The night before mine, I googled to see if I could find anything that would make me feel less anxious and uncomfortable and I couldn't. Well, fellow reader, I hope this comment and the article put you at rest when it comes to doing this important and necessary procedure.
As best I can tell general anesthesia for colonoscopy for low risk appears to be a cultural custom especially prevalent in the northeastern USA.
Anesthesia has many more possible side effects than sedatives and ought to be avoided unless needed (this applies to any unneeded treatment).
Plus if you’re awake you can actually watch the scope going, it’s cool! Not painful at all. Agree there is no reason to fear colonoscopy but there is also no reason to undergo general anesthesias for it either in most cases
They asked me if I wanted to watch, then angled one of the monitors so I could see what they were doing. Laid on side, knees up and relax. Blimely is my bum really that hairy? Don't normally get to see if from that angle.
It feels weird and a little uncomfortable at times, but certainly not painful - even when they found a polyp and removed it with a remote lasso tool of some kind. This later turned out to be harmless.
As is normal for Brits, there was a lot of humour, with the women discussing the latest TV soap opera whilest doing their thing with the "dynorod" tool. As they pump in a gas of some kind to keep the bowl inflated while they work, they tell me it's okay to fart whenever I need. Boy, I think I've got a bad job sometimes. Whatever the nurse with the pointy end gets paid - it's not enough.
It's not exactly pleasant, but necessary and quite interesting to watch inside your own body (not as interesting as watching surgeons put stents into my heart, but that's another story).
Totally agree with Graeme, nothing to fear and massive win if they find things before it's too late. Don't hesitate!
I will note that general anaesthesia generates lots of extra billable hours (anaesthetist! extra nurse/assistant anaesthetists!), which might be why US hospitals are so keen on it and NHS hospitals are less so.
This may sound like a strange sentiment, but years ago I broke a bone on a weekend and they put my arm in a sling at the emergency room. I got to see a doctor on monday and he said - you have to move your arm. "Move it every day, otherwise you will lose your range of motion. Let pain be your guide".
Completely different advice than I expected (I expected to keep it immobilized as much as possible until fully healed)
So I wonder if I was knocked out - would they damage something while they're looking around without my hints?
There are risks to colonoscopy, primarily in older patients. You can get a perforated bowel.
Quite plausible that where sedation is warranted this reduces the risk. But that would depend upon whether the cause of this perforation is even amenable to patient/doctor feedback.
If you're having a medical procedure and the physician mentions general anesthesia, always ask if IV sedation works as an alternative.
An acquaintance of mine with Down's syndrome, no less, couldn't do a gastroscopy to investigate a quality-of-life issue that was assumed to be benign, due to this. Boggles my mind, honestly.
General anesthesia might be over-used, but some healthcare systems go too far in the other direction too.
You can also go to other doctors in a socialized one, if their treatment (style) does not fit your cause.
Also, in my experience there's lots of choice in most socialized health care systems.
I had a gastroscopy in Austria, the Doctor asked me if I'd like a general anesthesia or rather a local, nerve blocker - mostly to avoid the gag reflex.
He said that it may not be as pleasant without the anesthesia, but I still opted for it and am really glad I did. While it really was not pleasant, I was up and going again in about half an hour.
It's just "how it's done". Just like the US has it's own unique methods that seem odd to Europe.
Don't it just turn on the chlorine tap on a neuron to open so that the voltage is now much lower and it will inhibit the signaling ???.
It is the natural mechanism of a neuron so I don't see what side effects there could be - it is like pulling a jumper wire from one pin to another pin on a board to get a voltage right.
Benzodiazepines are considerate anxiolytics whereas propofol would be considered moderate sedation. Neither of these require airway control (intubation) because people tend to keep breathing on their own and we really would much prefer that.
With general anesthesia, you cannot protect your airway whatsoever and will need some form of airway control via either endotracheal intubation or LMA.
The patient is aware, can breathe on their own, and can respond to basic commands, but is relaxed, with a much higher pain threshold, and has no memory of the event.
That sync with your experience, doc?
For the overwhelming majority of patients, you simply fall asleep, avoid discomfort, and then go on with your life. Weighing that against the risks of a traumatic or very painful wakeful experience is not trivial.
What I'm trying to argue is that "one step away from death" is a state we too-often in American medicine treat as hum-drum.
For sure! My first colonoscopy I was sedated and enjoyed watching the screen. In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. My second colonoscopy my doctor sedated me again, but put me further under for reasons that remain a mystery.
