Colonoscopy - pain anecdata
June 3, 2021 6:00 PM Subscribe
My doctors don't want to do it without general anesthesia - experiences please
My preference would be to do it conscious, with pain drugs but without general anesthesia. This might or might not be possible--they didn't want to. My question is: how miserable is it, if you have done this or someone you know has? Do I really really want to go under for this? Thanks.
My preference would be to do it conscious, with pain drugs but without general anesthesia. This might or might not be possible--they didn't want to. My question is: how miserable is it, if you have done this or someone you know has? Do I really really want to go under for this? Thanks.
I've never had one with a general. Why are they saying that's what they'd like to do? Have you had a colonoscopy before? If you don't want a general, it's a trivial matter to find a doctor who will do one where you are sedated but not knocked out. This is generally an easy procedure, and if you're of a mind to, it's fun to watch live!
posted by QuakerMel at 6:11 PM on June 3, 2021 [1 favorite]
posted by QuakerMel at 6:11 PM on June 3, 2021 [1 favorite]
I was not under general anesthesia for mine, but it some type of the sort of "deep sedation" drugs they use for removing wisdom teeth, cataract surgery, and other similar outpatient procedures. I remember counting backward from 100, getting to 97 and then them telling me the procedure was over.
posted by gatorae at 6:13 PM on June 3, 2021 [2 favorites]
posted by gatorae at 6:13 PM on June 3, 2021 [2 favorites]
I have a friend who did it without sedation and said NEVER AGAIN. Apparently it was super, super unpleasant, although I didn’t ask her for details. I’ve actually never heard of a colonoscopy done under general anesthesia — just propofol and fentanyl or what have you.
posted by holborne at 6:18 PM on June 3, 2021 [3 favorites]
posted by holborne at 6:18 PM on June 3, 2021 [3 favorites]
I've only done it under sedation. The first time I was awake enough to watch the monitor; the second time I fell asleep.
posted by lhauser at 6:31 PM on June 3, 2021
posted by lhauser at 6:31 PM on June 3, 2021
My doc also wouldn't do it without twilight sedation, because of how frequently patients get overwhelmed or panic during the procedure if they are on pain meds only. I went ahead with the sedation (though I dislike not being conscious/in control, and go without for dental extractions), I have no memory of the procedure. This is in Australia, for reference.
posted by third word on a random page at 6:47 PM on June 3, 2021 [1 favorite]
posted by third word on a random page at 6:47 PM on June 3, 2021 [1 favorite]
I didn't have a coloscopy but a similar procedure where I had an option of twilight sedation. To be clear: the pain drugs are the sedation. There is really nothing else they can offer. It can take more skill and a bit more time to minimize painful manouvers which may be why your doctors don't want to do it.
My procedure is an interesting one because hundreds of thousands of people undergo the same procedure every year without sedation in local clinics, but the provider who did mine in a hospital discouraged doing it without sedation. I think there is a (valid) philosophy that if you can avoid the pain with minimal side effects, then why not? But as the patient that is your decision to make.
posted by muddgirl at 6:58 PM on June 3, 2021
My procedure is an interesting one because hundreds of thousands of people undergo the same procedure every year without sedation in local clinics, but the provider who did mine in a hospital discouraged doing it without sedation. I think there is a (valid) philosophy that if you can avoid the pain with minimal side effects, then why not? But as the patient that is your decision to make.
posted by muddgirl at 6:58 PM on June 3, 2021
I've had several colonoscopies, all with twilight sedation. But, there was one office (never going there again!), that skimped on the sedation - I suspect because it was toward the end of the day and they wanted to get me out and go home. So, I started to come out of the sedation while the procedure was still going on. It felt like I was being impaled on a pole (which I sort of was; do not recommend!). The next time I used a different doctor and had it done at a hospital. Still twilight sedation but I had a long talk with the anesthesiologist about that bad experience and it was not repeated and I felt nothing.
posted by gudrun at 7:05 PM on June 3, 2021 [1 favorite]
posted by gudrun at 7:05 PM on June 3, 2021 [1 favorite]
Did it recently, fully sedated. Got pics afterwards so I didn't feel like I missed any of the good parts. Honestly, I would be more concerned about which laxative they give you.
