The Straight Poop – An Awkward Conversation

We have to have an awkward conversation.  It’s about your butt.

Curiosity may have killed the cat, but it was no picnic for the pinata either.

Curiosity may have killed the cat, but it was no picnic for the pinata either.

I recently told someone that I am scheduled for a colonoscopy.  He looked like I had just told him I was going to have both my arms removed and sewn back on my knee caps.  He then said, “I’d rather die of cancer than go through that.”  Let that sink in a second.  I sat in stunned silence for a while and then I said, “Could you look your daughter in the eyes and tell her that your fear of a colonoscopy is more important to you than walking her down the aisle at her wedding is?”  He looked like I had slapped him and the truth is that I wanted to.  I asked him what caused this fear of a colonoscopy and he tried to explain to me that it was invasive and painful and if you don’t have a history of cancer in your family, it was completely unnecessary.  Here’s the thing…he’s wrong on EVERY. SINGLE. POINT.  And I KNOW he’s wrong because I am having a colonoscopy on Tuesday…and this will be my fourth one.  I’ve done this before, and I know exactly what is involved and exactly how important it is and most importantly, I can assure you that it is not painful for most people.  And, if you wake up in pain for some reason, I assure you that if you communicate the level of your pain, it will be taken seriously.  Most people wake up with pain from the air trapped in their colon and just moving around and walking helps the gas pass relieving the pain but if you are in legitimate serious pain that is unrelieved by passing gas, the anesthesiologist and your physician have the right to administer pain medication if you need it.

So, I decided to write this post to share with you the real FACTS about a colonoscopy.  When you’ve had four of them, you learn some tricks that make it even more painless than those uninitiated that stumble into the prep process blind.  And I’ve heard some horror stories.  People that went through the prep and then because of one factor or another had to have the procedure aborted and rescheduled.  I can help you prevent this from happening.  Because the prep isn’t fun.  I’d pretty much RATHER do anything else but the truth is that it is the most important part and it can mean the difference between a successful colonoscopy screening and a bad experience.

I am providing section headers to allow you to easily skip ahead to the parts you have questions about if you do not wish to read this entire post.  However, if you are reading this in preparation for your very fist colonoscopy, I encourage you to read all of it.  It may help you to not feel anxious about the procedure.

COLORECTAL CANCER MYTHOLOGY – Why you need to get screened.

Myth 1:  No one in my family has had colon cancer so I won’t get it.

Reality 1:  Colorectal cancer is the third most common cancer-related cause of death and in the US, 85% of these patients have no family history of the disease.  Did you read that EIGHTY FIVE PERCENT of these patients have NO FAMILY HISTORY OF THE DISEASE.

Myth 2:  A colonoscopy won’t prevent cancer.

Reality 2:  A colonoscopy is not only the best screening tool to catch colo-rectal cancer but what few people realize is that it can most definitely PREVENT colorectal cancer.  Almost all colorectal cancer begins as a polyp.  These polyps are removed during a colonoscopy and it prevents them from growing into cancer.  It’s that simple.  These polyps are then sent for pathological evaluation and if the margins (edges of the area they cut away) are clear, that’s it, you’re done.  You just prevented cancer.

Myth 3:  I don’t need a colonoscopy unless I have symptoms of a problem.

Reality 3:  If your’e 50 years old, it’s time to start getting a colonoscopy every 10 years.  Colorectal cancer is directly correlated with age.  The older you are, the higher your risk.  A pre-cancerous polyp can take 5 to 10 years to become cancerous so having a colonoscopy every 10 years is an extremely effective way to screen for and prevent colorectal cancer.   Turning 50? Time to treat yourself to some extreme close-up photographs of your rear end.  I think 50th birthday cakes should all say “Happy Birthday, Turn Around and Say Cheese!” as a reminder to schedule your first colonoscopy for people that haven’t already have one.

If you’re like me and you have a history of colon cancer in your family, you will need to discuss with your doctor when your screenings should begin.  If you have symptoms such as a change in bowel habits, pain, rectal bleeding, or unexplained digestive problems, your physician may begin your colonoscopy screenings early.  Here’s the thing.  You have to be completely honest with your doctor if you’re having problems.  This means you’re going to have some awkward conversations about poop and your butt.  If you’re embarrassed to talk about it, write it down to give to your doctor.  I promise it’s less awkward than pooping through your abdominal wall into a bag.  My grandfather had colo-rectal cancer and because he didn’t get screening, it wasn’t caught until he had stage 4 cancer.  He had to have a colostomy.  If he’d only agreed to have regular colonoscopies….

And…BY FAR the BIGGEST excuse I hear about having a colonoscopy is that people don’t want to go through the prep.  For those of you uninitiated, the prep is the process of emptying your entire digestive track so that the camera can see the walls of your colon without any obstruction.  So, be sure to review the section on the prep called “I’M READY FOR MY EXTREME CLOSE-UP – The Dreaded Prep” to put your fears to rest.  I’ve turned a colonoscopy prep into an art form.  Granted, it’s still not my favorite procedure, but it surely is a lot less painful now than the first time I had to go through it.

YOU CAN TAKE YOUR CAMERA AND SHOVE IT WHERE THE SUN DOESN’T SHINE – What is a Colonoscopy:

If you’re not sure EXACTLY what a colonoscopy is, I have detailed the experience here for your learning pleasure.

A colonoscopy is a medical screening procedure in which a camera on a long flexible tube is inserted into the anus and then routed through the rectum and large intestine.  The procedure is usually done in an outpatient surgery center or in a hospital.

