. Anyone who has had colon cancer can tell you they’d much rather endure the prep and the colonoscopy, than the treatment for cancer, or taking the risk a pre-cancerous or early cancer area isn’t caught until it’s spread everywhere. A few hours of unpleasantness is a small price to pay for your health!

I hope that sharing my craptastic adventure has helped to ease your anxiety and encourage you to have that colonoscopy, whether you opt to use the sedation/anesthesia or without it. The most important thing is that you do everything you can to keep your body happy and healthy. It’s the only one you get, so take care of it!