Scopophobia

May 14, 2012 6:24 PM

Am I right to say no to this colonoscopy? Horribly personal details inside.

I have a generally irregular digestive tract. (Loose bowels, mostly; no pain.) I went to the doctor, who did four blood tests and a urine test and a stool test. Everything came back normal. He did 3 more blood tests to "double check," and wants to do a colonoscopy.

Now, to be honest, this seems unnecessary to me. I'm 29, and all of the tests so far seem fine. Furthermore, the anesthesia and colonoscopy are not without risks. What do you think, hive mind?

posted by anonymous to health & fitness (34 answers total)

I think I'm not a doctor. I think you have a doctor who thinks this is a good idea. If you don't agree with him, talk to another doctor, not random internet strangers.
posted by jenkinsEar at 6:28 PM on May 14, 2012 [5 favorites]

Has your doctor explained to you why he wants to do the procedure? If not, get it from him. Then, get a second opinion (from another doctor, of course, not the intertubes).
posted by vidur at 6:31 PM on May 14, 2012

Sounds like he's looking for something that his tests haven't ruled out. I have to say that your reasons to avoid it don't sound terribly convincing.

Get a second opinion. Or, grit your teeth and get the colonoscopy. But don't avoid it out of a vague sense that it's "unnecessary."
posted by hermitosis at 6:32 PM on May 14, 2012 [6 favorites]

Colonoscopy is a routine procedure. You'll have to balance the small risk of something going wrong against not knowing what's causing the squits. Speaking as The Ultimate Voice of Reason (aka some random guy on the internet) I'd take the camera up the bum. There could be some missing diagnostic lurking therein.
posted by scruss at 6:35 PM on May 14, 2012

Have you talked to your doctor about your reservations? You're surely not the only patient he's had who has been leery of a colonoscopy.

You can also get a second opinion. Most insurance programs cover these.
posted by elizeh at 6:40 PM on May 14, 2012

I like hermitosis comment: the risks associated with the procedure are rather low, when done by an experienced doctor. The test is recommended routinely every five years for people over 50.
posted by francesca too at 6:40 PM on May 14, 2012

I am bias, perhaps, because without a colonoscopy/endoscopy (I was the fingercuffs!), my colitis would not have been diagnosed, and my life would suck a lot more than it does currently, and it took literally years of faffing about before anyone took me seriously and got me the damned procedure I needed.

But... I think your metric for risk is pretty out of whack - what are you basing your feeling that colonoscopy is risky on? I'm not saying it's wholly without risk, but I think you'll find it's very, very small. Further, you may not even be anaethetised under general - for example, I was given fentanyl, a morphine analogue, and some kind of benzo I think - I was "conscious" in a fashion the whole time (I only remember one part, not especially pleasant, but then they upped the juice and I went away again).

Essentially, something is wrong with you. The doctor doesn't know what. It could be nothing, it could truly be something. The only way to know is colonoscopy, possibly the platonic ideal of routine surgery, performed thousands of times across the world every day. Get the colonoscopy, the risk of colonoscopy is a lot lower than untreated cancer etc etc.
posted by smoke at 6:44 PM on May 14, 2012

On reading thelastcamel's response, I wish to say that my procedure was painless and easy before (pooping what is essentially water was a painless, albeit very novel experience), and after (I ate sandwiches when I woke up, and felt just fine), with no lingering effects whatsoever, and it resulted in a prescription which has dramatically improved my quality of life.

I would also say I give a shit about a doctor looking at my rectum about as much as the doctor does: Not. At. All. It's just another body part to them, it's not like you're doing it in the park.

I would finally say that the ulcers thelastcamel talks about are no doubt accompanied by inflammation, and both are associated with cancer of the bowel as precursors. The doctor probably wished to follow up so as to see if symptoms worsened or continued over time - which may indicate something more serious.
posted by smoke at 6:50 PM on May 14, 2012

Absolutely find out what the doc is looking for and what the risk is of not having a scope. This is part of informed consent.

