Is having a colonoscopy without sedation a stupid idea?
January 16, 2019 2:12 PM   Subscribe

Have you had a colonoscopy without sedation? How was it? Did it hurt? On a scale of bad gas cramps to gallstones how bad was it? Is this even an option I can bring up with my doctor? Have you had one with sedation? How was the sedation is it less bad than I'm picturing?

I'm having a colonoscopy on Friday and have only just found out that my Dr is going to sedate me for it. I'm more terrified of the sedation than the colonoscopy. Seriously don't have any worries about the colonoscopy or even the starving & pooping my eyeballs out for a day, just the drugs.

I hate sedation. I have bad reactions mentally to it & the past two times I've had it I punched a nurse when coming out of General Anesthetic and had a panic attack under twilight sedation & took a swing at a doctor. Apparently I come up swinging when confused and my monkey brain takes over. Throw into that my twilight sedation ended up with me in hospital for 24 hours as I couldn't stop vomiting and I'm having anxiety attacks just thinking about being sedated.

I know you're not doctors or my doctor & I will be talking to my doctor about this before the procedure don't worry but, I just want to know more about my options before I do.
posted by wwax to Health & Fitness (46 answers total) 5 users marked this as a favorite
according to an NIH study and Europe, where it's a normal option offered to colonoscopy patients, it's not a bad idea at all.
posted by zippy at 2:21 PM on January 16, 2019

Not a direct answer to your question, but there are less invasive colon cancer screens available if you want to opt out of the procedure. I've only heard of them ( cologuard ) but if you're relatively low risk you might consider something like that given your concerns.
posted by roue at 2:24 PM on January 16, 2019 [2 favorites]

I’ve had numerous colonoscopies (thanks Lynch Syndrome!). I have never heard about no sedation being any sort of option. I’ve alwaya had the propofol sedation and I love it. During surgeries I’ve had regular general anesthesia I’ve had side effects (vomiting) and so that’s not fun. But I’ve never had a reaction to the propofol.

So - two years ago I had a colonoscopy and endoscopy at the same time. They did the endoscopy and then I accidentally came to right as they were beginning the colonoscopy. Coming out of it and really not grasping what was happening - I understood that a device was going in my butt and that I didnt like it - at all. I think I must have made some sort of sound of pain/displeasure and they quickly gave me more sedation and I blissfully went under again grateful for modern medicine that I didn’t have to endure more than a moment before I was administered more sedation.

But definitely talk to your doctor about your concerns and past experiences. And ask before the day of the procedure.
posted by Sassyfras at 2:25 PM on January 16, 2019 [1 favorite]

For me it's going to depend on what they offer me for sedation. The one reliable firsthand story I heard about propofol sounded absolutely terrible--loss of memory for the entire day of the colonoscopy and a long recovery period afterwards with mushy memory for days. I loved my wisdom teeth sedation, which was I think Demerol. I will avoid propofol twilight sleep at all costs. No. Nyet. Negatory. Notapaloosa. NOPE.
posted by Don Pepino at 2:27 PM on January 16, 2019 [1 favorite]

My father had one without sedation a few years back (the ninny didn't want to bother anyone to arrange for a ride home, and without sedation he could drive himself. I was irate when I found out). He said it hurt quite a lot, but didn't make it sound like a nightmarish experience.
posted by LizardBreath at 2:30 PM on January 16, 2019

For my first CS I had a local anesthetic with absolutely no problem. I had options to watch TV, a DVD, a monitor of the physician's view, and did a little of each. I experienced zero after-effects. This lady details a similar satisfactory experience.

The default at my most recent CS was global anesethesia including an amnesia component. I went with the flow. There were no tactical problems other than the longer time out of commission. What did bother me was that the global cost rather more than the local. YMMV.
posted by gregoreo at 2:32 PM on January 16, 2019

I've had bad times with general anesthesia (vomiting, itching like fire ants) but so help me, the sedation for my colonoscopy/endoscopy made me feel better than I've ever felt in my life. It's hard to recall any other time I've felt that comfortable and well-rested.

Do you know what specific drug they used the time you had twilight and a bad reaction? There may be a different one they could use.
posted by The Underpants Monster at 2:35 PM on January 16, 2019 [1 favorite]

Also, call NOW if you don't want sedation, don't try to bring it up the morning of the procedure because they'll have to re-do the whole set-up, tell the anesthesiologist to go cool their heels, and get irritated/flustered. It should be do-able, but probably not last minute.
posted by Don Pepino at 2:35 PM on January 16, 2019 [10 favorites]

Here is a video of a colonoscopy without sedation. They talk about it a bit before and during the procedure, including the colonoscopée.