You will be required to prepare for the procedure by cleaning out your digestive system.  Your physician will prescribe a “prep” which I will explain in detail in the “I’M READY FOR MY EXTREME CLOSE-UP – The Dreaded Prep” section below.  You will need to get the prep materials from your pharmacy.  The day before your colonoscopy, you will only be allowed to consume clear liquids. Then in the afternoon or evening you will begin following the instructions for the prescribed prep.  This prep is basically a super laxative.  DO NOT LEAVE THE HOUSE FOR ANY REASON AFTER YOU HAVE TAKEN THE PREP.  There is no way to know how long it will take to work but once it does, you will be in the bathroom for a while.  The goal of the prep is to completely clean out your digestive system.  At the conclusion of a successful prep, you will be passing only clear liquid from your bottom.

Your doctor will tell you what time you must cease to consume clear liquids based on the scheduled time of your procedure.

The day of your procedure, you will not be permitted to eat or drink anything.  If you take prescription medications, your doctor should have told you which ones you should take with the tiniest sip of water and which you should skip until the procedure is over.

Someone will need to drive you to and from the procedure.  Some places let your driver leave and come back and get you but you should check the rules of the facility you will be using.  The one I go to requires your ride to remain in the building the entire time.  If you rely on public transportation usually, you will want to splurge on a taxi on this day.  Prior to your procedure, you may still feel like you need to rush to the restroom now and then and afterwards you will still be pretty loopy from the sedation.  Even if you wish to use a taxi, you will still need an adult to accompany you.  After receiving sedation, the facility will expect this adult to monitor you and prevent you from signing any legal documents or endangering yourself for 24 hours.  It does not usually take a full 24 hours for the sedation to completely wear off.

Once you arrive, a nurse will take you to a “pre-op” area (even though this isn’t really a surgery) where you will remove your clothes and put on a hospital gown.  They will offer you a chance to use the toilet and if you are a female of child-bearing age, they may ask for a urine sample so they can verify that you are not pregnant prior to giving you any sedating medications.  A nurse will have you sign some paper work and you will be given an IV that will be used to administer fluids and sedating medications during the procedure.

The sedation is called “conscious sedation” or “twilight sedation” meaning that you are able to wake up during the procedure but most people nod off to sleep.  However, the sedating medications they use most commonly are called retro-grade amnesiacs meaning that it is unlikely that you will remember ANYTHING that happened after you receive the sedation until you “wake up” in recovery.  These medications may block pain or they will be mixed with a pain medication and make you really spaced out.  Most people just fall asleep during the procedure.  However, because it is not general anesthesia, you will be able to breathe on your own and even move around because they may need to re-position you during the procedure and you’ll be able to cooperate.  If you do have any memories of the event while you were sedated, they’re usually just like little flashes of memory.  It has been likened to blacking out during a night of heavy drinking, only when you wake up from this, you will not be hungover.

You do not HAVE to have sedation if you do not want to, you just have to tell your physician that you wish to remain un-sedated during the procedure.  However, I highly recommend the sedation.  While the procedure isn’t painful, it can be uncomfortable since they use air to inflate the portion of the intestine they are viewing, you may feel like you have bad gas cramps during the procedure without the sedation.  The few moments after the sedating medications are administered that you’re still aware before you fall asleep will be the happiest few moments of your life.  It makes me feel like someone dumped warm honey all over my brain.  It’s a pleasant sensation for me.  But I understand that some people dislike feeling out of control of their bodies and so these people might prefer to just power through un-sedated and that is an option.  I talk more about sedation in the “COMFORTABLY NUMB – Let’s Talk Anesthesia”  section of this post.

There is usually an anesthesiologist, a physician and somewhere between 1 and 3 nurses or technicians in the room during the procedure. Depending on where you are, they may give you sedation prior to taking you into the procedure room or they may wait until you’re in the room and positioned properly before administering sedation.  You will be wheeled in on a gurney and once inside, they’ll help you get rolled onto your side.  You’ll lay on your side with your knees drawn up and your backside exposed.  I remember the last time, they did use a drape over my rear end until they were ready to start.  The anesthesiologist and nurses will hook your IV up to the fluids and ensure the IV lines are untangled and accessible.  If you’re also having an endoscopy at the same time, they may place a bite guard in your mouth that straps around your head.  They will place oxygen on you usually via a tube that sits below your nose (nasal canula).  They will put a pulse-ox meter on your finger to monitor your pulse and oxygen saturation during the procedure.  They’ll put a blood pressure cuff on your arm that will automatically inflate throughout to monitor your blood pressure.  They may attach electrodes to you so they can monitor your heart rhythm and breathing as well.

Once you’re in position and everyone is ready and you are sedated, your physician will insert a long thin tube into your bottom that has a camera on it.  The camera will be guided through your large intestine so your physician can find and remove any polyps.  In order to get a better view, air may be inserted though the tube to give the camera a better view.  As a result, you may feel gassy when you wake up.

After the screening is complete, the tube will be removed.  You will be re-positioned into your back, all the monitors will be removed, you will be covered up and a nurse will transfer you on your gurney to a recovery area.  When the sedation wears off, they will offer you something to drink and possibly some cookies or crackers.  They will actually show you photographs taken during the procedure and let you know of anything they found and any follow-up appointments or care you will require.  Once the sedation is worn off enough that you can get dressed without taking a header, they’ll let you get dressed.  Whoever drove you to the procedure will drive you home and you’ll be allowed to return to eating and drinking normally.

I’M READY FOR MY EXTREME CLOSE-UP – The Dreaded Prep

If you’ve talked to anyone that has undergone colonoscopy, you’ve likely heard the phrase, “the procedure is okay, but the prep is terrible.”  Or something similar.  Here’s the thing, if you prep for the prep properly, you won’t have any issues.

1 Week Prior:  You must stop taking any iron-containing vitamins and any blood thinners like asprin or advil.  This is because there is a small risk of tearing or perforation associated with a colonoscopy.  In addition, if they remove any polyps, you could have some bleeding.  They want this bleeding to be as minimal as possible.  Discuss your vitamins and blood thinners with your doctor before scheduling your colonoscopy so he can tell you which you can safely continue and which you must stop taking.  Double check with your doctor to make sure none of your regular medications will need to also be stopped.  If it is too high risk to stop taking blood thinners given your medical history, your doctor may decide to do your procedure in a hospital so that if there is bleeding you can be quickly transitioned to surgery.