posted by brookeb at 7:13 PM on June 3, 2021 [2 favorites]
posted by brookeb at 7:13 PM on June 3, 2021 [2 favorites]
I have IBD and get a colonoscopy every three years (it used to be every two) - so I've had about 15 of them done. I have no meds - not sedation, and certainly not general anaesthetic. I prefer to drive myself to and from the hospital (in Canada), rather than trying to arrange someone to get me after the procedure. I've also had an endoscopy with no meds except a numbing spray for the throat to allow the endoscope down (for hiatal hernia diagnosis). They are comparatively uncomfortable, though the colonoscopy is a longer procedure. I have never heard of anyone being told that general anaesthetic is required, nor even recommended. Frankly, the risks of general anaesthesia seem totally out of proportion to any advantage over sedation. Whenever I go, there are plenty of other patients getting prepped, and I am a definite outlier in refusing sedation. However, I would absolutely be getting a second opinion about your procedure - and a DETAILED explanation of why they are saying you need to be knocked out for an outpatient procedure.
posted by birdsquared at 8:48 PM on June 3, 2021
posted by birdsquared at 8:48 PM on June 3, 2021
My sister had a chronic medical condition that required her to get a LOT of colonoscopies for several years. She also, without a doubt, has a the highest pain/discomfort tolerance of anyone I have ever met. Using any sort of sedation is pretty inconvenient for her because she has a job where she isn't allowed to return to work for quite a while after being sedated, so she was highly motivated to do these colonoscopies without sedation. After having 4 or 5 colonoscopies in one year, she eventually convinced her doctor to do one without sedation so she could go back to work the next morning. She says it was one of the most uncomfortable and awkward experiences of her entire life and that she would never even consider doing it again. Based on the other things my sister is 100% fine doing without sedation or pain medication, I think you almost certainly do want to be sedated for this.
I agree with the other posters though, this probably isn't going to be done under general anesthesia, just sedation. If for some reason this is actually going to be done with general anesthesia, you can probably look around for another provider who uses something less powerful.
posted by mjcon at 8:54 PM on June 3, 2021 [5 favorites]
I agree with the other posters though, this probably isn't going to be done under general anesthesia, just sedation. If for some reason this is actually going to be done with general anesthesia, you can probably look around for another provider who uses something less powerful.
posted by mjcon at 8:54 PM on June 3, 2021 [5 favorites]
Not a colonoscopy, but I have had minor surgery (a mole removal) done with only localized anaesthetic, and while that + pain meds meant I didn't feel any pain, it did not mean that I didn't feel anything. The sensation of having my skin cut into like that, even pain-free, was deeply unsettling and I feel like a colonoscopy could be very similar. Unless you actually have reason to know you won't find the sensation of the procedure itself upsetting, I'd go with sedation at minimum. Pain isn't the only uncomfortable part of the process.
posted by augustimagination at 9:14 PM on June 3, 2021
posted by augustimagination at 9:14 PM on June 3, 2021
I’m thinking that maybe there’s some confusion here over what “general anesthesia” means. As nantucket noted above, “general anesthesia” means that you’re given anesthesia where you’re completely unconscious and can’t breathe on your own without assistance; with sedation, you’re not quite fully unconscious in the same sense you’re not fully unconscious when you’re asleep — for example, if someone punches your arm hard when you’re asleep, you wake up — and you still breathe without assistance.
OP, are you saying they want to actually use actual general anesthesia, or are you saying that they just want to sedate you so you’re not aware of what they’re doing?
posted by holborne at 9:16 PM on June 3, 2021
OP, are you saying they want to actually use actual general anesthesia, or are you saying that they just want to sedate you so you’re not aware of what they’re doing?
posted by holborne at 9:16 PM on June 3, 2021
My question is: how miserable is it, if you have done this or someone you know has? Do I really really want to go under for this? Thanks.