Tl;dw It's not uncomfortable at all.
posted by fluttering hellfire at 2:35 PM on January 16, 2019

if i had the choice of being awake for an ass probe or being actually on fire irl i would choose the fire

source: probed yesterday, being unconscious was the highlight
posted by poffin boffin at 2:36 PM on January 16, 2019 [22 favorites]

Most of the equation is probably about how you personally react to sedation. I personally do really well with it and find the temporary dissociation quite a nice break from my usually anxious mind - I have had several colonoscopies. That's perhaps not useful to you though, as you are not me or anyone else here.

It sounds like no sedation may be worth pursuing, regardless of other's experiences.
posted by deadwax at 2:38 PM on January 16, 2019 [3 favorites]

I've had an endoscopy with sedation. The one I was given wasn't anaesthesia but a sedative with an amnesiac effect—I was required to be semi-conscious (to swallow the probe)—and the whole day is a blank in my memory, it's as if it simply wasn't there. I went into hospital, they put a tube in my arm, then I woke up, had a bit of a sore throat, and said 'so when do you start doing the endoscopy'? 'Oh we're done'.

It was nothing at all like general anaesthesia, which I've also had which has wrecked my brain for days, there was none of the nausea or confusion or mood swings or anything like that.
posted by Fiasco da Gama at 2:40 PM on January 16, 2019

I have been sedated with fentanyl which was awesome and I have had no sedation at all which was ok. I have a theory that maybe you are treated more gently when you are concious.
posted by InkaLomax at 2:41 PM on January 16, 2019

I’ve had them with and without sedation. Without sedation was uncomfortable at times, but perfectly tolerable. I was warned every time they were going round a bend, and it was no worse than some of the gripes my gut delivers all on its own at times.
posted by Segundus at 2:42 PM on January 16, 2019 [2 favorites]

I had general sedation for mine with no negative effects. I was nervous because after surgery with general anesthesia about a year before, I woke up crying and really emotional, but waking up after my colonoscopy was totally different. I remember being asked to turn onto my left side, and then remember coming to in a different room with the nurse telling me to let her know when I passed gas. I remember parts of the 15 minute ride home, and then I slept off and on for the rest of the day. Absolutely no pain, no emotional swings, and no foggy feeling or abnormal memory issues the next day. The prep and anxiety prior to the anesthesia and procedure were much worse than the actual experience.
posted by bookmammal at 2:42 PM on January 16, 2019 [1 favorite]

FWIW I also had no problem at all with sedation; what I got seemed pretty mild, though it did the job.
posted by Segundus at 2:44 PM on January 16, 2019

I had one without sedation two weeks ago. They gave me a valium as opposed to putting me out. It was a non-event. I had a conversation with the Doctor and the nurse during the entire procedure. I have also had them knocked out. Never again. I will always opt for the nothing or a valium.
posted by AugustWest at 2:47 PM on January 16, 2019 [2 favorites]

When my wife and I had ours a couple of years ago, I had sedation but she did not, and she said she was fine and enjoyed watching the scope video on the monitor. I fell asleep just long enough for the procedure and did not have any after-effects from the sedative (which I believe was just a Valium).
posted by briank at 3:02 PM on January 16, 2019 [1 favorite]

While I've never experienced the joys of a colonoscopy, I have had other medical procedures where I've opted for a valium prior. (I also have terrible anesthesia reactions.) I hate feeling slow and logy, but I hate the effects of anesthesia on me (and the risks) 1000000x more. Valium every time.
posted by phunniemee at 3:03 PM on January 16, 2019 [1 favorite]

My wife showed up for hers and said no to sedation / anesthesia. It went fine, but her take was that she's opt for some sedation the next time, just to avoid (awareness of) all the tugging and shoving and pulling as the scope got stuck at various bends.