If you are a vegetarian, vegan, or high fiber person…YOU WILL WANT TO SWITCH TO A LOW RESIDUE DIET at least several days before you have to drink the prep.  I have heard of many people who drank the prep, sat on the throne for hours, and never got a um…”clean” colon.  These were usually the people who live on raw veggies, nuts, seeds, and other hard to digest food that we know is healthy but is still hard to digest.  I know of one guy that thought he was all cleaned out only to find that the test had to be aborted because of the amount of lettuce and other plant material still hanging around in there.  I’m not suggesting that you stop being vegan or vegetarian or switch to a high fat western diet, I’m just saying that your best bet for a successful prep is to go low-residue as early as possible.

What is low residue?  It’s basically everything you’re probably used to limiting in your diet if you’re health conscious.  It’s highly processed carbs, and no high fiber foods.  You can have lean proteins like poultry but you should avoid beans because they are not easy to digest.  You can have pastas and crackers (low fiber) and low fiber breads.  You should stick to canned vegetables that have been cooked into basically mush.  You can have bananas and apple sauce and dairy but not a lot of dairy.  Soft cheeses are okay in small amounts and try to limit milk.  Basically, if you have Crohn’s disease or IBS or IBD, these are the foods you can usually eat safely during a flare.  No nuts, seeds, granola, popcorn or hard-to-digest foods.  If you need suggestions, just google “low residue diet” and you’ll get some guidance.

The more high fiber/high roughage foods you usually consume, the earlier you should consider switching to a low residue diet to make the prep easier.  I don’t eat much usually so the low residue diet was pretty easy for me to switch to.  I started it on Saturday for a Tuesday colonoscopy.

Finally, if you have a sensitive gag reflex…or even if you don’t…you may want to consider calling your doctor and asking him to call in an anti-nausea medication in case the prep makes you feel nauseated.  It can have that effect, and it will be amplified if you are dehydrated.  You just don’t want an anti nausea medication that is sedating (like phenergan).  Zofran or Reglan are better options for this scenario.  Just one or two should get you through the prep and you should only take them if you need them.  Just be sure your pill isn’t red.  You can’t have anything red on the day of the prep.

3 Days Before

You’ll need to go pick up your prep from the pharmacy.  Don’t wait until they last minute, they don’t keep all of the different kinds available in stock and you don’t want to be the one that has to call the doctor for a different kind of prep because the pharmacy doesn’t have time to get it in before your appointment.  Read the prep instructions and compare to the instructions from your doctor.  If there are discrepancies between the two and you have questions, call your doctor today for clarification.

You will also want to go ahead and buy your food for your day of liquid diet.  You can have yellow and green colored stuff.  No red, blue or purple as these colors can look like blood in the digestive track.  You can have orange IF it is light orange and not red-orange but it’s best to stick to yellow or clear.

-Gatorade or other electrolyte sports drink (yellow or green or clear)

-Apple juice (lots of it) or white grape juice

-Italian ice (the lemon flavored one because you can’t have anything red, purple or blue)

-Broth (I have found that I hate chicken broth but I like the broth in the ramen noodles package so I eat the noodles while on my “low residue” diet and strain the broth out and save it for my liquid diet day.  I also have a tip for you, if you add plain unflavored gelatin to broth, it increases the amount of protein (and dissolves in warm soup so it doesn’t change the texture) which will help stave off hunger.).

-Hard candy, clear or yellow or green is okay.  I buy butter rum lifesavers.  These will help get the taste of the prep out of your mouth and help with the dry mouth that I tend to get during the prep.

-Straws (you will need these to get the prep down.  It tastes really bad and a straw helps keep it off your tongue as much as possible).

-Lemonade mix (ask your doctor if you can mix the prep with lemonade drink mix to make it more palatable).

-popsicles (they can’t have fruit or dairy in them – and they should be yellow or green)

-Sorbet (again, no fruit pieces or dairy in it and mind the colors you’re allowed to have).

-Tea or coffee.  you can sweeten them but no creamer.  I like to have hot beverages to drink because the prep will usually be ice cold to dull the awful taste and you’ll find you get cold easily the day of the prep.

-Soda.  Sprite, 7-up, or ginger ale are best…BUT…you can have mountain dew if you are someone that has a serious caffeine addiction.  Just keep in mind that your mountain dew isn’t as hydrating as other options and you’re already going to be fighting an uphill battle to stay hydrated on prep day so use caffeinated beverages judiciously.

-yellow or green jello (pineapple flavor is also yellow if you can’t do lemon or lime).

-Plain unflavored gelatin.  This is a trick I learned.  When you’re hungry, if you eat protein, you’ll feel less hungry.  Broth will usually not fill you up because there’s not all that much protein in it.  but, you can add an envelope of unflavored gelatin to broth and it will dissolve and remain liquid since the soup is hot.  But once you eat it, you’ll be getting a good hit of protein and that will help you to feel full.

-Gummy Bears – I read that lots of people eat gummy bears on prep day because at body temperature after you eat them, they will remain liquid.  But, they make you feel like you’re eating real food.  I personally hate gummy bears but if this helps you get through prep then by all means do it.  You just have to sort out the colors you can’t have so you don’t forget and eat a red one.

-Wet wipes.  Trust me, your bottom is going to get way too tender for toilet paper.  If you don’t think to buy these, then at least use a wet wash cloth or just shower after each throne session.  TP will get suuuuper irritating.  A quick rinse in the shower or a cool wet cloth will save you a lot of discomfort.

