What To Expect During A Colonoscopy: Your Complete Guide

What Is a Colonoscopy?

A colonoscopy is an endoscopic exam that uses a long, flexible tube with a light and camera attached (colonoscope) to view the inside of your rectum and entire colon. During the procedure, your doctor can check for abnormalities like inflammation, ulcers, polyps, or tumours. Special instruments can also be passed through the colonoscope to take biopsies or remove suspicious growths in the same procedure. A colonoscopy test typically takes 30-60 minutes and is performed under sedation so you remain comfortable.

Why Would I Need a Colonoscopy?

A colonoscopy is often recommended for prevention, diagnosis, or treatment. Your doctor may suggest it as a routine screening, especially if you're at higher risk for colorectal cancer. Since this cancer can develop silently without symptoms, early detection is crucial. During the procedure, your gastroenterologist can also remove abnormal growths or take tissue samples, helping to prevent issues or confirm a diagnosis before more serious complications arise.

Screening

Most people have their first colonoscopy as part of routine colorectal cancer screening, especially since the risk increases as they get older. Even if you feel healthy and don’t have symptoms, it’s important to get screened once you reach the age of 45 for average-risk adults, earlier if you have higher-risk factors (such as family history or inherited syndromes). Colorectal cancer can develop silently and usually doesn’t cause symptoms until it’s advanced and harder to treat, so early screening is key.

You may need a colonoscopy test if:

• You’re over 45 and have never had one.
• It’s been more than 10 years since your last
• Polyps or other tissue were removed during your last procedure.
• You have a family history of colorectal cancer.
• You have an inherited condition like familial adenomatous polyposis (FAP) or Lynch syndrome.
• You’ve been diagnosed with inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis.

If you’re seeing your doctor for a checkup or any other health issue, ask if you’re due for a colonoscopy. Your doctor can review your medical and family history and help decide when you should be screened or refer you to a specialist.

Diagnosis

A colonoscopy procedure is an important tool for diagnosing several colorectal conditions:

• It can help determine the cause of symptoms like rectal bleeding, iron-deficiency anaemia, chronic diarrhoea, abdominal pain, or unexplained weight loss.
• Colonoscopy is used to diagnose inflammatory bowel diseases (ulcerative colitis and Crohn's disease), diverticular disease, and colorectal cancer.
• If other screening tests (like stool tests or CT colonography) show abnormal results, colonoscopy allows your doctor to examine the inside of your colon and take biopsies if needed.
• Tissue samples obtained during colonoscopy are analysed by a pathologist to determine if any polyps or growths are precancerous (adenomas) or cancerous. This information helps guide treatment decisions and follow-up recommendations.

Treatment

In addition to its diagnostic capabilities, colonoscopy offers several therapeutic benefits:

• Polyp removal (polypectomy): During the procedure, your doctor can remove polyps using special instruments. This is a critical step in preventing colorectal cancer, as polyps can develop into cancer over time.
• Treating bleeding: If any areas of bleeding are found, they can often be treated during colonoscopy using techniques like cautery (burning) or clipping.
• Dilating strictures: Narrowed areas of the colon (strictures) can be widened using special balloons or stents.
• Removing early-stage cancers: Some small, localised cancers can be removed entirely during colonoscopy.
• Marking areas for surgery: If a larger polyp or cancer is found that cannot be removed during the procedure, your doctor can place a tattoo to mark the location for future surgical removal.

By combining diagnosis and treatment in a single procedure, colonoscopy streamlines the management of colorectal conditions and reduces the need for additional invasive tests when possible.

How You Prepare

Many people wonder if a colonoscopy is painful. The answer is, not particularly. However, preparation is key. Proper bowel preparation is a critical step to ensure your doctor has a clear view during your colonoscopy procedure. A clean colon is essential for detecting and removing any abnormalities. Here's what it involves:

• Diet changes: The day before your test, you'll need to follow a clear liquid diet. This means avoiding all solid foods and opaque liquids. You can have water, broth, black coffee or tea (without milk), clear juices without pulp, clear sodas, and gelatin. Avoid red, purple, or blue liquids, which could be mistaken for blood or interfere with visibility.
• Bowel preparation: Your doctor will prescribe a strong laxative preparation, which causes diarrhoea to clear out your colon. This comes as a liquid or pills that you mix with water. Often, you'll take half the evening before and the other half the morning of your colonoscopy. Be sure to follow the exact instructions provided.
• Medication adjustments: At least a week before, discuss all your medications with your doctor. You may need to temporarily stop or adjust blood thinners, diabetes drugs, or supplements like iron.