On the plus side, since she hadn't been sedated, she was OK to drive the rest of the day.
posted by RedOrGreen at 3:04 PM on January 16, 2019

I had a colonoscopy without sedation about 15 years ago. I don't want to alarm you, since my problem was compounded by undiagnosed lady problems, specifically endometriosis and ovarian cysts. But for me it was a traumatic and agonizing experience that I wouldn't wish on my worst enemy. Prior to this, I'd had some abdominal discomfort, but nothing that I would have considered outside of the range of just bad period cramping. If you ever have any abdominal pain or any inkling at all that you could have any troubles, then I urge you to use the anesthesia.
posted by backwards compatible at 3:04 PM on January 16, 2019 [2 favorites]

It's colonoscopy fortnight at AskMeFi Towers, clearly. I also had one done last week (I get them on a regular basis thanks to colon cancer being A Thing in my family) and had not very much sedation at all and remained conscious but relaxed throughout the whole process. It was a little uncomfortable at times but not for long. I think for me it was more about the relaxing than the sedation, because I really wasn't as "under" as I have been in the past. I think at a pinch I could go without sedation but even just a little bit helps. On the pain scale, I would say maybe a touch of crampy wind.

As an aside, the person doing the colonoscopy was a woman nurse practitioner in training and I think it was the most thorough and careful exam I've had since I started. A++, would allow that NP's camera to inhabit my nether regions again.
posted by Martha My Dear Prudence at 3:05 PM on January 16, 2019 [3 favorites]

While I'm a person who tends to feel sick for days after general anesthesia for surgery, and I had such a bad reaction to versed that I list it in the "allergies" section of my paperwork, there was no problem at all with propofol. My memory and sense of time passing were interrupted for the duration of the procedure, but unaffected before or afterwards.
posted by chromium at 3:12 PM on January 16, 2019

Just want to say that you should talk to your doctor about this prior to the day of the procedure. Otherwise they'll have gotten everything and everyone prepped and ready to go, and you'll kinda throw them off their stride if you stick a wrench in right before they stick the probe in.
posted by Anticipation Of A New Lover's Arrival, The at 3:14 PM on January 16, 2019 [3 favorites]

I have had multiple colonoscopies without sedation, due to a medical study I opted to take part in. There is a little mild discomfort. Sedation seems completely unnecessary to me, but I know people can be pretty uptight about butt stuff.
posted by roger ackroyd at 3:14 PM on January 16, 2019 [2 favorites]

Yeah this highly depends on what they're giving you, your level of current abdominal pain, and how well you can relax during a procedure. For example I've been under general anesthesia twice and sedation more than a few times. No severe reactions to any though each were different - but I can tell you that I forsure had propofol for my colonoscopy and woke up feeling like I had the best sleep of my life. It was wonderful.

I can also tell you I woke up in the middle of an upper endoscopy (allergic reaction to a med) and I found the feeling of the scope severely uncomfortable but it was down my throat and not up my butt.

But it's certainly reasonable to opt for another medicaiton like Valium or something instead. However you will want to call as soon as possible as they would likely want you to pick up a RX before your procedure so you can take it with enough time for it to start to take effect.
posted by Crystalinne at 3:19 PM on January 16, 2019

Do you play videogames? I'm going to use a videogame metaphor: the cutscene. Cutscenes are mini-movies where suddenly you can't do anything inside videogames. They are often so annoying that you will have a "skip cutscene" option, asnd suddenly you're back in control of the game.

I had a colonoscopy that started without sedation, because I also hate sedation. Apparently, colonoscopies are worse if you are tiny (check) and a (cis) woman (check) because it means your intestines make more/tighter turns.

I tapped out after 5 minutes because, while it wasn't unbearable by any means, it was also distinctly unpleasant. Why was I doing this to myself when I could 'skip cutscene'?

I also have, per my hand surgeon and occupational therapist, an unusually high pain tolerance.
posted by flibbertigibbet at 3:25 PM on January 16, 2019 [3 favorites]

My anatomy teacher famously regaled us of stories of her insisting on being conscious and observing her colonoscopy, and passed around the pictures. Her take was that it was uncomfortable in a “ I can feel things snaking around in a different way than I’ve ever felt before.” but not overtly painful. Nthing the talk to your doctor beforehand. It is absolutely not unheard of for people to wake up swinging, and that’s the kind of thing you want in your chart.theyll be more than happy to work with you on alternatives
posted by jacy at 3:45 PM on January 16, 2019

I've had colonoscopies both ways: with and without. I understand why you want without. With was going on 25 years ago in the States, so I wonder if techniques and equipment have changed. Without was about 4 years ago? (Time to schedule another one. Thank you family history!) This was in Japan, so techniques may differ. I was wide awake. IIRC I didn't even get a valium or anything. But the way they did it was that the assistant helped me turn from side to side to on my back as needed to help get around the twists and turns. This may be the local practice and seemed to work. They want you awake to be cooperative. I would be curious to know if that is also what happens elsewhere.