The prepwork required is (by far) the most miserable part of the procedure and there's no getting around that no matter what kind of anesthesia you get. Sorry.
posted by space_cookie at 9:21 PM on June 3, 2021 [6 favorites]
The prepwork required is (by far) the most miserable part of the procedure and there's no getting around that no matter what kind of anesthesia you get. Sorry.
posted by space_cookie at 9:21 PM on June 3, 2021 [6 favorites]
I've know people that have had them done without anesthetic in Australia and said it was like having bad gas cramps, but when when I moved to the US and had to had one I had to fight tooth and nail to stop the doctor bulldozing me into using anesthesia as I have bad reactions to it and wanted to avoid them.
Colonoscopy's can be done with it but they take longer as the doctors have to go slower and more carefully, which takes time and skill. Apparently my doctor had neither, the first twinge of discomfort before I could do more than tense slightly and get used to what was going on the doctor knocked me out against my will with twilight anesthesia, according to the nurse who faced my wrath afterward I was the last job of the day and the doctor was in a hurry. You're not drugged for your sake you're drugged for the doctors sake, it's faster as they don't have to take care or deal with embarrassed patients.
Whatever anyone tells you about the prep work, the pooping isn't the worst part it's the damn horrible tasting stuff you have to drink my body kept wanting to throw it back up so
posted by wwax at 9:42 PM on June 3, 2021 [1 favorite]
Colonoscopy's can be done with it but they take longer as the doctors have to go slower and more carefully, which takes time and skill. Apparently my doctor had neither, the first twinge of discomfort before I could do more than tense slightly and get used to what was going on the doctor knocked me out against my will with twilight anesthesia, according to the nurse who faced my wrath afterward I was the last job of the day and the doctor was in a hurry. You're not drugged for your sake you're drugged for the doctors sake, it's faster as they don't have to take care or deal with embarrassed patients.
Whatever anyone tells you about the prep work, the pooping isn't the worst part it's the damn horrible tasting stuff you have to drink my body kept wanting to throw it back up so
posted by wwax at 9:42 PM on June 3, 2021 [1 favorite]
It's not like they put you under for surgery. It's more like being asleep and then when you wake up you don't remember it. For reference, when I had my tubes tied, I was definitely under and had to wake up. When I had my colonoscopy, I was sort of awake but not really. I never felt a thing and I wish they could give me the drugs indefinitely. The last time I did it, I didn't drink the prep stuff right and now I have to do it again. Yay, me.
posted by Marie Mon Dieu at 9:50 PM on June 3, 2021
posted by Marie Mon Dieu at 9:50 PM on June 3, 2021
You know colonoscopy is just a benzo, not general anesthesia, right.
posted by Marie Mon Dieu at 10:03 PM on June 3, 2021
posted by Marie Mon Dieu at 10:03 PM on June 3, 2021
General anesthesia: delivered via IV - requires an anesthesiologist and a tube down your throat for breathing. Unconscious. Cannot breath on your own. Used in more major surgery. Often feels like you missed no time.
IV Sedation / Twilight Sleep: IV drugs administered by an anesthesiologist. Usually something like propofol. You are asleep, like bed time sleep, often dreaming - or hallucinating - but you don’t remember because it has an amnesiac affect. You can wake up or become “too light”. You can also usually answer questions and move on your own but may not remember. It often feels like you took a heavy nap. Often used for dental work, scopes, minor surgery, etc.
Oral Sedation / pills: those are benzos or other anxiety pills. Often promoted in dentistry. (We do oral sedation dentistry = we give you a big dose anxiety pill to take.) Usually takes the edge off. May cause drowsiness or sleep. Anesthesiologist isn’t required.
All forms of sedation require someone to drive you. (Local anesthesia or numbing isn’t quite applicable to your entire colon. So a shot to numb an area for biopsy / stitches isn’t the same application.)
Usually a colonoscopy or scope is done with IV sedation or pills. I’ve only done scopes and major dental work with IV sedation. I have some some dental work with some benzos because of my anxiety / health problems.
I personally would never do a scope without IV sedation (which again, is not general anesthesia). I woke up during a stomach scope because of an allergic reaction to a different medication. It was - uncomfortable.
Some people can tolerate that stuff well. Some doctors are very gentle. I am not one of those people.