Don't hesitate to ask your doctor about the meaning of colonoscopy and preparation instructions to reduce the chances of needing a repeat procedure.

What You Can Expect

Here is what you can expect during and after the colonoscopyprocedure:

During the Procedure

On the day of your colonoscopy, you'll register and complete consent forms. Your medical history and medications will be reviewed, and an IV line will be placed for sedation. Most colonoscopies are performed under moderate sedation (twilight sleep) or deep sedation.

You'll lie on your left side with your knees drawn up toward your chest. Your doctor will gently insert the colonoscope through your rectum and guide it through your colon. The scope will inflate your colon with air or carbon dioxide for better visualisation. As the scope moves through your colon, your doctor will carefully examine the lining, looking for any polyps, abnormal growths, or signs of inflammation. This is done both as the scope is inserted and withdrawn.

If any polyps are found, your doctor will remove them using special tools passed through the scope. Tissue samples may also be taken (biopsies) for further analysis. If any bleeding occurs, it can usually be stopped during the procedure. Your vital signs (heart rate, blood pressure, and oxygen levels) will be continuously monitored to ensure your safety and comfort.

Once the entire colon has been examined, the colonoscope is slowly withdrawn. The procedure typically takes 30 to 60 minutes, but it may take longer if polyps are removed or the colon is difficult to navigate.

After the Procedure

As you recover from your colonoscopy, you may feel abdominal discomfort or the need to pass gas due to the air introduced during the procedure. Walking around can help relieve this pressure. Plan to take it easy for the rest of the day. You may feel groggy from the sedation, so it's important to have someone stay with you after the procedure.

Start with small, light meals and gradually resume your normal diet as tolerated. Your doctor will advise you on when to restart any medications that were held for the procedure.

A small amount of blood in your first bowel movement after the exam is normal, especially if polyps were removed or biopsies were taken. You'll receive specific instructions about follow-up care and when your next colonoscopy should be scheduled based on the number, size, and type of polyps found. However, if you experience persistent or heavy bleeding, severe abdominal pain, or fever, contact your doctor immediately.

If any tissue samples were taken, your doctor will share the pathology results with you once they're available (usually within a week). These results will guide further treatment recommendations if necessary.

Risks

A colonoscopy test is a very safe procedure when performed by a trained professional, but rare complications can occur:

• Perforations: There is a slight chance of a tear or hole in the colon wall. This can sometimes be closed with clips during the colonoscopy if recognised right away. Large or delayed perforations may require surgery to repair.
• Bleeding: Minor bleeding is common after polyp removal, but it usually stops quickly on its own. Rarely, continued bleeding could require a blood transfusion or another colonoscopy to control it.
• Reaction to sedative medication: Though uncommon, some people can have changes in heart rate or breathing from the sedation. The medical team monitors you carefully to prevent and manage any reactions.
• Infection: The risk of infection is very low, as the colonoscopy equipment is either disposable or thoroughly disinfected between patients.

Results

Your doctor will examine the findings from the colonoscopy and discuss the results with you.

Negative Result

If your colonoscopy is clear and no polyps or abnormalities are found, this is termed a negative result. The test is considered complete if your doctor was able to see all the key landmarks of your colon and you had an adequate bowel prep for good visualisation. With a negative result, your next routine colonoscopy is usually recommended in 10 years, unless you have other risk factors that require earlier rescreening.

If you have a family history of colon cancer or other risk factors, you may need repeat screening every 1-7 years. Your doctor will make a clear plan with you so you understand any ongoing prevention steps.

Positive Result

A positive colonoscopy means one or more of the following were found:

• Polyps: Most polyps found during a colonoscopy are removed right away. These tissue growths will be sent to determine the type (adenomatous, serrated, or inflammatory) and if they are cancerous.
• Diverticulosis: Seeing small pouches in the colon wall is a common finding, especially with age. Unless they are inflamed or bleeding, diverticula don't need specific treatment.
• Inflammation: If your doctor sees redness, swelling, or sores, this could signal inflammatory bowel disease like Crohn's or ulcerative colitis. Biopsies are taken to confirm the diagnosis.
• Cancer: Though less common, colonoscopy can identify colon cancer. If a tumour is found, your doctor may take biopsies and recommend additional scans to determine if it has spread. This helps guide your treatment plan.