-Aquaphor diaper rash cream – trust me on this.  When you’re doing a prep like this, the digestive enzymes in your body don’t get neutralized and your back door will get really really irritated.  If you have a family member that can help you, consider keeping your wet wipes in the fridge and asking them to bring them to you as needed.  But even with wet wipes, if you put some of this around your blow hole, before the prep takes effect, you’ll be glad you did.  Just reapply a layer every time you wipe for protection.  If you forget to buy this, you can use some Vaseline if you have it to at least help be a barrier.

-Adult diapers or incontinence pads.  If you have mobility issues or are just worried about ‘anal leakage’ you may want to get some depends or incontinence pads that you can put in your drawers to ensure you can get to the bathroom in time.  you may also find that wearing one to the facility in the morning helps you feel confident that you aren’t going to leak.

1 Day Before

If you’re already eating a low residue diet, great.  If not, today should be your low residue day.  You do not want to eat a bunch of salad and pistachios today.  You also want to eat a big breakfast, a moderate lunch, and a light dinner.  You also want to hydrate today.  Hydrate your heart out.  Try to drink a glass of water every hour you’re awake.  Once you start the prep, you will get dehydrated.  The better hydrated you are to start with, the better you’ll feel through the prep so if you’re not peeing clear all day today, you’re not hydrated enough.  After breakfast, try to just eat enough at meals so that you’re not hungry anymore.  The less you eat today, the easier tomorrow will be.

If you have a slow bowel or you have had an unsuccessful prep before, you will want to switch to a liquid diet today just to be sure the prep works.

Today is also the day to decide what you’ll be doing with all your time in the bathroom tomorrow.  Download movies to your tablet, pick out a good book, update your playlist on your iPod.  Once the prep starts you aren’t going to be leaving the bathroom very much.

And if you bought jello to enjoy, go ahead and make it.

Prep day!

Remember, clear liquids all day.  Go ahead and put a sign on the fridge and pantry to remind you.  Try to continue to drink a glass of water every hour you’re awake until you have to start drinking the prep.  The better hydrated you are, the better you will feel.

Set up the bathroom.  Stash your tablet, phone, laptop, book, whatever you want in there.  Put a sweatshirt in there because you will likely feel cold during the prep.  I prefer one I can unzip to take on and off instead of having to take it on/off over my head.  I also put a space heater in the bathroom and the charger for my tablet.  You’ll need to be sure you have access to a phone in the bathroom because if you get dizzy, you will need to call for help, no matter how embarrassed you feel.  Several people have taken headers off the potty and knocked their teeth out because they didn’t hydrate well enough before starting or because they had a bad reaction to the sudden fluid loss so don’t be a hero.  If you’re dizzy, call for help.  If putting your head between your knees doesn’t stop it, call 911 and have an ambulance take you to the ER for supplemental fluids.  If you are just having intermittent dizziness, you need to have someone at least stay with you so that if you do fall or pass out they can call for help.

But when you’re setting up the bathroom, consider that you’ll be there for several hours.  You’ll get tired of sitting, your legs and bottom will hurt, your back may hurt (consider putting a pillow behind you to lean back on if there’s room), and you will go through hot/cold temperature swings.  You may want to put a chair or stool in there because you may feel that you can leave the throne and want to sit on a more comfortable seat but you might not feel that you can safely leave the room and make it back quickly enough.  I’ve even built a cot on the bathroom floor before so I could lay down to relieve some of the sore back.

Here’s the most important thing:  put a water bottle in the bathroom so you can drink water while you’re in there.  Once the prep starts, any water you drink will essentially go straight through you.  But you still have to try to keep drinking water or sports drink.  A friend of mine said pedialyte seemed to work best since it’s made for babies with diarrhea to help them keep hydrated.  So, whatever you decide to drink, you won’t have time to fix it once you need to go so get it ready before hand.  I had a tiny little lunch box cooler with a couple bottles of water and a bottle of Gatorade in it on ice.  Try to take a few swallows of water or sports drink every 15 minutes or so.  You won’t want to.  But if you can at least keep sipping, you’ll feel a lot better by the end.

Then prep your bed.  By the time you can go to bed, you’ll be exhausted but not TOTALLY sure you’re finished.  Go ahead and put a towel over your sheets in the area where your caboose will rest and put a plastic bag under it just to be safe.  You don’t know how much time your body will give you to go from sleep to the potty.  Also, since most colonoscopies happen early in the morning, make sure your alarm is set and check in with your ride to be sure they know what time you need to leave in the morning.

About 30 minutes before you have to drink the prep, mix it up and put it in the freezer.  The colder it is, the longer it will take for your taste buds to activate and I’m not kidding when I tell you that this stuff is vile.  Now, if your last colonoscopy involved that Fleet’s phospho soda stuff, you’re in for a treat, the new stuff is WAY BETTER.  However, those of you that weren’t exposed to the Fleet’s stuff will not understand how anything could be worse than what you’re being exposed to.  All I can say is that the phospho soda stuff was like drinking sea water that had been spiked with extra salt and loathing.  It was the worst thing I’ve ever tasted and it always made me nauseated.

Most preps will require you to drink a large volume very fast.  This has a high nausea potential.  As soon as you start feeling queasy, take that nausea medication if you have it.  Drink the prep with a straw while it is cold.  If you take a break for a few minutes, put it back in the fridge to keep it cold.  Put the straw as far back on your tongue as you can and try to not let the liquid fill your mouth as you drink if you can help it.  If your prep can be mixed with lemonade mix or honey, these things might help.  Some are pre-flavored though so make sure that adding lemonade mix to it won’t make it worse.  You want to drink it as fast as you can but above all else, you DO NOT want to vomit it up.  So, if you need to slow down, be reasonable about it.  But do your best to drink everything that’s required as fast as you need to.  But if you’re queasy, give yourself a few minutes to let your tummy settle.  If you vomit the prep up, you will likely have to reschedule your procedure.