Let them know that you really do not want to hurt them or yourself and that is why you do not want. But, I'd suggest calling and having that convo now--not on the day. If they are set up for 100% sedating people, you may have to cancel, so earlier is better. Good luck!
posted by Gotanda at 3:53 PM on January 16, 2019

A friend of mine with colitis and a whole bunch of drug allergies gets them done without sedation. She described it as bearable but she encourages that you make sure the person doing the procedure communicates with you well.
posted by Ashwagandha at 3:59 PM on January 16, 2019

Hi! I’m a nurse who works in endoscopy. I’ve taken care of literally thousands of people before and after their colonoscopies. The drug most commonly used is propofol and propofol alone - it’s unusual to give fentanyl or Demerol for a colonoscopy. I have never had anyone, literally not one, wake up aggressive/combative after a colonoscopy. I’ve witnessed ONE person get sick after receiving propofol - it has anti-emetic properties, so that’s extremely rare.

We have maybe one person every few months undergo a scope with no sedation. It’s literally a non-issue. We don’t have to change our set up and no one gets flustered.

If you are a small ciswoman, especially one who’s given birth or had abdominal surgery, it’s possible the scope will be harder to pass through your bowel. This will be more painful for you. Whether or not it’s something you can bear while fully awake depends on your pain tolerance.

Feel free to MeMail me with any questions. Good luck, whatever you decide!
posted by pecanpies at 4:06 PM on January 16, 2019 [30 favorites]

I can't speak to a colonoscopy but it is ALWAYS appropriate to discuss whether sedation is necessary before every procedure, and to talk about prior negative experiences with sedation. My experience is that in the US doctors use sedation in more procedures than other countries because sedation is generally safe and there is a risk that a patient may be more sensitive than others and may need to stop the procedure due to pain, which is less than ideal for patients, or that the negative experience of getting a colonoscopy will prevent them from getting the procedure in the future. According to this review of 1.4 million colonoscopies done in the US, general anesthesia is becoming more common but the majority of practices still use a combination of midazolam & fentanyl.
posted by muddgirl at 4:29 PM on January 16, 2019 [1 favorite]

My sedation for colonoscopies has varied. I've had three. The first two I was awake enough to follow at least some of the scope's travel and hear everything going on, but felt no pain or discomfort at all. The third one I slept through from start to finish.

I've had a few other surgeries and procedures that required anaesthesia and have never had a problem with it. In fact, the very first time I went under, waking up was one of the most pleasant experiences I remember.
posted by lhauser at 4:38 PM on January 16, 2019

I've had a colonoscopy where the sedation didn't work, and it was agony.

I was fully conscious, in agony, and begging them to stop or slow down the entire time.

The experience was genuinely as traumatising as being sexually assaulted.

Get the sedation.
posted by Murderbot at 4:41 PM on January 16, 2019

Just to correct some misinformation: propofol is not “general anesthesia.” General anesthesia refers to the administration of inhaled gasses that render the patient unresponsive to stimuli and unable to breathe independently. Outpatient colonoscopies are not done under general anesthesia (with perhaps extremely rare exceptions that do not apply to you.)
posted by pecanpies at 5:04 PM on January 16, 2019 [3 favorites]

I’ve never had sedation. It’s not fun, but it’s certainly bearable. YMMV.
posted by Ideefixe at 5:12 PM on January 16, 2019 [1 favorite]

I kind of did this. Being drugged or confused scares me more than being embarrassed and uncomfortable.

The attending nurse said he'd give me a minimal dose, as things can be uncomfortable, and a tiny bit of anti-anxiety meds to keep me chill. He also said he could boost the meds right there in my IV if it wasn't enough. I got propofol and versed in very small amounts and was conscious. He and I chatted about his son's upcoming prom plans while things proceeded uhhh behind me. Other than the point of entry, he said you're unlikely to feel anything unless there's an unusual bendy bit, which I found to be the case.
posted by Ink-stained wretch at 5:13 PM on January 16, 2019

Sedation for my recent colonoscopy went like this: Doctors and nurses prepping me, a doctor telling me I was going to start feeling sleepy, and then what felt like a few seconds later I turned my head to the doctor and said, "The sedation isn't working, I am still awake." He immediately said, "You're done!" I had no sensations or understanding that I "went under" and then "came out of it". It was smooth as silk, absolutely effortless. The one other time I was under sedation was years ago for my wisdom and I had an emotional reaction when I came out of it, I sobbed like a baby for no reason. I have no idea which drugs were used for either of the experiences.
posted by molasses at 5:24 PM on January 16, 2019

I've had them both ways. Times when I had propofol only sedation I felt great immediately after and had no trouble with the sedation at all, except that I had to bring a chaperone to pick me up. My one bad experience was when I was having a colonoscopy+endoscopy; I think I got propofol + Versed or possibly Versed only, and required an increased dose because of getting antsy during the endoscopy, and was snowed for the rest of the day, which really sucked.