Having had three, let me tell you my experience briefly:

1. The worst part is the prep. Ask them to 'prescibe' the Magnesium Citrate approach - it comes down to this: taking stool softeners, drinking the mag cit (the lemon/lime flavor doesn't suck and it's even better with a squeeze of fresh lime juice), and tons of clear liquid (chicken broth, non-red Gatorade, whatever else the doc says is OK). Then you'll wish your toilet had a seat belt. If the doc suggests using "GoLytely" (the world's most ironically named product), say no thanks. Even with the flavor packet, the stuff tastes like crap to me and you're supposed to drink close to a gallon of it. I nearly puked it up.

2. The best part is the narcotics. Make sure you have a ride home. It wiped my memory of the event on the first one.

3. A scheduled colonoscopy is way, way, way, way better than an unscheduled trip to the ER when your body starts to curl up like a boiled shrimp and because of the Crohn's disease flare up and the run saline into you so fast that you get shivers from the delta in temperature from your body and the room temperature IV and they blast you with morphine and that just takes the edge off. If they suspect Crohn's or Ulcerative colitis or something of that ilk, consider an earlier diagnosis.
posted by plinth at 6:58 PM on May 14, 2012 [8 favorites]

By the way, if you are worried, colonoscopy may be late-night talk show har-har fodder, but truly, not a big deal. At all.
posted by thinkpiece at 6:58 PM on May 14, 2012

Do it, you will feel better when it is over - it is painless and the prep is much better now than it was in the past. If you don't, you will hear every commercial (admittedly aimed at the over 50 crowd) which says early detection though colonoscopy might save your life from colon cancer and worry till you get one...

I assume you went to a doctor because it was impacting your quality of life - it probably will not get better if you do not know what is causing the problem. To my knowledge you do not have pain receptors in the colon, so the lack of pain should not indicate that all things are fine...

Bowel problems can get out of control very quickly and only heal slowly. Catch things early and they will be much easier to control.
posted by NoDef at 7:02 PM on May 14, 2012

If this is covered by health insurance, I don't think I would resist what is a very reasonable next step. IANAD, but it is a common diagnostic procedure that can reveal some very serious conditions or precursors to very serious conditions. It also sounds like your doctor is being very methodical and didn't just jump to recommending a colonoscopy. If you have your doubts, by all means get a second opinion, but, if I were you, I would just do it. It won't be pleasant, but it also won't be the worst thing in the world. I've had invasive, uncomfortable procedures before, and while I wouldn't jump at the chance to do any of them again, I'm glad I did them at the time. Lastly, the procedure may reveal absolutely nothing, but ruling things out is equally important if you want to find out what is causing your problems. Good luck!
posted by katemcd at 7:04 PM on May 14, 2012

My mom just had one. Easy peasy and they caught a large polyp before it could become cancerous.


I had one years ago while acutely ill with what turned out to be paratyphoid. Not fun but I was ill and wide awake. Mom wasn't. Go ahead and have the procedure.
posted by St. Alia of the Bunnies at 7:07 PM on May 14, 2012

Strongly agree with smoke here. Colonoscopy prep certainly isn't fun, but it's far from the worst experience ever. I'd rather do it again than have a cavity drilled and filled, for example. Moreover, I'd most definitely do it again because it was necessary to diagnose my colitis and for me to start getting the treatment I needed.

There are risks associated with any surgical procedure and with any time you're given anesthesia, just as there are risks with driving, crossing the street, or having a pint at the pub. Presumably you went to the doctor and submitted to stool, urine, and blood testing because you are somewhat bothered by your irregular digestive experience and you are interested in being diagnosed and treated. Your doctor has determined that a colonoscopy is the best way to do that.

Colonoscopies are performed by gastroenterologists, so assuming your current doctor is a general practitioner, you'll need to be referred to a GI specialist. It's totally kosher and normal to meet with that GI specialist first to discuss your background and symptoms, make sure you're comfortable with him or her, and to get their opinion regarding whether or not you should have the colonoscopy.

Regarding the anesthesia risks, if that's non-negotiable for you, it isn't required that you go under for the procedure. In the US it's most common for patients to be sedated, but in other countries (England, for example) it's standard for patients to stay awake. It's uncomfortable but usually not prohibitively painful.