Here’s a tip for you Crohn’s or IBD people.  If you’ve ever had to tube feed and can get the tube down by yourself, get a tube and bag from your doctor and use that to bypass the awful taste of the prep.  This may be the ONLY  benefit you get from having had to tube feed before.

You will immediately feel cold from drinking so much ice cold liquid so fast.  Make yourself some coffee or tea and go wrap up in warm clothes.  Finally, go put a little of that Aquaphor or Vaseline around your anus to protect you from the inevitable discomfort that is coming.  It will create a barrier that will help prevent the digestive enzymes that are exiting your body from irritating the skin.  If you can nap a little, you might get a jump on the lost sleep that will happen later tonight.  If you have mobility problems, you’ll want to put on an adult diaper because you may not get a whole lot of warning that you need to get your butt to the throne.  It can take hours in some people for the first prep to start working.  So, don’t trust it…just presume that any second you’ll have to run to the potty.  I’d recommend not even risking passing gas without having your tail planted on the throne for safety’s sake.  Try to keep drinking water.  You’ll feel overly full from the prep but if you can sip every 20 minutes or so, it’ll be worth it not to feel dizzy later.

If you feel like you’re going to be finished for a while, gently wipe using wet wipes or a wash cloth.  Don’t try to use TP.  If you use TP, you’ll end up making yourself sore and start bleeding pretty fast.  Just bite the bullet here and use the most gentle method even if it feels wasteful or like you’re creating too much laundry.  I usually wet wiped followed by a rinse in the shower since I have a hand-held shower head.

At some point you’ll have to repeat drinking the prep again.  Some physicians tell you that if everything is clear you don’t have to do the second step.  Others will say that you have to do the second step even if everything is clear.  Follow the doctor’s instructions.  Again follow with tea and snuggling up in sweats if you’re cold.

During the prep portion, you will first pass stool and then it will become all liquid.  By the time you’re finished, you should be passing mostly clear fluid.  If you aren’t passing clear fluid or the prep doesn’t work at all, you should call the emergency phone number on the paperwork from  your doctor.  If you’re passing fluid but it isn’t clear, you need to drink more water to help finish flushing out your system.  Just be sure to stop ingesting anything at the time prescribed by your doctor.

Sometime way later than you like, you’ll feel mostly finished.  Try to get as much sleep as you can.  You’re now deprived of food and possibly getting a low blood sugar headache, getting dehydrated, and you’re tired.  Needless to say, by the time you get to the facility in the morning you’re going to be in a less than stellar mood.  This is why I always lose my  mind sometime after I get there.  Warn your driver.  And if you feel like you just can’t talk right then and not lose your mind, tell them.  It’s okay to let them know you’re having a hard time.  Usually that morning I am bordering on psychopath and I just need to get to the surgery center and get sedated.

Don’t get dressed up to go have a colonoscopy.  You have permission to wear sweat pants or even flannel pajama pants if they’re comfortable.  If you worry about leaking, use a feminine pad strategically positioned to protect the area of concern or an adult diaper or incontinence pad.  Don’t wear makeup.  Make sure if you have on nail polish that it’s just clear so that the pulse-ox meter can read through it.  Wear slip on shoes so you don’t have to fiddle with laces coming out of sedation.  In fact all your clothes should be easy to put back on after being sedated.  Don’t wear heels…I shouldn’t have to tell you this but I’ve seen someone show up in heels before.  You won’t be able to walk in them afterwards.  Flip flops if it’s warm or slippers are perfectly acceptable footwear for this particular excursion.

COMFORTABLY NUMB – Let’s Talk Anesthesia

As you already know, I HIGHLY recommend a colonoscopy WITH the conscious sedation option.  It’s far far less risky than general anesthesia and I experienced zero discomfort and had virtually no memory of the event afterwards.  Whether you would like or would not like sedation, this is a topic you must talk to your doctor about BEFORE the day of your procedure.  You do not want to get to the facility only to be told that you have the one physician in your area that does the procedure without sedation.  You want to know what your sedation options are as well as what your doctor recommends.  Some doctors will not do this procedure without sedation.  Others encourage you to not use sedation.  Some will let you have pain medication even if you skip sedation to make you more comfortable.

Next, you’ll need to make a quick call to your insurance company.  Your insurance will likely cover sedation.  But they might not cover all types of sedation.  For example, general anesthesia is not typically used for this type of procedure but there are facilities that still use general anesthesia.  But using general anesthesia requires more monitoring and also means you are not awake enough to breathe on your own during the procedure so risks are higher AND your insurance might only cover it if it’s considered medically necessary for some reason.

So, you NEED to understand what sedating options are offered and what your insurance covers prior to your procedure.  You’ll also want to know what kind of copay you might be expected to pay the day of the procedure so you can be sure you have the money available.  You don’t want to go through the prep only to have the facility refuse to do the procedure if you can’t afford the copay.

Typically, the anesthesia is a “conscious sedation” or “twilight sedation” which means that you shouldn’t feel any pain during the procedure, you will probably fall asleep but can easily be woken up, and you will have control over your body so you will be able to cooperate if someone asks you to roll or move around a certain way to assist in maneuvering the camera.  Once the anesthesia wears off, you won’t really remember anything.  The only “flashes” of remembrance that I have had from previous procedures were the moments someone was trying to wake me up so I could move a little to help maneuver the camera and I just remember them saying my name.  I don’t remember any pain although I did remember feeling like my body was restrained because the nurse was holding onto my hands to help me to roll the way they wanted me to and I felt a pressure in my rectal area.  That’s it.  That’s the one flash of memory I have from this procedure.  I have more memories from an endoscopy that used the same type of sedation.

