How to have a great colonoscopy

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Via a sad letter* in Cary Tennis's "Since You Asked" advice column on, I discovered that March is National Colorectal Cancer Awareness Month.

As the recipient of no less than four six search missions up my asshole, I feel that perhaps I have some valuable information to offer those on the fence about whether or not to submit to the amazing photographic biopsy machine, and how to proceed once one does.

NUMBER 1: Take care of your asshole, don't be one

Starting at 50, you need to be screened. (Earlier if you've a family history of colorectal cancer; I was told to be screened at 40, since I'd had an uncle DXd with cancerous polyps.)

Yes, a colonoscopy is nothing but a big, fat punchline (for some people, anyway). Yes, it's daunting, the thought of having a foreign object shoved up your butt (for some people, anyway). Don't worry: if you follow some pretty easy steps, it's really a no-big-deal operation. Talk to your doctor and get a referral to a specialist who can give the exam.

One note: if you have any kind of gastrointestinal problems or family history of inflammatory bowel disease (Crohn's or ulcerative colitis), I'd suggest having them screen for that at the same time, and having a gastroenterologist do the colonoscopy rather than a colorectal surgeon; they'll likely do a more thorough job of screening for GI disorders.
But mainly, don't avoid a screening out of fear of horrible pain. Trust me, prepping for the colonoscopy is usually worse than the thing itself.

NUMBER 2 (heh, heh): Name your poison

How well you prepare for your colonoscopy will pretty much determine how easy the procedure goes. As of my last colonoscopy, there were three types of colon blow to choose from to ready your pipes for the camera:

The worst of the three is FLEET'S PHOSPHO-SODA, an over-the-counter formula available at any drugstore that will violently blow every last bit of whatever out of your intestines, cause horrific pain and cramping and generally make you wish you were dead. Looks innocuous; will kick your fucking ass. Pun intended, and NOT recommended.

Marginally better is Kool-Aid from Hell, also known as "GO-LITELY". This is a saline All of the flavors suck and you have to drink gallons of this stuff. I'm serious: gallons. In a very short span of time. It is much, much milder than Fleet's, but that's about all it has to recommend it.

Finally, there VISICOL, the brand name for a prescription pill one takes in combination with various glasses of water and fizzy drinks. It's not a party, and you've got to swallow an awful lot of them, but I've found it to be the easiest on my GI tract of the three methods.

Remember, the world of meds changes fast and furiously. And with all these boomers headed into the colonoscopy years, you can bet there will be further refinement of technique. ASK! Make your doctor explain the differences to you. Do a little internet research (I guess I don't have to tell you that if you're reading this). You are your own best advocate.

NUMBER 3: A little extra prep pays off huge dividends

Your doctor (or his assistant) will give you a list of things you can and can't eat right before the procedure. If you know what's good for you, don't stop there. Give yourself at LEAST one additional day of extremely light eating before the day you're actually required to, especially if you are one of those people with a slow transit time (i.e., you don't poop a lot, or tend towards constipation). Despite my Crohn's, I've always been one of those people, and believe me, the evacuation process is a helluva lot more pleasant when the purgative isn't blasting its way through the intestinal equivalent of bedrock. I recommend salads and smoothies and broth, along with as much water as you can stand.

NUMBER 4: If possible, schedule first appointment

Due to the mild sedative you'll be given, you're not even allowed water for several hours before the procedure. Combine that with the purgative and lack of nourishment your body has dealt with over the last 24 hours and you want to make sure you spend the minimum amount of daylight feeling like you do. If your doctor offers an 8am appointment, take it; you'll do most of your hungry/icky time asleep, and won't have to worry about expending a lot of energy that you don't have.

NUMBER 5: Lay in a supply of eeeeeasy foods (and videos!) for afterward

You will probably be a little gassy and uncomfortable afterwards: all that colon-emptying creates a lot of residual gas; in addition, they sometimes blow air up your colon to get a better look. You will get hungry anyway, and believe me, you don't want to give your tummy anything challenging or heavy for a day or so afterwards. Again, the facility where you have your procedure done will probably give you a list, but non-heavy soups, smoothies and other "sick" food are a good bet.

You will probably also be not your shining best for the rest of the day. Try to take it off completely, or if you must, only really light work from home. I'm sure there are some hardy souls who spring right off the table and are ready to chop wood or bury the competition, but really, that gas can be ba-a-a-ad, and a day and a half without real food (by the time you're home from the procedure) can make you weak as a kitty.

NUMBER 6: Follow up!

Your specialist will probably go over the visual assessment briefly in the recovery room; you'll get the in-depth results later on. If you're not used to talking to doctors, consider bringing someone along with you to actually hear the news with you and ask questions. Barring that, do a little research, bring questions and make sure you understand what your doctor is telling you. Write it down, if you have to. I know it sounds weird, but we have an uncanny way of not hearing what we don't want to, or at the very least, minimizing it. I'm convinced that if I'd had someone with me the first time I'd gotten my c-scope results, I would never have suffered the violent onset of Crohn's that I did.

That's about it. Please remember, I'm not a doctor and none of this constitutes medical advice. It merely represents the sum total of my experience before, during and after having cameras shoved up my heinie (which is not inconsiderable).

Good luck, and don't forget to ask for a picture!


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UPDATE 7/21/08: After two less-than-great preps with Visicol and a similar prep drug, I'm back to endorsing the Phospho-Soda. Basically, there's no fun prep, but I think this is the cheapest and least awful of them.

UPDATE 5/30/09: Phospho-Soda has been taken off the market.

PHOTO of my beautiful colon by Dr. Graham Woolf, G.I.

LINK: National Colorectal Cancer Awareness Month