With regard to the scopes I've had entirely without sedation, they are generally... fine. Yes you feel something going up your butt. If you're used to that sensation, it's no worse than anything else. The worst part is when air is puffed into the bowel in order to make it easier to visualize; I had maybe 60 seconds of my last scope when I had to really grit my teeth and focus on my breathing because I felt so full of air that it was like a very, very bad cramp.

The other thing to be aware of is your tolerance for being completely unmedicated in the event that a procedure is required, e.g. removal of a polyp. A good compromise might be to have an IV placed so that you can get sedation if you need it but otherwise plan on going without.
posted by telegraph at 5:35 PM on January 16, 2019

A relative had his without sedation so he could watch it happen on the screen and see how it worked. He got to ask the doctor a lot of questions and had a great time telling us all about it. He said “going around corners” made him want to jump, though. Second-hand, but highly recommended overall.
posted by michaelh at 8:06 PM on January 16, 2019 [1 favorite]

Propofol sedation is amazing. I woke from my colonoscopy & endoscopy (both in same session) feeling better than I'd ever felt before. Like, it was the best sleep in ever.

It sounds like whatever they used for sedation doesn't suit you. Hopefully they can use something else (propofol for the win!)

I was terrified of having one beforehand, now if you said I had to have one every month I'd be quite thrilled.
posted by kitten magic at 8:35 PM on January 16, 2019 [1 favorite]

Sedation for colonoscopy isn't standard in Europe.
FWIW The Canadian Task Force for Preventative Health recommends AGAINST colonoscopy for routine screening.
posted by Violet Hour at 9:36 PM on January 16, 2019 [1 favorite]

Recently had one (on a watch-list), care of NHS. Cannula in hand/wrist to deliver an anti-spasmodic as necessary, and 'gas and air' to manage discomfort. The former is to assist the medic performing the procedure, in terms of what they're exploring; the latter is for the benefit of the patient. Didn't use it, thanks to the skill of the consultant who was in charge.
posted by davemack at 8:00 AM on January 17, 2019

I have malignant hyperthermia, meaning I am allergic to many anesthetics.

I had my second colonoscopy in my life just last Friday, and it was fine. I was groggy when I got done and fine after a few hours. The great thing is that I was out before I even was on the operating table, and it felt to me like I was only out for a minute. I do NOT recommend being awake.

Speak with the anesthesiologist and let them know your concerns, and they may have other options for you.

For me the prep is the worse part of the procedure, but that the prep is better now than is was in 2004 when I had my first.

Good luck!
posted by terrapin at 8:31 AM on January 17, 2019 [1 favorite]

I've had multiple scopes with sedation and with general. Neither were a big deal. The thing that's inconvenient is that you have to have someone known to take you home because of liability (can't take a cab).
A friend of mine had to get a scope and he couldn't arrange a ride, so he insisted on no drugs. They were surprised and stressed the discomfort. He replied that he was gay and quite used to having things up his ass. He said it wasn't a big deal and that he found it hilarious when they blew air up his ass as part of the process.
posted by plinth at 6:08 PM on January 17, 2019

Had the colonoscopy today. Talked to the doctor & we compromised instead of a complete knock out I just got a light sedative to relax me, was mostly conscious during the whole thing but relaxed in a sleepy I've had a bit too much to drink & should call a cab kind of way. There was a little discomfort but no worse than bad gas. Drinking the stuff to flush you out was by far the worst part. Double plus good not a polyp in sight so I'm good for the next 10 years by which time I hope they make a prep solution that tastes better.

Thank you everyone that responded & giving me the knowledge to know there were options. Even if I didn't mark your answer as a "best answer" all your tales made something that was giving me anxiety a lot less scary so thanks.
posted by wwax at 4:28 PM on January 18, 2019 [7 favorites]

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