UK here for context. We only have to fast for 12-24 hours prior to the colonoscopy. You can drink water or plain tea (no sugar, cream or milk).

They offer "gas and air" mainly. You don't even have to have that. You are fully awake during the procedure, laughing at the live HD video feed from inside you on the big screen.

You can be fully anaesthetised but that's very rare here in the UK.

After the appointment, it's a free cup of tea, and some biscuits. You have to wait for a couple of blood pressure tests, but after 15 mins recovery you can leave and go home. The entire process from entering the clinic unti leaving is about an hour.

The process is mildly uncomfortable but not really painful. Nothing like childbirth for example.

Don't be scared. It doesn't hurt too much. And as other commenters have written, any polyps they remove could have become tumours in 10 years, and afterwards, you are effectively safe from colon cancer for a decade.

If the NHS (UK) find and remove any polyps, they'll add you to a watch list for regular colonoscopy procedures. I have one every 2-3 years, others have them annually.

Get that camera up you... It might save your life.

I've suffered from IBS all my life. At this point I've had several colonoscopies done in different countries.

The one in the UK was done without sedation and was a terrible experience. Apparently having an overly sensitive colon makes it pretty unbearable.

But yeah, the stigma around a doctor introducing a tube/camera up your ass is just that. You dont lose anything and you dont become any more/less anything. The prep is a bit rough but nothing unbearable as well.

I am 40 now, but will deffo get to it yearly once I'm 45.

In Switzerland it's 4 days restricted diet (zero fibers etc), a day fasting with liquids or sugar, and strong laxatives the evening before and the morning of the action. You sleep (aka pass out for like a blink) during the intervention then wonder at your incredibly clean pipe on TV. 5 years later you come again if they found and removed something, otherwise after 10.

> UK here for context. We only have to fast for 12-24 hours prior to the colonoscopy. You can drink water or plain tea (no sugar, cream or milk).

Are you saying you only have to fast, without laxatives/prep? How does that work? I find it hard to imagine that anyone's colon is clean enough to get a good view after only fasting for a day?

Based on how much my need for toilet paper depends on what I’ve been eating recently, I suspect diet makes a massive difference to how clean you are inside.

Not sure how waiting longer than 24 hours is going to get you much cleaner in any case.

We have to take laxatives as well. The night before the appointment usually. That's when you must start fasting.

I have to have colonoscopy every year since I was 18 because of risk factors. I agree it's much less awful than people think (and I especially agree that laxatives and liquid diet prior to it suck much more than the procedure itself). I never take sedation cause it doesn't really hurt and doctors say it's better to have feedback from the patient.

I also have to do MRI every year and it's much more frustrating for me because they always complain I'm breathing wrong, and I have asthma so it's not easy to "breath right". It takes ages.

I think it depends. It doesn't hurt for you but it does for me. I had to take some pain killers during mine. The doctor told me that having a bigger belly would help, though I should not become fat for the next time.

Yes - mine was no-fuss, but my sister had major reflux-like complaints and great discomfort after hers.

The first (and only) time I ever had a CAT scan was pretty awful because they didn't tell me exactly what to do.

I walked into an urgent care because I had severe back pain. They put me through a bunch of chest x-rays where they told me to inhale and hold my breath, then they bring me over to the CAT scanner and tell me to hold my breath when the light goes green. So I inhale and hold my breath. Then the tech comes out and tells me "did you inhale? don't do that, it ruins the results".

They decided not to re-run them because the odds I had something wrong even with those symptoms were apparently less than the odds of the additional CAT scan giving me cancer down the line. Certainly didn't help my peace of mind.

But the muscle relaxants and a proper desk chair seems to clear it up within a week so I guess they were right...

I actually enjoy my annual MRI scans. It's a meditative experience.

"Fortunately" they only have to scan my head, so no issues arise from (wrong) breathing.

In my experience, the entire process takes up about 3 days: 2 for the colon cleansing, 1 for the process and recovery from sedation and possible biopsies.

Mine takes in total 1 evening and 1 morning; the cleansing is 1 evening and they biopsy on the way through which makes it take up a little bit more time but not much. And I never take the sedation as I want to really get out of there asap and I don't feel much anyway.