Talk with them about 1) what the form of sedation is / what medications and side effects 2) any concerns you have 3) if they can administer sedation if you change your mind
posted by Crystalinne at 11:51 PM on June 3, 2021 [3 favorites]
IV Sedation / Twilight Sleep: IV drugs administered by an anesthesiologist. Usually something like propofol. You are asleep, like bed time sleep, often dreaming - or hallucinating - but you don’t remember because it has an amnesiac affect. You can wake up or become “too light”. You can also usually answer questions and move on your own but may not remember. It often feels like you took a heavy nap. Often used for dental work, scopes, minor surgery, etc.
Oral Sedation / pills: those are benzos or other anxiety pills. Often promoted in dentistry. (We do oral sedation dentistry = we give you a big dose anxiety pill to take.) Usually takes the edge off. May cause drowsiness or sleep. Anesthesiologist isn’t required.
All forms of sedation require someone to drive you. (Local anesthesia or numbing isn’t quite applicable to your entire colon. So a shot to numb an area for biopsy / stitches isn’t the same application.)
Usually a colonoscopy or scope is done with IV sedation or pills. I’ve only done scopes and major dental work with IV sedation. I have some some dental work with some benzos because of my anxiety / health problems.
I personally would never do a scope without IV sedation (which again, is not general anesthesia). I woke up during a stomach scope because of an allergic reaction to a different medication. It was - uncomfortable.
Some people can tolerate that stuff well. Some doctors are very gentle. I am not one of those people.
Talk with them about 1) what the form of sedation is / what medications and side effects 2) any concerns you have 3) if they can administer sedation if you change your mind
posted by Crystalinne at 11:51 PM on June 3, 2021 [3 favorites]
I get colonoscopies every five years or so as there is a family history of bowel cancer. I've never been offered general anaesthetic, only whatever they stuck into the back of my hand. That works ok although I can get a bit of breakthrough cramping as a result of the air they fill you with, and sometimes when they go round a bend and have to twist the camera around. It's bearable even when it does get uncomfortable.
I'm in the UK.
posted by Martha My Dear Prudence at 12:38 AM on June 4, 2021
I'm in the UK.
posted by Martha My Dear Prudence at 12:38 AM on June 4, 2021
I have a friend who had one recently without sedation (he lives alone and doesn't drive, is generally very independent, and felt it was logistically more straightforward to be able to get home via public transport without needing a driver/escort). I don't think it was a super pleasant experience but he seemed to think it was worth it to avoid the hassle of getting his sedated self home afterwards.
posted by terretu at 12:57 AM on June 4, 2021 [1 favorite]
posted by terretu at 12:57 AM on June 4, 2021 [1 favorite]
In the US, normally it's Propofol, which is a Benzo, and yes, it does cause forgetfulness, which in my case, I think it's a good thing. It's not a big deal at all, and it's a very good thing to do. If you can't drive yourself, there are many options to help you get home.
posted by Marie Mon Dieu at 1:04 AM on June 4, 2021
posted by Marie Mon Dieu at 1:04 AM on June 4, 2021
I’ve had a few colonoscopies now and a general has never been offered so like others have said, I’m wondering if you’re confusing it with twilight sedation? Either way, I would definitely take them up on sedation, this is not a procedure you want to remember! Best of luck.
posted by Jubey at 2:37 AM on June 4, 2021
posted by Jubey at 2:37 AM on June 4, 2021
Propofol is not a benzodiazepine. It is an “iv sedation hypnotic”. OP, get a clear list from your doctor about the options available to you, the class of medications, and what options are available if you change your mind. I’m all for being under IV sedation as I said.
posted by Crystalinne at 3:48 AM on June 4, 2021 [2 favorites]
posted by Crystalinne at 3:48 AM on June 4, 2021 [2 favorites]
In my one and only colonoscopy (so far) I was put under. As in "one moment I was awake, then I got really drowsy, then I woke up in recovery." I have no idea what twilight sedation is like, but what I experienced was exactly like every other time I was put under for surgery.
posted by Thorzdad at 4:39 AM on June 4, 2021
posted by Thorzdad at 4:39 AM on June 4, 2021
I just had one a couple of weeks ago, no anaesthetic or sedation, I had gas & air (aka entonox) plus fentanyl. Much of it was totally fine and not even uncomfortable. A few bits were very painful and I had both doses of the fentanyl on offer when that happened. Either the fentanyl, or the scope making it past an awkward corner, made it OK again.
