The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that 60-70 million people suffer from all types of digestive diseases in the United States. Moreover, the Centers for Disease Control and Prevention estimates that over 3 million adults in the United States have inflammatory bowel disease (IBD), one of the most prevalent digestive problems in general and specifically of the colon.
What is particularly troubling is that the incidences of these colon-based diseases, especially Crohn’s disease, and ulcerative colitis, appear to be increasing in the United States and all around the world. The risks for patients with these inflammatory bowel diseases also include an increased risk of developing colon cancer. Beyond the obvious human cost in terms of sickness and possible death, there is also a growing economic concern about the increasing cost of treating these diseases.
What can be done about this? For individuals, there are a variety of lifestyle changes that can greatly reduce the chances of developing a digestive disease. Because many researchers consider IBDs to be an autoimmune disorder, it is possible to do all the “right” things — or make a change after years of unhealthy living — and still, potentially develop IBD or some other digestive disease. This is why doctors and digestive health scientists strongly recommend regular colonoscopies for people of a certain age; it is the easiest way to get ahead of any problems that might develop.
What is a colonoscopy?
For many people, the popular perception of a colonoscopy makes it a topic that is either taboo or the subject of jokes; indeed, in many movies and television shows, getting a colonoscopy is negatively associated with old age or being past one’s prime. For these reasons, and because of general misconceptions about any pain or discomfort involved, many people actively avoid a colonoscopy even though they possess the knowledge that getting one could save their lives.
So what is a colonoscopy in reality? In specific terms, a colonoscopy is a particular type of endoscopy, the technical medical term for any examination inside the body by an endoscope. An endoscope is an illuminated optical device that typically involves a long, narrow tube with a camera at one end; some versions are also equipped with tiny tools that are used to perform procedures laparoscopically.
In a colonoscopy specifically, the scope is utilized to examine the lower gastrointestinal tract, which includes the rectum, the colon (also known as the large bowel), and the area of the small intestine (also referred to as the small bowel) that attaches to the colon. When inserted through the anus, the doctor can visualize the inner lining of the colon in order to detect abnormalities such as polyps or lesions. A related procedure is a sigmoidoscopy; this examination is of the sigmoid colon, the area of the colon directly before the rectum.
Why get a colonoscopy?
So why do doctors want people to get colonoscopies? In the simplest terms, it’s because it is the cheapest and easiest way to screen for all sorts of potential digestive diseases before it’s either more difficult to treat or too late to treat. In cases of colorectal cancer, for instance, the difference between catching the condition early can literally mean the difference between life and death. Here are some of the most prevalent digestive diseases that a doctor may be on the lookout for if you get a colonoscopy:
- Colorectal cancer
- Crohn’s disease
- Ulcerative colitis
- Diverticulosis or diverticulitis
Colorectal cancer is the by far the most dangerous potential colon-related disease; there over 140,000 new cases every year, and every year over 50,000 people die as a result of the disease. Because it is such a serious threat, and because getting an early screening is so crucial to improved survival rates, the American Cancer Society recommends getting a colonoscopy every 10 years after the age of 45, in addition to a variety of other tests at more frequent intervals. Some research suggests that getting a colonoscopy could potentially lower the risk of colorectal cancer by 77%.
Beyond preemptively screening for colorectal cancer, colonoscopies are often used as diagnostic tools to investigate symptoms related to the digestive disease. Many of the conditions that can be identified by a colonoscopy have similar symptoms, and some are even related to each other (for example, polyps can start as benign growths and then become cancerous), so it is the mix of symptoms that will generally lead a doctor to order a colonoscopy:
- Abdominal pain or discomfort
- Chronic constipation
- Rectal bleeding
- Chronic diarrhea
- Changes in bowel habits
- When present with the above symptoms: unexplained weight loss, fatigue, or anemia
How does the procedure work?
In order for a colonoscopy to be successful — in other words, so that the doctor has a clear view of the intestinal lining — the colon must be free of any solid fecal matter. In order to achieve this, the first step requires the patient to adopt a special diet in the days leading up to the procedure. Two and three days before the colonoscopy, a diet of low fiber foods is necessary; on the day before the procedure, only clear liquids are allowed to be consumed. And then finally, on the evening before, the patient will have to drink a special laxative solution that causes the digestive tract to be cleared of any remaining solids.
When the patient goes to the doctor’s office, he or she will be given a sedative intravenously. There are a variety of different sedation methods the doctor may use, depending on the patient’s medical history. Also, since different sedatives can have different effects on different people, many patients are awake but extremely relaxed while the procedure is happening. Some may even wish to watch the procedure on screen as the doctor is performing the examination.
While lying on their side, the doctor will gently insert the scope into the anus and feed it through the entire colon. While it is an unusual sensation for most people, the sedatives (and sometimes soothing music) help make it a manageable procedure; most patients don’t report significant discomfort while it is happening. The entire examination typically takes 20-30 minutes to complete. It can sometimes take longer if “loops” form during the process of feeding the tube through the colon, but usually subtle shifts in position by the patient can resolve loops without a problem.
Risks of a Colonoscopy
While serious risks and complications from a colonoscopy are very uncommon, they are still possible. Overall, there appears to be about a 1-2% chance of developing complications. The following are some potential examples:
- Perforation: This is the most serious possible complication, but it’s also one of the rarest. It is possible, though, that the camera end of the scope itself could cause a tear in the lining of the colon. In such circumstances, major surgery would be required to repair the damage.
- Bleeding: There have been cases where the contact of the scope with the lining of the colon can lead to irritation or bleeding. In the vast majority of circumstances, however, the bleeding can be dealt with directly during the procedure via a cauterization tool mounted on the scope.
- Anesthesia: As with any medical procedure that utilizes sedation or anesthesia, there is a chance of serious complications. These kinds of complications are almost always a factor of a negative reaction to the medication, and blood clots, heart attack, or stroke are possible extreme outcomes. This is, however, extremely rare in colonoscopy procedures.
- Bowel preparation: In some cases, it is the preparation steps and not the colonoscopy itself that can present a risk. Since strong laxatives are used to clear the digestive tract, it is possible for dehydration to occur.
Schedule a Colonoscopy
When one considers the overwhelming potential benefits of getting a colonoscopy — most notably alerting doctors to colorectal cancer at an early stage when it is much more treatable — it must be regarded as a “no-brainer.” If you have experienced recent changes to your bowel habits and you have some of the symptoms described here, or if you are 45 or older and haven’t talked to a doctor about a colonoscopy, contact GI Associates to make an appointment. The board-certified gastroenterologists will be glad to answer all your questions about getting a colonoscopy.