I will warn you that depending on how fast the anesthesia doc pushes your meds, you may have a few minutes of conscious thought after the sedation medication “hits your brain” and before you’re too zoned out to speak.  This is a dangerous few moments.  I took this opportunity to tell my very first GI doctor that he wasn’t fooling anyone with his toupee.  In other words, you may talk non-sense…or you may be brutally honest.  But no matter what you feel the need to say, you’re probably not going to be tactful.  Nurses and doctors are used to it.  But you stand a good chance of feeling mortified about anything you can remember saying if you are all chatty so try to reign it in and just admire how pretty the lights look while you’re that high, okay?  Answer questions as quickly as possible and shut up again.  After my toupee insult, the nurse assured me that I wasn’t the first one to say such a thing to him…in fact, I wasn’t even the first one THAT DAY to say something like that to him.  Awesome.  Keep this in mind while you are selecting your GI doctor too.  The last thing you want to do is admit you’ve been checking out the doc’s backside so much that this colonoscopy is just a chance for him or her to return the favor while you await chemically induced oblivion.  You may experience a similar moment of uncontrollable honesty waking up.  It will be short lived so consider asking the nurse to not bring your loved one back to recovery to see you until you’re fully awake lest you “honesty” yourself into sleeping on the couch for a week.  Remember, if you feel funny, stay quiet because your filters are down.

If you aren’t sure how you feel about sedation, you can ask your anesthesiologist to explain all the options to you. I know one person that has opted to not have any sedation for any of her colonoscopies.  She had a bad experience when she was younger in which she was given a date-rape drug and the “zoned out” feeling of sedating medications brings back some PTSD type of feelings and so she prefers to just deal with the discomfort associated with the procedure and tries to enjoy the novelty of watching her intestines on TV for a little bit.  She assures me it is uncomfortable but completely bearable and since she is not sedated, her physician is quick about his work.  She said that they always start an IV so that they can push sedation and/or pain control medication if necessary during the procedure if it becomes too uncomfortable.  However, thus far she hasn’t had to ask for it.  Instead she said any pain usually only lasts several seconds and she just squeezes her eyes shut and tries to count backwards from 10.  I will warn you that if you wish not to have sedation, you need to tell your doctor prior to scheduling your appointment.  I have heard that many doctors do not offer a no-sedation option as the level of pain one experiences is dependent on the skill of the doctor.  However, there are many who refuse the sedation and live to tell about it.

I have another friend that prefers not to receive the full punch of the sedation.  Instead they give him just pain medication and none of the sedating medication.  He said he feels a little buzzed and relaxed but not so much that he falls asleep.  He also has a lot of fear associated with the feeling of losing control of his body and this makes the procedure bearable for him without feeling like he’s giving up full control of his body.

My point is that the anesthesia doctor should talk to you and explain what he or she will be giving you and how you can expect to feel.  It’s okay to tell this doctor your fears.  My fear is feeling pain during the procedure.  I usually ask the doctor to give me the maximum amount of medication he can give me safely.  You have the right to ask if there are other options that will allow you to remain alert if that is your preference.  You even have the right to request that they start without anesthesia and administer it only if you ask for it.  Since you have an IV in your arm, once they push the medication, it will take effect almost instantly.  I have very small and delicate veins and they blow easily so I always ask the anesthesia doctor to push any medications very slowly…but to please give me the full dose so I remember as little as possible.  Even with this “slow push” the medication is at full potency and fully effective within 3 minutes.  I’ve never had an issue.

Where I have had an issue is pre-medicating.  I prefer to get a little hit of that sedation before they roll me into the procedure room to take the edge off my raging anxiety.  I’ve had a LOT of really big surgery and the sounds and smells of a surgery center send me into an internal panic and I know it’s irrational but that doesn’t stop it.  The surgery center my doctor uses now has a policy of not pre-medicating before taking patients into the procedure room.  What this means for me is that I’m usually having a full on panic attack by the time I roll in there and by the time someone asks me to roll over, I’m usually getting teary-eyed and upset.  My doctor has found that as a result, it takes more anesthesia than usual to get me sedated because I’ve fully entered that fight or flight reflex in my brain and I’m ready to bolt out the doors, exposed butt and all.  I haven’t bolted yet but since this center doesn’t pre-medicate, I make sure anesthesia is aware of the depth of my anxiety and is ready to push meds the second the brake on the gurney is engaged because if he gives me much longer than that, I’m liable to be as docile as a velociraptor on amphetamines while they’re trying to hook me up to the monitors.

Sometimes even if the facility doesn’t pre-medicate, if you burst into tears fast enough when anesthesia comes to talk to you before your procedure, they will pre-medicate you anyway to make everyone’s life easier.  The anesthesiologist has the right to say pre-medication is medically necessary.  The more anxious, scared, and neurotic I become in pre-op, the more frequently this becomes “medically necessary.”  I never set out to lose my mind over the anxiety but somehow I always seem to do so.  I’m only telling you this because if you melt down and cry in pre-op, you know that you are not alone – I do it every. single. time.  Despite having had this and other similar procedures so many times before, I always feel like I’m going to lose it after about 10 minutes of waiting by myself in pre-op.  I won’t apologize for getting upset.  Anyone who has had the kinds of medical procedures I’ve had would have some PTSD issues in a surgery center.  So, during this whole fiasco, if you are going to be sweet to anyone, make it the anesthesiologist.  If you are anxious and you want to be pre-medicated, you have the right to ask.  They may refuse you, but there’s no harm in asking.  I’ve found that hospitals are more likely to allow pre-medicating than surgery centers are but that is just my experience.

IS IT OVER YET – Returning to your normal diet

Remember that the effects of the prep won’t wear off instantly.  However, the pain medication mixed into the sedating cocktail slows down your digestive system which should help you return to eating quicker.  So, most people can return to eating and drinking regular food pretty quickly without incident.  But, you may have diarrhea after you eat so you shouldn’t risk eating at your favorite restaurant as soon as you leave the facility.  Instead, I recommend drinking a little soda or tea and testing your system with something kind of bland like maybe some buttered pasta or toast.  If you do okay with that, you can work up from there.  You cannot have any alcohol for at least 24 hours and you should follow your doctor’s instructions for when you can take your regular medications again including vitamins and blood thinners.   If they took a biopsy or removed a polyp it may be a while before he wants you to have blood thinners again.