You might want to talk to your doctor or your gastroenterologist about the possibility of starting with a flexible sigmoidoscopy instead of a colonoscopy. A sigmoidoscopy is basically a colonoscopy that doesn't travel as far into your colon -- it's almost always performed without anesthesia, is virtually painless, and the risk of perforation is lower. Furthermore, it requires significantly less prep than a colonoscopy (usually just an enema).

Finally, I would urge you to work with your doctor to explore what is going on and make a diagnosis if possible. As NoDef said, bowel problems can escalate quickly. I started experiencing symptoms of colitis but my ultra conservative doctor wrote it off as constipation from poor diet and shamed me into thinking my diet was making me sick, so I waited it out and eventually my colitis went into remission. A few years later it flared up again, much worse this time, and a different doctor ordered the colonoscopy that showed that my bowel was gravely sick. I only wish I had done it sooner.
posted by telegraph at 7:10 PM on May 14, 2012 [2 favorites]

I had a colonoscopy a few weeks ago. While the prep wasn't the funnest evening I have had recently, the colonoscopy revealed a polyp -- benign, thank god.

Because I am of "a certain age" (heh) my procedure was completely covered by my private individual insurance -- thanks, Obama! You may want to check with your insurance regarding your circumstances.

Yeah, there are risks, but there are risks crossing the street. And wouldn't it be great if this procedure can finally diagnose your problem and point the way to resolving it!

All the best to you!
posted by potsmokinghippieoverlord at 7:14 PM on May 14, 2012

I'm not sure if the whole internet needs to know this, but I had a colonoscopy today, as it happens. I had my first one when i wasn't much older than you are now, because of a test that looked funny. My doctor said it was probably nothing, and he was right. But I'm glad I did it.

If your doctor is like mine, you don't get anaesthesia per se, you get "twilight sedation," which is a much milder business, less risky and quicker to recover from. It's a completely routine procedure these guys do dozens of times a day. An hour after my colonoscopy I was out having lunch with my wife, feeling totally normal. And if your medical coverage is like mine (which I'm guessing it is, if you had all those tests,) the colonoscopy is covered.

Plus you get to see a color photograph of your own bowel!
posted by escabeche at 7:14 PM on May 14, 2012 [1 favorite]

Yeah, I was dubious about needing one two years ago, but went ahead and did it anyway. That's how my colon cancer was diagnosed -- which surprised all of us (my doc included) because I was only 40 at the time and have none of the risk factors and wasn't experiencing some key symptoms. So I'm pretty grateful I did it even though I didn't want to. I'm pretty sure my cancer would have been diagnosed even earlier (at least a year, if not more) if previous doctors had actually been paying more attention to my seemingly minor complaints. If your doctor has determined that the next step in diagnosing your problems really is a colonoscopy, I would take that seriously. I really don't think it's something a doctor is going to suggest lightly for a 29-year-old.

Ask to do the Miralax prep, which in my experience is the easiest to tolerate (beware GoLytely, which seems to have been created with a sadist intent on ruining everyone's fond memories of Breakfast at Tiffany's). I had the twilight anesthesia a few years ago but apparently didn't tolerate it well (I don't remember!), so when I had my follow-up last week they put me under at the next level -- which is not full general anesthesia, but rather propofol, which you may remember as Michael Jackson's drugs of choice (results: I am not only still cancer-free -- huzzah! -- but also I can moonwalk now).

tl;dr: I would take your doctor seriously.
posted by scody at 7:22 PM on May 14, 2012 [8 favorites]

I would talk frankly with the doctor and perhaps get a second opinion, but a colonoscopy is (as far as I understand) the gold standard for someone with recurrent bowel issues. They want to identify issues like colitis or Crohn's Disease as early as possible wherever they might exist.