Also, a year ago we buried my brother-in-law at age 53. He was diagnosed stage 4 at age 48. DO NOT DELAY your colonoscopy. I think 50 is too late to wait.
It was the 15th time that week he'd heard the "rectum, damn near killed them" joke and he didn't feel he needed another aspiring comedian on the operating table.
Jimi Hendrix remembered he was playing MUCH BETTER guitar when he was on acid.
Until he heard the recordings....
I must admit, the experience wasn't awful. It was like getting an intestinal reset. Getting completely cleared out from the fast and prep. I felt like a new man, and very well rested after the "twilight" sedation.
I only wish they could have given me a copy of the video of the procedure for my YouTube channel.
This is the primary purpose of the "sedative".
I had samples taken from the interior of my stomach via a machine that went down my throat. It was an intensely unpleasant experience; you're trying to vomit for most of the time the cable is there.
Anesthesia was not even recommended, but they really wanted me to take something that would inhibit memory formation. I asked if people who took the drug struggled or retched any less. "No." (I declined to take it.)
This is also how women were drugged for childbirth in the mid-20th century. No anesthesia, but memory inhibitors so they couldn't remember what had happened. That was eventually "discovered" by the press and became a huge scandal. I don't get how the approach persists elsewhere.
Aside from potential lasting effects from trauma remembered or not, and so on, I always thought: It would still change the doctors.
The concept of anesthesia is that you don't feel pain, not that you're unconscious. If you're unconscious, it's "general anesthesia"; if you're not, it's "local anesthesia".
Can you provide any additional information on this? I can't find anything online. Maybe I'm using the wrong search terms.
The rate of new colorectal cancer diagnoses has been increasing for those under 50 years old, despite the rate falling for the older population. I don't know if they've narrowed down a major cause. My pet theory is obesity.
The usual recommendation to start screening at 50 is for asymptomatic people with no increased risk. If you have symptoms, family history of colorectal cancer, or enough other risk factors, bring up screening with your doctor. As somebody else mentioned, you could do fecal occult blood tests (FOBT) or other non-invasive tests if you're worried about colonoscopies.
Of course, 1.5 IQ points is not likely to dramatically change the course of your life, but I would absolutely not get it if the procedure could be done under sedation.
Still, getting anesthesia for something like a colonoscopy or a root canal strikes me as a very disproportionate risk given the evidence.
If you feel like you're relaxed enough to be calm when someone does something to you that your body will tell you is going to kill you, then it's not so bad. They sedate your throat to kill the gag reflex, but it doesn't work 100%.
The upside for me was that it was over so quickly, and I could go on with my day, was allowed to drive, etc.
I went for no sedation during a colonoscopy too, but after a while it got too painful and I asked for some
Once every few years they find a suspicious polyp and snip it of / cauterize the wound, all with just local numbing. Still nothing worse than stubbing a toe, and certainly not worth the risk of using sedatives.
I can understand if some people want sedatives, but anesthesia is pretty high risk like you were saying.
"Not a single shred of evidence to be found" -> "I didn't actually look but like telling people they're wrong lol"
If you want to come into a thread telling people that are already apprehensive about a procedure "please don't do X its dangerous!" when an _actual_ first google will give you a Mayo Clinic saying its perfectly fine, then you need to provide some fucking evidence.
Your evidence is unconvincing, but good job being condescending.
It gets worse the farther they go.
My experience is that GI doctors enjoy chatting during the procedure but specialist nurses (who often perform minor endoscopies) are usually not very communicative.
Colonoscopy was generally OK, and it's quite interesting to see both what your insides look like, and the radar image of the path the scope takes.
The prep the day before is the worst bit IMV
A good, modern anaesthetist in a western hospital has access to an incredible array of information about their patient, ranging from their complete physiological state to the partial pressures of anaesthetic gasses going into, and out of, their lungs (and thus in their blood stream). This largely means that the horror stories of the past about people "waking up and being unable to move" -- the triad becoming unbalanced and muscle relaxation ± analgesia being (barely) adequate, but narcosis clearly not -- remain in the past.