I think if I could rewind for my first procedure I'd do the same again. It was really fascinating to see inside myself and the nurses looking after me were incredibly lovely, their TLC was actually the best bit of the whole thing and it would have been a shame to miss it! The pain was bad (like, the second wave was 'screwing your eyes shut, suddenly stopping talking and sticking your arm out so they could get the fentanyl in as quickly as possible bad) but I survived it. Maybe if I had to do it again, having already seen my innards, I'd go for sedation, I'm not sure.
In the UK the standard choice you're presented with is between sedation+entonox or just entonox. I declined the sedation because I figured it would be more for my body to recover from, and I live alone and couldn't face the upheaval of finding a way to have someone with me for 24 hours afterwards, which is required. It was only when I got into the procedure room they said they could also give me a cannula in case I wanted fentanyl during the procedure. Don't know why they didn't mention that ahead of time, my first thought was that they wanted to satisfy themselves I wasn't an opiate addict before bringing it up but I suspect it was just as likely NHS procedures not catching up with practice.
Anyway. From all my reading beforehand, what I learned is that it seems to be one of those things where everyone's experience is different, which is not much help.
posted by penguin pie at 4:58 AM on June 4, 2021 [1 favorite]
I think if I could rewind for my first procedure I'd do the same again. It was really fascinating to see inside myself and the nurses looking after me were incredibly lovely, their TLC was actually the best bit of the whole thing and it would have been a shame to miss it! The pain was bad (like, the second wave was 'screwing your eyes shut, suddenly stopping talking and sticking your arm out so they could get the fentanyl in as quickly as possible bad) but I survived it. Maybe if I had to do it again, having already seen my innards, I'd go for sedation, I'm not sure.
In the UK the standard choice you're presented with is between sedation+entonox or just entonox. I declined the sedation because I figured it would be more for my body to recover from, and I live alone and couldn't face the upheaval of finding a way to have someone with me for 24 hours afterwards, which is required. It was only when I got into the procedure room they said they could also give me a cannula in case I wanted fentanyl during the procedure. Don't know why they didn't mention that ahead of time, my first thought was that they wanted to satisfy themselves I wasn't an opiate addict before bringing it up but I suspect it was just as likely NHS procedures not catching up with practice.
Anyway. From all my reading beforehand, what I learned is that it seems to be one of those things where everyone's experience is different, which is not much help.
posted by penguin pie at 4:58 AM on June 4, 2021 [1 favorite]
Last time I had a colonoscopy, it was a combination endoscopy/colonoscopy. Twilight sedation. I remember being asked to turn on my side. They fit some kind of guard in my mouth that would keep it open while they slipped the scope in. Next thing I knew, I woke up in recovery. After I got home, I ate half a sandwich and took a long nap.
posted by emelenjr at 8:25 AM on June 4, 2021
posted by emelenjr at 8:25 AM on June 4, 2021
Why don't you want to be unconscious? Il'll share my experience in case it's relevant.
I had a pretty crummy experience with twilight sedation the first time it was used on me. The disturbing feeling of having lost time (somewhat akin to being blackout drunk, with the accompanying anxiety) lingered for days and days afterwards. The next time I had twilight sedation, I told the anesthesiologist (different office) about my bad experience, he asked me a few questions and tweaked the mix somehow, and the experience was absolutely fine.
posted by desuetude at 8:57 AM on June 4, 2021
I had a pretty crummy experience with twilight sedation the first time it was used on me. The disturbing feeling of having lost time (somewhat akin to being blackout drunk, with the accompanying anxiety) lingered for days and days afterwards. The next time I had twilight sedation, I told the anesthesiologist (different office) about my bad experience, he asked me a few questions and tweaked the mix somehow, and the experience was absolutely fine.
posted by desuetude at 8:57 AM on June 4, 2021
Response by poster: I'm sorry, I guess I was using the wrong term. They use propyphol, which I suppose is twilight, not general.
