Health Matters: At what age should people consider getting a colonoscopy?
Dr. Schnoll-Sussman: We typically start screening people for colon cancer at 50 years of age, unless you have a family history of colon cancer or a genetic predisposition to colon cancer. If you have a first-degree relative with colon cancer, we start screening 10 years younger than the age at which they were diagnosed, or at 40 years old, whichever comes first.
Why is it important to have one?
Colonoscopies are both diagnostic and therapeutic. At the time of a colonoscopy, polyps can be identified and removed. We know the precursor lesion for colon cancer is the colon polyp. The ability to remove polyps during a colonoscopy has been proven to decrease mortality from colon cancer.
How do you recommend people prepare for the procedure?
A week before the procedure
The preparation for a colonoscopy is extremely important. The key to a successful procedure is cleaning the colon of all stool so that all polyps and other abnormalities can be easily identified. There are several things you may need to do starting as early as a week before the procedure. You may need to stop taking or change the dose of some of your medications. Certain medications such as blood thinners and antioxidants need to be stopped a few days prior to the procedure. If you take insulin or other medications for diabetes, you may need to change the dose. Based upon your personal medical history, you may require a clearance letter from your internist or cardiologist.
Some modifications in your diet should also be made a week prior to the procedure. This is especially important if you have had an issue with a poor colonoscopy preparation in the past. Starting one week before your colonoscopy, you should limit the intake of seeds (such as poppy or sesame), whole kernel corn, and raw fruits and vegetables. Canned or cooked vegetables are OK.
A few days before
You should buy all of the medications and supplies you will need for the examination — this will avoid any last-minute trips to the pharmacy or grocery store the night before your procedure. If you are usually constipated or have had a poor prep for a previous colonoscopy, you should start on a full liquid diet two days prior to the procedure. This includes yogurt (plain or blended without pieces of fruit), broth or strained cream soups, ice cream and fruit ices (without pieces of fruit), pulp-free fruit juices, nutritional liquid supplements, and all clear liquids.
The day before
You will be on a clear liquid diet (you should be able to read a newspaper through it) and ingest the prep medications according to the instructions given to you by your doctor. You will be going to the bathroom, a lot, so be kind to your backside and buy soft toilet paper, flushable premoistened wipes, and petroleum jelly or A+D ointment to apply to your bottom to protect it from getting irritated.
Are there foods I should avoid in the days before my colonoscopy? What foods do you recommend?
Probably the most important thing is to not overeat the few days before the procedure. Many people are so concerned over the prep and the need for a liquid diet that they over-indulge before the preparation. This will just make the preparation more difficult and potentially less effective. In general, a few days before the procedure, patients should limit their intake of seeds, raw vegetables, and whole kernel corn. These may be difficult to pass with the prep. I recommend a lower fiber diet and lots of fluids to keep you hydrated.
How does the “prep drink” work? Is there an alternative prep drink or a new one being developed?
There are multiple prep options that your physician may prescribe to clean out the colon. There have been many studies comparing the efficacy of one against the other. The most important thing is to try your best to follow your doctor’s instructions carefully and complete the entire preparation as prescribed. In general a 5’1” female requires the same amount of preparation as a 6’4” male. If she has a tendency toward constipation, she may actually require more. There are novel preps that are being evaluated, including a cleansing system using gentle infusion of warm, gravity-flow, filtered water infused into the colon in place of ingestion of laxatives.
Are there some key color foods or liquids to avoid during the prep? If so, why?
We recommend for people to avoid drinking red or dark purple liquids. This is because the red/dark purple can look like blood if not totally cleared from the colon while prepping.