I’ve tried to include every recommendation I’ve heard and used to make the process as easy as possible.  If you’ve had a colonoscopy and have any additional tips or tricks to getting through it, please leave a comment.  More importantly, leave a comment to tell everyone if the procedure saved your life.  There are still people that believe that this is a painful and minimally useless procedure.  If this post convinces even one person to schedule their colonoscopy , then it’s worth the awkward conversation.  So, that’s the straight poop on colonoscopies.  It’s a necessary screening and if it’s time for yours, don’t wait until it’s too late.  Colo-rectal cancer is CURABLE…not just treatable.  But you have to have a colonoscopy to catch it early enough to cure it.

Finally, if you haven’t read Anne’s story yet, please do.  Cancer screening saved her life so it’s sort of in the same vein.  Plus, she’s still looking for a job and you might have just the contact she needs.

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23 Comments

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23 responses to “The Straight Poop – An Awkward Conversation

  1. Diana Rogers

    I am having one on June 10th. I also have panics attacks. I don’t want to be medicated to heavy. I also have to have an endoscopy at the same time. I have a big fear of medicines anyways. I have have so many reactions to stuff. That is what scares me. Can they reverse it if you are having a reaction?

    • I apologize for not replying sooner but I was on vacation and just saw your comment. I hope your procedure went well. And yes, if you have a reaction to the medication, they can give you something right away to stop it.

  2. therealmrsH

    Thank you for this. I am having my first colonoscopy today and I am in my 30’s (my father died of colorectal cancer at age 47, with no family history of cancer and was “too young” for the routine exam that comes at age 50). I was so nervous especially for the prep…thank goodness I finally got through that! Your blog helped me laugh and get ready for what’s coming. Glad I found it through a Google search. I am waiting to go to my appointment for the procedure (due to my ride home’s work schedule I had to wait until the afternoon – uggh!) and really thinking about how I am going to keep quiet as I go under sedation! My prep: I had to drink a gallon of Nulytely in 2 sessions. I mixed it with lemonade mix and ice, and chased it with apple juice and also added a lick of a fresh lemon before and after each swig. I only spit up once. At first it wasn’t too bad – after 48 oz I was over it. I couldn’t figure out how that whole gallon would get in my belly in the time needed. I did a celebratory dance when I was done with it..and then ran to the bathroom. Also A&D ointment and wet wipes for the bathroom are wonderful helpers! And I wish I would have drank more liquid yesterday because I am super thirsty as I wait for my appointment and I’m not allowed to drink or eat anything. Ugh.

  3. Jonathan

    Very well written… Thank you for taking the time to help put others at ease.
    Here’s to my first colonoscopy tomorrow. The Gummy Bear option is
    brilliant ! It feels like your eating.
    Thanks again.

  4. Eliza Graves

    Thank you so much for your post!!!! I am 28yo and have my first endoscopy and colonoscopy scheduled on Wednesday morning. Starting my liquid diet tomorrow and the dreaded prep tomorrow night! I have major anxiety so have been freaking out & having panic attacks all week doing the low fiber diet, and I really appreciate your in depth post- it is exactly what I needed to hear. I’m certainly not excited for either procedure, but know they are so important and that I will get through it okay, hopefully with as little discomfort as possible thanks to your advice. ❤ ❤

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  7. Missy

    Really enjoyed reading this as I am stuck in the middle of my 1st prep!!!! I’ll be honest with you, I’m 40 years old and really scared. Luke an idiot, I didn’t adequately prepare myself and I forgot today was D day and ate a Pretty hefty breakfast of biscuits sausage cheese and hashbrowns!!! It was by 10am on the day I’m only supposed to have clear liquids. Shortly after, I realized my mistake and have stuck to the required diet and have done the prep as directed. My question is, should I be ok??? With all the previous planning weeks ahead, to make arrangements for kids, finding a ride, and taking a day off work, etc… I couldn’t possibly reschedule!!! Should extra laxatives or magnesium citrate help?? I’ve had only diarrhea… No solid stool…. Is that normal? I feel really stupid for jeopardizing this opportunity especially since my sister had had precancerous polyps removed but I’m lucky to remember my name most days! Thank you again for your post. It’s extremely well written and I’ve enjoyed it tremendously!!!! Any help or advice you may be kind enough to share would be greatly appreciated!!!!!

  8. Suzanne

    I am wondering if the physician allowed you to have the procedure Missy. I suspect it had to be rescheduled but I hope not. Lilpyrogirl asked us to post if a colonoscopy saved anyone. It saved me! I had my first colonoscopy at 49. No symptoms, no family history. I woke up and I could tell that something was wrong when the nurses averted their eyes when I asked if everything was OK. Then I asked again and got the dreaded, “The doctor will speak with you shortly.” Long story short, I had rectal cancer found early. I had chemo, radiation and surgery. Fast forward 8 years. I am fine and my doctor tells me I can say I am cured. I am prepping right now for my 10th colonoscopy. I will never say I hate having them. I am glad I had every one of them. Colonoscopies are our friends.

  9. Thank you so much for taking the time to put this blog together. This is my second colonoscopy. The first one was a year ago, along with an endoscopy. While I drank a big-gulp sized something-or-other they gave me (after drinking the gallon of poo-drink), the Food Channel was put on for my entertainment. I have never been so HUNGRY as I was then.
    I have a lot of anxiety normally, so even thinking about having to drink all the fluid that will go into that HUGE container next week, is making my stomach ache. I am small person. Last time I couldn’t drink it all (had about 4 cups left over) but it was good enough. This time, I wanted to pre-prep so that when the day comes, I won’t have much waste and maybe get to be done with the drink even sooner.