posted by Sterros at 12:17 PM on June 4, 2021
posted by Sterros at 12:17 PM on June 4, 2021
I (voluntarily) skipped the twilight anesthesia because I wanted to watch the process (how often do you get to see inside your body?). They warned me that about 25% of people feel pain and to let them know if I was. It was slightly uncomfortable at first, but when they hit the first turn, it became painful. I grimaced and they had me out in seconds. You can always tell them you don't think you want it but you'd like it to be available should you discover you're in pain.
posted by zug at 2:26 PM on June 4, 2021 [1 favorite]
posted by zug at 2:26 PM on June 4, 2021 [1 favorite]
I had a couple colonoscopies done with me completely out (following a bad experience with twilight sedation). However, my gastro convinced me to try twilight again for my latest and (echoing desuetude’s experience above) with some tweaks to the meds, I had a great experience. I’ll be doing twilight again for my followup this year.
My first twilight sedation experience wasn’t great but it was more due to the aftermath of the med than discomfort during the procedure—but there was some memorable discomfort. I would not want to be fully conscious.
posted by pepper bird at 4:09 PM on June 4, 2021
My first twilight sedation experience wasn’t great but it was more due to the aftermath of the med than discomfort during the procedure—but there was some memorable discomfort. I would not want to be fully conscious.
posted by pepper bird at 4:09 PM on June 4, 2021
Ooh, something I can answer! They gave me fentanyl and Midazolam for conscious sedation. I did feel some discomfort toward the end of the procedure, but it wasn't that bad. They ended up giving me 7 syringes of the sedation meds. I remember saying I was feeling some pain and the doctor said they were almost done and to just hang on. With the meds I just didn't really care what was going on so I wasn't traumatized or anything. I remember the discomfort but it was not that bad. Notes said: "Recommend future colonoscopies with MAC due to patient tolerance to medications." MAC is monitored anesthesia care. In the future I would feel like I would not need general anesthesia.
posted by Billy Rubin at 10:54 PM on June 4, 2021
posted by Billy Rubin at 10:54 PM on June 4, 2021
I had it done at age 69 without sedation of any kind. The air that gets pushed up along with the scope is a little bit cramping. I drove there and back on my own. As others have said, the prep (and all that it involves) is a million times worse than the procedure.
posted by andreap at 11:05 AM on June 5, 2021
posted by andreap at 11:05 AM on June 5, 2021
The first time I was out from propofol was for an endoscopy. My first thought upon waking up: Best nap ever!!!
I’ve had two minor surgeries this year alone using propofol. Was chatting with the anesthesiologist as they wheeled me in, I thanked everyone in the operating room, he added the stuff to my IV. 1-2 seconds later I’m out. Woke up in other room.
Best to take a nap afterwards, but other than that, you should be good.
posted by Neekee at 8:39 PM on June 5, 2021
I’ve had two minor surgeries this year alone using propofol. Was chatting with the anesthesiologist as they wheeled me in, I thanked everyone in the operating room, he added the stuff to my IV. 1-2 seconds later I’m out. Woke up in other room.
Best to take a nap afterwards, but other than that, you should be good.
posted by Neekee at 8:39 PM on June 5, 2021
My partner had a colonoscopy with no meds at all and found it uncomfortable but fine. He would not take meds next time. He has a generally extremely high pain tolerance (e.g., sometimes cuts/injures himself without noticing). If this sounds like you, maybe you'd be fine too.
posted by Frenchy67 at 7:13 AM on June 8, 2021
posted by Frenchy67 at 7:13 AM on June 8, 2021
This thread is closed to new comments.
The experience of twilight/conscious sedation might feel similar to general anesthesia afterwards, because an effect of the drugs is that often you don't remember the procedure. But you're not as deeply sedated during the procedure itself, it can be done with a colonoscopy nurse instead of an anesthesiologist supplying the sedation, and you're able to breathe on your own. It is much safer than general.
A close friend had a colonoscopy with no sedation at all and found it very unpleasant. They said they would not do it again without the usual twilight sedation.
posted by nantucket at 6:11 PM on June 3, 2021 [8 favorites]