What is the purpose of the yearly MRI, if I may ask?

I have colitis ulcerosa and liver problems associated with that - called PSC in English I believe? When I was younger I did MRI every 2 years but now they told me to do it every year.

Timely colonoscopies save lives.

However, I have a hunch that frequent colonoscopies are maybe not a good idea.

Doubts:

1. We know more but we don't know all things creating colon cancer. Knowing the existence of cancers caused by viruses, disinfection procedures applied on the device could matter a lot.

2. Even if we disinfect properly, we know of a notorious little fellow: H.pylori, which can go down to the intestines. "Helicobacter pylori infection is associated with colon adenomatous polyps detected by high-resolution colonoscopy." https://bmcgastroenterol.biomedcentral.com/articles/10.1186/...

3. H. pylori (which serves just as an example, there can be other bad guys) is really hard to get rid of with disinfectants. It builds up resistance over time so it's doubtful that our disinfectants currently in use will stay as effective as well.

4. Frequently putting a foreign object to different people's colons (yes, I know it's disinfected) would increase the probability of transmitting such unknown risks.

I didn't talk about perforation risk. Just the possibly transmissible cancer risk.

So I remain doubtful that it's completely harmless It's necessary but every year? Doubtful without more data.

Finally, thanks for the people who invented and use it to save lives. I wanted to share my doubts on frequent colonoscopies

> It's necessary but every year? Doubtful without more data.

Did you read the part where the commenter said that they have an unusual genetical condition and that's the reason they have yearly colonoscopies?

Yes, I did. I'm not denying the validity of the case here. My concern is related with the core risks of the procedure.

Why are you concerned about it? Doctors aren't going to recommend intervals shorter than 10 years for people with no risk factors and even with risk factors the cancer screenings are every 5 years. If someone is getting them more frequently than that, there are probably additional factors.

In the US, insurance isn't going to pay for it unless a doctor says it is medically necessary.

This is an incredible stretch. (your doubts based on reading the source you provided)

There is an interesting difference between the way countries approach this btw. In US, sedation is standard and used in 90%+ of colonoscopies. In UK sedation is rarely used unless specifically requested by the patient, you usually get some gas and air instead. It's not even due to cost, it's just that sedation for colonoscopy is generally unnecessary, it's an uncomfortable but not particularily painful procedure.

The US loves to sedate. You guys get absolutely blasted when you have your wisdom teeth removed. In most of Europe you get strong pill painkillers for the first few days and then it’s paracetamol.

I don't know if you're expressing a common misconception here, but a lot of Americans also think general anaesthetic is widely used for wisdom teeth removal, and it isn't. What is widely used is deep sedation, a combination of ketamine and benzos which keeps the patient calm and, the nice part, prevents any memories of the event from forming. It's maybe an extra hour of recovery, same-day procedure in either case.

Post-care is a few day's worth of entry-level painkillers unless the patient gets a dry socket. We use acetaminophen for post-treatment rather than paracetamol, since it's better (never understood the British obsession with that stuff, it's nasty business).

Anywhere else I would walk away from a terrible joke like that, but this is HN. I'm joking.

You really got me there, was halfway through writing an angry reply when I read the last sentence.

I don't see the joke -- is this entire post untrue then?

Ah no. It hinges on paracetamol and acetaminophen being two names for the same analgesic. Everything but that sentence was perfectly serious.

It's also a rare joke where explaining it won't reduce the effect: by the time a Brit hits the end of the offending sentence, it's too late.

It depends on the situation. I had all of mine out this past weekend (in the US) and, because they were fully grown in, all they had to do was some local anaesthetic (about 8 shots around various parts of the mouth), wait 15 minutes, and loosen/pull them all. Total procedure was less than 30 minute and no painkillers prescribed after the fact.

> In UK sedation is rarely used unless specifically requested by the patient

It varies by hospital trust, there is no uniform guideline.

My local NHS hospital sedates for colonoscopy as a matter of course (using fentanyl). But as you say, some don’t, and others ask the patient.