  10. Elizabeth

    Thank you so much for your post. I am so glad I came across it in preparing for my first colonoscopy today. All your helpful tips really helped me and the step by step also helped me understand what to expect. They found some polyps today and luckily early and I am now encouraging everyone I know to get their test and I will share your post as well to help first timers. Thank you again!

  11. Andrea

    I’m about to have my 20th (or so) colonoscopy, and for the first time, the doc didn’t prescribe MoviPrep or similar, instead relying on a whole bunch of OTC laxatives. Without thinking, I bought mango Gatorade, translucent, but now I’m worrying it’ll look like blood tomorrow. In any case, thanks for the post. I’m really commenting because this is the first place I’ve ever seen anyone acknowledge the profound, bone-deep happiness that sets in with that first hit of scope sedation. I’ve tried to describe it, but have usually ended up just saying, it’s a good thing it’s not available in pill form because I’d be high ALL THE TIME. Thanks for this.

  12. Kerrybett

    I was just surfing the web while waiting to poop:) I’m 46 and this is my 11th colonoscopy. My mom and her mom both died at age 53 from colon cancer. I got my first colonoscopy at 33 and the polyps removed were precancerous. This is a great article, and I concur with it in its entirety.

  13. Beck

    Thanks so much for this very detailed and informative post. I just had my first endoscopy and colonoscopy at age 49. And because I’ve been diagnosed with Lynch syndrome, my doctors are recommending that I get a colonoscopy every year for the rest of my life… Joy. This post really helped me prepare mentally and physically. Considering some of the other medical stuff I’ve endured this year, it actually wasn’t as bad as I thought it might be. But like you and others have written, I have a very high amount of anxiety as well. I’m terrified of IV’s and cry nearly every time I have to get one, and I can send myself into a full blown panic attack just thinking about “going under.” I’m glad to know I’m not the only big scaredy cat out there!

  14. Jean

    Thanks so much tor this very-helpful and calming post! I was googling “can I eat gelatin powder during my colonoscopy prep” (yay, protein!) which led me to your blog. I love the gummy bear idea as well as using bottom-protecting cream (I’ve got tronolane) and your chronology of what to do (set up bathroom, set up bed, get food ready, start prep) is simply brilliant. Thanks again! My first colonoscopy is in two days and you’ve helped me feel confident that I can do this thing! 🙂

  15. Suzanne

    Thanks so much for all of the fabulous detail in your post. At 46 years old, I will have my first colonoscopy on Tuesday, and am feeling anxious about the prep although the procedure itself doesn’t worry me at all. Having had conscious sedation several times before, I’m actually really looking forward to the wonderful relaxation and peaceful sleep that I know will result. A month ago I had a perforated appendix, and after antibiotic therapy to treat it, I am having the colonoscopy to see if there are any tumors or other blockages that might have caused it since this is apparently not common over the age of 40. My surgeon who will do my appendectomy next week (3 days after my colonoscopy!) has (unintentionally I think) convinced me that I must have colon cancer, so I’m anxious to get this over with and find out what the situation is. Your tips will definitely help with the prep – thanks!!!

  16. Liz

    I’m about to have my 5th colonoscopy in 5 years (thanks, Crohns), and I thought I had it down pretty well – but I’ve picked up a couple of good tips in here! Delightfully written – glad I got to have a laugh about “the straight poop” before I go in next week. Thank you!

  17. Cathy flickinger

    Thank you I’m on my second colonoscopy and I forgot about the urgency, needing wet ones and all . I found your page like ten minutes before the prep started. I grab needed things and prepared the bathroom, just in time. I also made sure to have plenty of toilet paper. The crazy thing is I got on the Internet to see if I could have butter run lifesavers and it led me to your page.

  18. Cathy flickinger

    Thank you, I’m 54, this will be my second colonoscopy,they found precancerous polyp the first time at 52,and was going to wait 5 years until I started getting really sick, lost weight rapidly.im doing my prep now and this was helpful. I had forgotten a lot about the prep . the crazy thing is I found your site by searching to see if I could have butter rum lifesavers on a clear liquid diet . This was very helpful. Thanks again.

  19. This may be the most read part of your blog but it’s a boon to nervous soon to be recipients of the “journey thru (insert name)” procedure. In ‘hindsight’, it was fate or destiny that compelled you to place your humor & factual lessons learned here on the internet for the benefit of the rest of us.

    I chuckled as I read and was impressed when I perused the comments section where others had chimed in with appreciation, life impact stories, as well as recommendations. I used quite a few of the tips to prep for my 1st ever ‘journey-thru-john’ procedure last month and they were spot-on so it was almost too-easy! My doctor did find/remove four polyps that were precancerous so I’m a reformed Not In My Back Yard advocate who encourages my male friends to get’r done.

    Thanks to all here.

  20. Jill Cohen-wilson

    What a fantastic blog. I am about to have my first colonoscopy tomorrow. I’m 58 and have been putting it off for eight years, because I had to do this kind of prep for a hysterectomy 7 years ago, and just couldn’t deal with it again. But I know how important it is, so I’m biting the proverbial bullet. I did my first dose of SuPrep almost 6 hours ago – and man,it sure worked fast. Only took about 10 minutes, and I spent the next hour in the bathroom. Been enjoying bouillon and chocolate Italian ice. I didn’t think chocolate would be allowed, but there it is on the approved list – that helped make my decision to get this done even easier, by the way. Well, time to go down the second dose and get ready to do this again. But I just wanted to say how much I appreciated this – and I’m going to put my big water bottle in the bathroom right now!

  21. celestjill

    thanks finishing prep now colonoscopy is tomorrow…hopefully some answers will come through this too. your post has helped me take a deep breath.

  22. Michelle

    Amazingly great write up. THANK YOU

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