It typically takes a few days to get the pathology results of a biopsy. Your doctor will explain your results in detail and recommend a treatment plan personalised to your health needs. Follow-up intervals are based on factors like:

• Having more than two polyps
• A polyp larger than 1 centimetre (about 0.4 inches)
• Presence of polyps combined with leftover stool that hinders a full view of the colon
• Polyps showing cellular features that suggest an increased risk of developing cancer
• Cancerous polyps

Problems With Your Exam

In some cases, the colonoscopy may not be completed as intended. Reasons for this include:

• Inadequate bowel preparation: If there is too much stool residue, your doctor may not be able to see the colon lining clearly. This increases the risk of missing small polyps.
• Anatomy challenges: The female colonoscopy procedure requires careful consideration of anatomical differences to ensure patient comfort and accurate diagnosis. The test may be incomplete if your doctor can't see the caecum.
• Complications: If there is a perforation or significant bleeding during the procedure, your doctor may have to stop the exam.

If any of these situations arise, you may need to repeat the colonoscopy sooner to ensure thorough screening.

Who Performs a Colonoscopy?

Colonoscopyprocedures are most often carried out by gastroenterologists or colorectal surgeons—doctors who specialise in diseases of the digestive system. They are specially trained to use the colonoscope, a flexible instrument that lets them see inside the colon and perform small procedures like removing polyps or taking tissue samples. Their expertise ensures the procedure is done safely and findings are properly evaluated for your health.

Are There Alternative Ways of Screening for Colon Cancer?

While colonoscopy is considered the gold standard, there are some other screening tests for colorectal cancer:

• Stool tests: Several types of stool tests can check for microscopic blood or abnormal DNA markers that could indicate cancer. Examples include the faecal immunochemical test (FIT), the guaiac faecal occult blood test (gFOBT), and stool DNA tests like Cologuard. If any of these are positive, you'll still need a colonoscopy.
• CT colonography: Also called a "virtual colonoscopy", this scan takes multiple X-ray images to create a 3D model of your colon. You still need bowel prep, but no sedation. If polyps are seen, they can't be removed, and you'll need a colonoscopy.
• Flexible sigmoidoscopy: Using a shorter scope, this test looks at just the rectum and lower part of the colon. It requires less prep and is often done without sedation in a doctor's office. However, any polyps in the upper colon could be missed.

The right screening test for you depends on your preferences, risk factors, and access. But regardless of the initial method, any abnormal findings must be followed up with a colonoscopy for complete evaluation and treatment.

What Are the Advantages of Colonoscopy for Cancer Screening Over the Alternatives?

The main advantage of colonoscopy is that it allows both detection and removal of precancerous polyps in one procedure. This one-stop approach lowers your cancer risk and decreases the need for frequent follow-up exams compared to other screening tests.

Metropolis Healthcare offers reliable diagnostic services with smooth sample collection and easy access to reports through the TruHealth app. The process is designed for accuracy and convenience, helping you stay informed about your health with minimal effort.

FAQs

1. How long does a colonoscopy take?

The colonoscopy procedure itself usually takes 30-60 minutes, but plan to spend 2-3 hours at the facility when including preparation and recovery time.

2. How long does it take to recover from a colonoscopy?

Most people feel back to normal later the same day, once the sedative medication wears off. It takes about 24 hours for the full effects of the sedatives to resolve.

3. Can I drive myself to a colonoscopy?

No, you cannot drive after having a colonoscopy due to the effects of the sedative medications. You must arrange for someone to take you home after the procedure.

4. Is a colonoscopy a serious procedure?

Colonoscopy is generally a safe and routine exam, but it still carries some risks, particularly if polyps are removed. Complications like bleeding or perforation are rare but can be serious if they occur. However, the benefits of screening far outweigh the risks for most patients.

5. Is colonoscopy recovery painful?

Colonoscopy itself is not painful due to the sedative medications used. Mild abdominal cramping, bloating, and gas after the procedure are common, but any discomfort is usually gone within a day. Severe pain is not normal and should be reported to your doctor.