Fair enough, I was told that this is standard practice

It is not due to cost, but profit. In the US the hospital makes more money if you get sedated. So why not offer, or even push it?

It's unnecessary but a lot of pain medication is "unnecessary." We use it to reduce pain because we don't like to feel pain. This seems self evidently common sense to me. In New Zealand my colonoscopies were carried out with ketamine, which is incredibly safe under medical supervision. Unless there are contraindicated medical conditions, I see no reason not to use something like ketamine or a light dose of oxygenated nitrous oxide.

In Poland they give you option for sedation, but advise against it because sedation disables the feedback from patient and that slightly increases the risk of complications. When they do the procedure they ask how you feel and when it gets too uncomfortable they change the angle etc.

I've had like a dozen of colonoscopies (have to be checked every year cause of risk factors), and they were never really painful.

Pain relief and sedation are two separate things.

Nitrous oxide is a fairly strong anagelsic (pain medication) but a very weak sedative. That's exactly why it's often used for minor routine procedures where keeping the patient awake and reasonably alert is more valuable than keeping the patient fully sedated.

Used a lot during birth here in the UK too

>>or a light dose of oxygenated nitrous oxide.

Which is what "gas and air" is in the context of my comment.

How many have you had? My understanding is the risk of a perforated colon is actually quite high, like 1 in 500. Do you worry about that risk? I got referred to a gastroenterologist before I was 45 and he talked me out of it because he didn't think it was going to show anything (my symptoms that I was referred there for were gone by then) and the risk wasn't worth it. Obviously if you're going to get some life-saving results, the risk-reward calculation changes.

I've heard such numbers before and asked my doctor about them, but been told that those are overexaggerated. A higher risk apply to patients with intestinal diseases such as Chron's (not me) or when doctors have conducted minor surgery from inside the gut.

A normal colon is quite flexible, and should not get hurt just from the endoscope being pushed through the gut.

Snipping a "normal" polyp or taking a biopsy would cause a little bleeding, but should heal up quickly. I've been told that I could see blood in my stool after it, but it's been so little that I haven't.

Commonly quoted figures are 1:2000 in western countries with experienced operators with good operators claiming significantly better than that

You consider 1 in 500 high? That's only 0.2%. At that rate, assuming the probability of complication for each procedure is independent from all the others, you could undergo the procedure 20 times with only about a 4% chance of complication. Since the American Cancer Society only recommends colonoscopy every 10 years, starting at age 45, most people wouldn't even have 5 procedures done in a lifetime, which would give about a 1% cumulative chance of complication.

It would be one thing if you were to have done that math to show "the risk of colon cancer is so high that this decision is worth it"--and to be clear: maybe it is!--but the idea that you simply don't find a 1% chance of a complication to be a big deal as the absolute number looks small to you (as opposed to making some relative comparison to the rate of preventable cancer) horrifies me... and, for your sake, I hope you aren't that careless continually with all of the other decisions you make in your life (any number of which might also have a 1% chance of going badly for you). 1 in 500 is absolutely a very very large number.

You have roughly a 4% chance of developing colorectal cancer in your lifetime: https://www.cancer.org/cancer/colon-rectal-cancer/about/key-...

Amazingly, the American Cancer Society had already done that calculation when they made their recommendation to get scoped once every 10 years.

... which might lead one to ask "do you worry about the risk of complications?" when hearing about someone who gets the scope 10x as often as recommended. The answer may be "well, even if the risk of complications is 10x, my risk of getting a disease the scope will catch still far outweighs it, so it's worth it. Or it may be "yeah, that is a concern, but it's mitigated somewhat by xyz factor." And both of those are interesting answers. Why the hostility to this conversation?

That is very high if you get one every year.

So, don't do that, unless you have enough risk factors to justify it. Get it done once every 10 years as per the recommendation.

You realize the context of my question was that I was responding to someone who actually does get one done every year, right? And that I acknowledged that the risk-reward calculation changes quite a bit depending on what risk factors you have? I don't know what point you're trying to make, unless you think I'm just wrong to be asking this person in a special circumstance how he thinks about the risk. For example, perhaps there are extra precautions that I don't know about that can be taken for someone for whom yearly scopes are important.