Now, if you're like me (I think I had my first colonoscopy at 28) they won't find anything. If that happens, let me suggest that you work with your doctors to start looking at food allergies and sensitivities. Also celiac disease. Because that was what (it turned out after 10+ years) was making my digestive system unhappy.
posted by Sidhedevil at 7:26 PM on May 14, 2012

Also another voice on the anti-GoLytely bandwagon. That stuff is the devil. The magnesium citrate and all the other horrible things are so much less horrible than GoLytely.
posted by Sidhedevil at 7:27 PM on May 14, 2012

I've had two colonoscopies and I'm 46. I will be having another one in the next few weeks. I hate the prep but I'm glad I've been getting them. Getting an early colonoscopy is much better than getting easily preventable colon cancer.
posted by dgeiser13 at 7:46 PM on May 14, 2012

A friend of mine had vague abdominal symptoms for about 18 months. His PCP wanted him to have a colonoscopy, but he opted against it.

In July, he was diagnosed with stage IIIC colon cancer. He was 24.

I'd just have the colonoscopy.
posted by easy, lucky, free at 8:03 PM on May 14, 2012 [6 favorites]

As potsmokinghippieoverlord pointed out, you definitely want to check to see if your insurance company will cover it; many of them consider this to be a routine preventative procedure, even in circumstances similar to yours.
posted by Specklet at 8:15 PM on May 14, 2012

My Celiac Disease was discovered by doing a routine endoscopy (down the throat instead of up the bum, thank goodness) that wouldn't have otherwise been discovered by blood tests. I was only 26.

My life has greatly improved thanks to that stupid camera on a tube.
posted by TooFewShoes at 8:29 PM on May 14, 2012

Your insurance company absolutely should cover this when a doctor orders it based on symptoms. However, it needs to be coded as "diagnostic" rather than "preventative"; if it bounces back to you, have the doctor's office recode it, and then if it still bounces file an appeal.
posted by Sidhedevil at 8:32 PM on May 14, 2012

don't avoid it out of a vague sense that it's "unnecessary."

This is the key thing I think. I wouldn't even venture an opinion on whether it is necessary because I am not a doctor and because your description of your issues was extremely vague and explicitly ("loose bowels, mostly") incomplete.

One thing you might consider is to seek a referral to a specialist like a gastroenterologist or a specialty clinic to review your issues and talk about the relative benefits of colonoscopy. It is a very routine, commonplace procedure and it can rule out a lot of serious stuff, but it's certainly fair to get an expert's opinion on how well-indicated (or not) it is for you.

I recently went through a whole round of this kind of thing (including colonoscopy which as others are noting is not pleasant but not a big deal and I'm no longer bothered by the idea of it - due to a family history of colon cancer it will be a regular event of my middle- and old-age) and my doctor recommended going to a gastroenterology clinic to kind of put all the pieces together and get an expert review, and I found it very helpful and informative.
posted by nanojath at 9:51 PM on May 14, 2012

Nthing everyone, this isn't a procedure prescribed lightly for someone under 45, let alone under 30, and it can easily rule in or rule out some serious stuff. It's not painful, just unpleasant, but not as bad as it used to be (the last ten years have seen some definite improvements in considering the patient's comfort with the "emptying" part.)

Get yourself a book of very juvenile poop jokes for company and let the docs take a look.
posted by desuetude at 10:15 PM on May 14, 2012

Seconding scody's recommendation for the Miralax prep. I found it to be completely tasteless when dissolved in 64 oz of Gatorade. Easy peasy.
posted by funkiwan at 1:42 AM on May 15, 2012

Nthing the people who say get a second professional opinion to help guide your decision.

If you do decide to have the procedure, and your doctor wants to use the GoLytely, I do have some advice. My doctor's prep suggested mixing the GoLytely with diet-lemon lime soda in addition to the flavor packet, which at least helped with the taste, if not the sheer volume you're supposed to consume over a limited period of time. If you go this route, let the soda go flat first; you have to shake the gallon jug to get the powder to dissolve, and if the soda's at full fizz, you'll have to repeatedly bleed off gas.