I've probably waffled incoherently enough, but it's worth reiterating that anaesthesia is a _field of medicine_ in its own right. There are literally thousands of approaches, drug combinations, and "gotchas" to deal with, in all sorts of situations -- right the way from the straightforward and simple to patients with massive facial injuries where it is very difficult to know how to intubate them without causing further damage. Drug combinations are prescribed on the basis of the patient, the indication, and local rules and availability (including toxicity to the operator and cost -- many anaesthetic gasses are carcinogenic if you're exposed to them for a long period of time in trace amounts, which occasionally becomes an issue).
Re: the content of this article --- if you have blood in your stool, see your doctor. (S)he won't be embarrassed about shoving a finger up your arse, and the outcomes range from "eat more fruit", or "don't have anal sex for a little while" to lifesaving surgery.
What they tend to do is "conscious sedation". Basically load you up with a sedative and painkiller - midazolam and fentanyl as an example. You're not completely out of it, you can breath on your own and will show some response to stimuli. But you won't remember any of it due to the amnesia from the sedative.
(Fentanyl gets a bad rap because it's very dangerous as a street drug. In a healthcare setting it's a wonder drug, superior in almost every way to morphine.)
Side note: I was never warned about a particular effect of propofol. They started pumping it in and told me to count down from 10. At about 5, I suddenly felt this horrible searing, burning pain in my IV-connected arm that I felt spreading throughout my body. Thinking something was terribly wrong, I opened my mouth to say I'm feeling awful pain, but by then I was already falling unconscious. So I only consciously felt the pain for a few seconds, feeling totally fine (besides grogginess) when I woke up, but it was panic-inducing and some of the worst pain I've felt.
Apparently it's pretty common for propofol. I think they might have told me I might feel a little discomfort, but they didn't mention the possibility of sudden, dramatic pain, for some reason. I could've grit my teeth through those seconds if I knew it was possibly going to happen, but I feared that I was having an unexpected severe allergic reaction or something, so I spent those few seconds absolutely terrified.
I’ve experienced the exact same pain you’re talking about but with IV antibiotics. No nurse or doctor could actually explain why it was happening to me, other than to say the IV had “gone bad.” Because I was in the hospital for so long, they eventually switched me to a PICC line. Absolutely zero pain with that.
My own experiences with propofol involved either the PICC line, or maybe some kind of arterial line or something (I was unconscious when I was first sedated during this incident).
At my first, I was offered the option of minimal sedation, which I took. Then my doc offered to put up an extra monitor so I could take the tour, as it were. It was fascinating.
By now, I've had 9 colonoscopies. My brother had colon cancer, hence the maybe higher frequency than usual. They've all been either non-events or pretty interesting.
If you have any symptoms at all, get the procedure done. Immediately.
The worst part or the prep was not sleeping much that night because I was up until 3am. Watching TV most of the night was relaxing, though. After the procedure I took it easy all day while the propofol effects wore off.
Don’t wait to have a colonoscopy. The prep isn’t that difficult!
So in a sense it wasn't that different than a regular night of staying up till four in the morning playing Factorio, except that I had to drink a gallon of stuff that tastes like diluted seawater. I had forgotten how gross that stuff is, but in the end that was the worst part.
My father found he had bowel cancer from a routine fecal occult test they were sending to all men above 65 in my area. He took some convincing to do the test, but found he had cancer and was swiftly operated on. My older brother found he had it far younger, about 52 and his was far more advanced when it was discovered, and 5 years of treatment later it won't be something they can cure. So it is pure chance my father's was caught so early and was so successful.
After speaking to my gp they agreed to start my colonoscopy cycle at 40 - with one every 5 years until I hit 55 and then likely more frequently.
I was a little nervous but it was totally fine and I feel freed that it is one worry that is if not behind me, that is controlled.
Top tip is to follow the instructions of the laxatives well and eat nothing except a broth or miso soup, and it will be far easier on your gut.
That and the sedation depends on whether you’re getting a “flexible sigmoidoscopy” or a full colonoscopy. The latter is the full 1.5-2 metre insertion to inspect all the way to where the small intestine starts, which typically involves sedation (though conscious). The former is usually preceded by a home enema rather than laxatives and done with pain relief only.
Not necessarily, you can get the Good Stuff that knocks you out during the procedure in the UK (I have), but I'm not sure what the criteria are for getting it, if any.
> Entonox pain relief should be available at all sites where bowel scope screening is provided, as the procedure will be performed without sedation, unless a decision was made and documented at a best interest meeting about the appropriateness of performing the test with reasonable adjustments.
Please don't romanticize invasive diagnostics. If you want to advocate for the occasional bowel purge or using anesthetics to sleep have at it though. But also, general anesthesia should be avoided as much as possible, it's not a trivial matter.