After being diagnosed with colon cancer when I was 26, I'd say start even earlier. Don't settle for "it's probably just hemorrhoid's". That's the reason my kids will start when they are 16.

Does anyone know why I got cancer? No. Does it really matter? Honestly, no.

Just to re-iterate the point: Go through all the screening you can, cancer (of any form) is easer treated when caught early. Or even prevented.

>Go through all the screening you can, cancer (of any form) is easer treated when caught early. Or even prevented.

There's reasons why we don't screen for all cancers all the time - one being that when you are young and healthy the false negative rate and risk of complications of the test are often higher than the chance the test catches something.

Full-fledged biopsies, without any other indication, are exaggerated. A simple colonoscopy isn't. Nor are the other, standard, screening tests. And still most people just don't even use the standard screening options. My personal guess, because people are afraid the screening is finding something. Without the screening, you can happily continue your life in ignorance. Usually, this is regretted if they actually have cancer later, once the cancer is so advanced that actual symptoms manifest.

If you got it at 26, I'd recommend a gene test to see if there is a hereditary factor, and for your kids too.

That is what I have. "Luckily", out of four siblings, I'm the only one that tested positive and therefore the only one in my family that gets checked every year.

That was the first they did, now that's almost 14 years ago. Luckily it's not hereditary, would have sucked with a 3 year old back the day.

Nope. That's how medical costs get out of control. Routine colonoscopies for 20-somethings is just a waste of money.

High risk? Sure. But the general population, no.

I did mention the available screening, didn't I? High risk is much earlier, for sure, and much more frequent. I'm down to one every 5 years now, plus some routine checks every two.

Sorry to hear that. What were your symptoms if you don't mind sharing.

Hemorrhoids, initially. Being rather, young with damn office job, that's the initial diagnosis. Lucky for me, I had a good doctor that started to feel uneasy and insisted on a colonoscopy. All things considered, I think I was lucky!

So were no serious symptoms so, cancer is a sneaky bastard.

In my country we have a national program that screens via a stool sample, no need for colonoscopies unless the test comes back positive. It’s for 60-74 year old who aren’t at high risk of bowl cancer, those with family history still get colonoscopies.

I've had a colonoscopy and yeah: it's a nothing procedure. You're anesthetized for it and there's no recovery period so its just been and done. You also feel great afterwards from the prep medicine (at least I did).

If you have the money, I recommend a bidet toilet seat (which I recommend anyway) before you do the prep for it - makes the whole process a breeze.

I know some gastroenterologists and they take competitive pride in how good they are at scoping patients. Not everywhere does the restricted diet as long as you suggest, but just don't eat bread with little seeds on it. They hate that

You're clearly someone who takes care of yourself, so why watch polyps being snipped from your colon on a tiny screen? Hi, I'm Cologuard. I'm a non-invasive product to detect altered DNA in your stool. I find 92% of colon cancers even in early stages.

This is good advice but that laxative can be a doozy. I was pooping for 12 hours straight. I had to drink several litres of laxative. I'm sure it was squeaky clean inside afterwards.

> Myself I have an unusual genetic condition, so I unlike normal people, I do a colonoscopy every year. I stay awake and watch the monitor, because I actually want to see what I look like inside. At the end when you reach the small intestine, the cilia on the walls inside there are quite fascinating.

Same here, but I stopped watching the monitors; I just watch a movie on my phone; makes it go (much) quicker for me => I hardly notice anything if the movie (or tv show) is good.

See- I didn't know this. I'm in that age group. When I get my yearly checkup I will ask doctor to add it to the list of checks.

To whomever might be curious, the author probably is talking about MUTYH-Associated Polyposis. If you have 2 of the wrong genes, you are very likely to develop colorectal cancer at some point in your life. That's why it's indicated that you test every year.

To scale whole population could just do ultra-sound for colon Polyps + CRP blood test. Then go from there.

Ultrasound is not a useful imaging modality for anything in the GI tract. Most countries do have FOBT screening available