And I've found this video (NSWF language) to be helpful in dealing with the prep.
posted by radwolf76 at 1:47 AM on May 15, 2012

Why not ask your doctor what diagnoses he's wanting evaluated from a colonoscopy?
posted by gramcracker at 1:48 AM on May 15, 2012

I had almost the same situation and opted to have the colonoscopy. At that point, I was just so fed up with the issue that I wanted to find out what the hell was going on. The colonoscopy was able to diagnose the issue which in turn was directly related to medication that I was taking. If I hadn't had the procedure, I would not have known.

Is it unpleasant? The worst part was the cleansing ahead of time. The actual procedure was completely unmemorable, because I was knocked out. Recovery was a little iffy since I had all those drugs on a very empty stomach, but it was ok.

I'd say do it because it has a good chance of diagnosing what's wrong.
posted by Leezie at 7:10 AM on May 15, 2012

You have to discuss your concerns with your doctor, and if you're not satisfied by that discussion, get a second opinion. Nobody here is going to say ignore your doctor's advice and don't get a colonoscopy.

As a repeat player, it's not a huge deal. The worst part is losing a day and a half to prep and recovery. I hope you like Jello. There are some logistical problems; they won't let you leave without someone picking you up (and a taxi doesn't count, I've tried.) These days, I go to the outpatient clinic in the hospital, where you have to deal with all of the forms and waiting and other nonsense - I used to be able to do this in the doctor's office. So that takes some extra time. Also, I got billed the co-payment for "surgery" (the snarky insurance rep says "when they put something in you, it's surgery.")

The procedure itself isn't bad at all. They pump you with a boilermaker of Demerol and Valium. THIS PART IS AWESOME. Then you don't feel anything after that. I sleep through the whole thing but YMMV.

If you're worried about pain and comfort, a colonoscopy with all of the logistics and prep issues is better than a sigmoidoscopy, which doesn't involve any anesthetic and is not pleasant. It feels like a "reverse fart" if that makes any sense. In any event the sigmoid only covers the lower part of the colon and doesn't reach as high as the doctor might want.
posted by moammargaret at 7:49 AM on May 15, 2012

I really don't think it's something a doctor is going to suggest lightly for a 29-year-old.

Just another comment from someone that got one at 29. Ask this doc (or another) why he or she wants to do it, but I'd guess that you should probably do it.

In my case, I didn't have serious symptoms, just some minor ones, but both my maternal grandparents and a maternal uncle died of colon cancer. Genetic susceptibility plays a role in a certain percent of cases of colon cancer.

It's not fun, but it's really not that bad.
posted by Pax at 9:30 AM on May 15, 2012

I just had a colonoscopy a few weeks ago. I went to a colonoscopy center, and the waiting room was filled with people, all waiting for their colonoscopies. The staff had it down to a science. I was in and out. It was like a colonoscopy factory. They do this all day, every day. I like to call it the Colonoscopy Industrial Complex.

It was really no big deal. I wasn't even very groggy after--I ate a nice lunch and went to the grocery store later in the day. I've had other procedures that were much worse. The anesthesia they give you is very gentle.

The prep is Not Fun (I had GoLytely), but don't let the stories scare you. It's not that bad. The hardest part for me was drinking all the fluid (it tasted really bad). I prepped my bathroom before hand with a blanket and pillow, some soda to "chase" the GoLytely, my Kindle, some medicated wipes and butt cream, some incense. The pooping wasn't even that scary. I actually felt a little better after cleaning out my bowels. I was surprised how little was in there.

Agreed with everyone above, bowel problems can escalate quickly.
posted by hotelechozulu at 11:19 AM on May 15, 2012

I was in your position a few years ago - self-diagnosed for years and then officially confirmed as IBS-D (D is diarrhea, C is constipation). Blood tests prior to the colonoscopy showed I was low on vitamin K indicating malabsorption of some sort. Anyway, the prep was the worst part (plinth speaks the truth), I didn't have to take a stool softener because my bowels were already loose (duh!). Just make sure you get full anaesthesia, not twilight; my mum had twilight and it wasn't fun. Long story short - I'm fine; no polyps, etc. Also no idea what is causing the IBS, but whatever, at least it's not the C version.
posted by deborah at 8:29 PM on May 16, 2012