The movicol prep stuff they give you isn't ideal either; you've got to drink a lot of odd tasting fluids that then give you basically explosive diorama which can be awful in itself. It also causes some people to explosively vomit as well (it's designed to make your body want to eject it asap) which really isn't fun when it's trying to escape both ends at once.
The actual procedure isn't amazing either. A camera down either end is uncomfortable at best ranging to extremely painful (short term) as they try and get round the corners in your bowel. There's also the potential it to go wrong in some nasty ways or for odd side effects, and at absolute best, you're still stuck on a table trying to make polite conversation with 2m of camera tube stuck up your bum.
Can confirm your refusal to confirm; none of it's a thrilling or trivial experience.
I wasn't knocked out but I might as well have been as I didn't feel any pain and kept kind of drifting off half to sleep. It was completely fine and I'd not worry at all about getting it done again.
I think the traditional guidance has been to go for your first colonoscopy around age 50. My doc mentioned that they're recommending that move down to 45, because they're seeing more and more young people with issues. You should bring this up with you doc if you have any similar symptoms or if there's any family history of colon cancer.
Bullshit. I've got Crohn's, and have had more colonoscopies than I can count since age 13. About 75% of the time, I'm throwing up due to the prep. The prep is the WORST part.
It has gotten better over the years. If you go for one, do NOT let them give you the jug full of powder. I've had much better luck with prep-o-pik.
The other PITA is they generally won't let you go for the procedure by yourself, since you're under anesthetic and don't trust you to get home OK. That means you have to find a friend who is willing to wait 2+ hours for you.
I will say though, after having the colonoscopy, my general bowel symptoms(never ending gas, mostly) improved dramatically. I'm thinking about doing a chemical cleanse every year just to keep things working fine.
I didn't particularly enjoy it, but it wasn't a problem.
I think people will have different tolerances to different protocols.
They usually are, for most people. But for me the first time I did it was the most painful experience ever. So painful in fact that they had to abort it and book me for another time and that time I went under.
That was before my surgery and when my intestines were all over the place. That being said, after my surgery in which they corrected the placement of my intestines, it was painless. That time, the last time I did it, I chit chatted with the doctor and nurse and it was funnily a pretty relaxing experience since I'd gotten some mild drugs before because I was nervous it would hurt as it did the fist time.
I have done a colonoscopy 3 times.
Getting a genetic test might be another option if cancer is what you're worried about. Not as accurate as a colonoscopy, though.
The other option is stool sample testing for blood.
The procedure was 20 minutes, painless and slightly uncomfortable where the nurse had to push on my stomach to help the probe round the guts, that was like some brief constipation. You get to your appendix from the inside and physically realize how much the colon takes up in your body.
BTW, in Denmark, a 40+ yo patient with rectal bleeding that cannot be physically confirmed as hemorrhoids by the GP would likely be referred to the emergency cancer track, with I think, 2 weeks before all the tests have to be finished.
I checked and general anesthesia seems to he a custom used in some regions of America. I’ve had 3 colonoscopies and been awake for each one. They aren’t painful in the slightest and you get to watch them on screen! Anyone who gets one should talk to their doctor about sedation options.
Alternatively, you can opt for no anesthesia/sedative, if like me your major concern is lingering after effects (and a fear of going under). I had a colonoscopy and an EGD in the same visit, really wasn’t a big deal. Also quite fun to see your insides on the monitor — gave me peace of mind to see perfectly uniform pink healthy flesh, as opposed to some of the craziness you can find on YouTube.
I had the exact same feeling afterwards. The issue has disappeared since, and that was 2 years ago.
From my past experience, I'd recommend MRI over anything else (especially CT scans), though it's apparently not as useful in diagnosing bowel stuff as colonoscopies.
Both can be very useful and helpful in aiding diagnosis with more data points.
Case in point, I have had an MRI (which showed nothing), several CT scans (which showed temporary blockage) and both methods have not really led to a conclusive diagnosis.
For example in Germany you can get a colonoscopy paid by the health insurance without any specific reason every 5 years from the age of 50. You can always get one at any age for no reason if you simply pay yourself.
, especially because gut flora isn't something you necessarily want to reset.
I experienced the same.
That sounds good.
> Waking up from the anesthesia
Hm, that's not something that would happen if they were easy and painless.
I don't like going under.