First Colonoscopy: Tips for Getting Through Prep

The American Cancer Society now recommends getting your first colonoscopy between ages 45 and 50.

I recently had my first colonoscopy. Was this something I expected to have to deal with before my 50th birthday? No. But it’s a medical procedure those of us in our mid-40s will now be facing routinely.

In 2018, the American Cancer Society lowered the recommended age for adults with average risk from 50 to 45, because, while colorectal screenings have been helping to catch cancer in people 50 and above, the rates of colorectal cancer have been increasing in the younger population.

Colorectal cancer is the second leading cause of cancer death in the U.S., although with early diagnosis there is a 90 percent survival rate. The ACS recommends that people with average risk get a colonoscopy at 45 and every 10 years thereafter, and advises a conversation with their doctor to weigh the risks and benefits at age 75. Colonoscopies are not recommended after 80. People with high risk factors are recommended to get colonoscopies earlier and more often.

Happily, I have no family history of colorectal cancer, but I do have mysterious digestive ailments and am chronically underweight. I have interstitial cystitis, IBS, and have developed multiple food sensitivities over the years. When my urologist referred me to a gastroenterologist, thinking that the base cause for my symptoms could be intestinal, the gastroenterologist immediately suggested a colono-scopy. The procedure not only checks for bowel cancer and potentially dangerous polyps, but it can also help diagnose other intestinal health issues. Polyps are usually benign, but some can become cancerous.

Prep: What to Expect

The thing about a colonoscopy that most people worry about is the prep. It’s generally recommended to follow a low-fiber diet three to seven days before the procedure. Different clinics may have slightly different dietary guidelines, so follow the guidelines from your clinic.

The recommended foods include white rice, white potatoes and white bread—none of which I can really eat. The no-nos in a pre-colonoscopy diet are red or blue foods (which can mimic blood in the stools), high fiber foods, and gassy foods. So as a mostly vegetarian flexitarian, I was eating slippery elm gruel for breakfast and low-fiber veggies in chicken bone broth, with some well-cooked grain for lunch and dinner. I was, not surprisingly, hungry.

Three nights before the procedure, I was supposed to drink a 10-ounce bottle of magnesium citrate after dinner. It was a little quease-inducing, but I kept it down. I found lemon-ginger tea to be a good sugar-free remedy for queasiness.

Don’t expect to get much sleep after talking a large dose of magnesium citrate. It sort of rumbles around in the intestines for a few hours before the purging starts.

Two days before my procedure was clear liquid diet day. Again, I can’t eat a lot of the recommended options, so it was just herbal tea and chicken broth.

It’s better to take the day off or work from home, as you’re going to need quick and frequent access to the toilet. Investing in adult diapers can help with peace of mind.

Just as things were settling down, I got to introduce the high-powered colon-scouring laxative, Suprep. My first Suprep cocktail was at 4 p.m., with a half-dose at 9 p.m. and the remaining half-dose by 5 a.m. the next morning. It tastes sort of bitter and salty, with a grape-flavored overlay, and is not particularly pleasant. Some people find it less nauseating when it’s cold. You get 20 minutes to finish a dose, and it’s important to chase that with the recommended amount of water. The directions say it can take up to two hours to work, but I had results within 20 minutes.

Getting To Your Appointment

It’s important to have someone to drive you to and from the appointment, since it takes a while for the anesthesia to wear off and it isn’t safe to drive. Your driver needs to be someone who can come in and physically support you when you’re done and still shaky from the anesthesia.

My mom took the day off work and we left for Iowa City bright and early in the morning. I felt surprisingly good after an evening spent getting two-hour chunks of sleep. I’d gotten up at 4:45 a.m. to take my last dose of Suprep, hoping if I took it earlier, the results would be done by the time we hit the road. I had to stop drinking by 7 a.m., so I tried to drink tea or water fairly often before that. Just in case of accidents, I brought some large incontinence pads, but we only had to stop once on the way.

Here Goes

My mom dropped me off at the ground-floor entrance to Mercy Hospital and Clinics. Everyone was kind and polite. I checked in and stared nervously at the walls until the presiding nurse ushered me into a treatment room. I changed into a hospital gown and footies with textured bottoms. Another nurse went over my medical history and allergies, checked when I’d last eaten or drunk anything, and asked when I’d taken my last dose of Suprep. The nurses covered me with warm blankets and inserted an IV, which immediately helped me feel less dehydrated.

My doctor introduced herself, and another nurse wheeled me into the operating room, which was quite cold, so I got another warm blanket. I was hooked up to oxygen and had to roll onto my left side, knees bent and pulled slightly in.

The doctor gently inserted a flexible tube through the rectum, equipped with a tiny video camera, and inflated my colon with carbon dioxide, to make it easier to push the camera through my lower intestines. This is why there’s a fair amount of gas to pass after the procedure. I was given Fentanyl and Versed with my oxygen. Whenever it got uncomfortable, I was told to breathe deeply to get more anesthesia.

The doctor said my intestines were nice and clean. I could watch on the monitor as she checked out my colon, though I was definitely spacey and it was fairly surreal. The doctor removed a couple polyps and took some random biopsies, which were sent to the lab. A nurse wheeled me to my room, where I crashed for awhile.

The anesthesia and the fasting made me tired and wobbly. Once I’d passed enough gas to feel normal, I got to drink from the thermos I brought. Huzzah! When I was stable enough to get up, I got dressed. The nurse had told me I could eat solid food.

The clinic recommendations advised against driving or making important decisions for at least 24 hours after the procedure. I definitely needed at least that long to recover. I was still very unfocused and unsteady the next day, and wasn’t capable of much aside from eating light meals, sleeping, and binging Netflix. I was glad I’d finished my latest writing assignment before the procedure, because I wasn’t capable of focusing enough to write anything sensible. My brain was more online the next day, but I continued to be tired and shaky for a few days. I’m sensitive to anesthesia; someone less sensitive might feel more normal sooner.

Done for 10 Years!

On the whole, it wasn’t horrible. Having the stomach flu or food poisoning is worse, as far as purgative experiences go. The staff at Mercy Hospitals and Clinics were all professional and compassionate. It’s not an experience I’m looking forward to repeating in the next 10 years, but I’m glad to know more about the health of my colon.