Are you afraid of a colonoscopy? Let's talk about this simply.

Has your doctor told you to have a colonoscopy? You may have felt a little scared and nervous when he said that. It's normal to think things like, "What is this? Will it hurt? I don't know what to do." But this is really nothing to be afraid of. This is a very important test for your health, especially to protect you from serious diseases like colon cancer. Today, we'll talk about this very simply, in a way that you can understand, as if you were talking to a friend.

Simply put, what is a colonoscopy?

Imagine that the doctor wants to see something inside your body that you can't see from the outside. A colonoscopy is just that. It examines the inside of your large intestine , which is the large intestine and its connected rectum and anus.

This is done using a very thin, flexible tube. There is a small camera and a light at the end of this tube. We call this instrument a 'colonoscope'. This tube is inserted through your anus and slowly passed up your large intestine. The doctor can then watch the images from the camera on a large screen. It's like watching a TV show inside your colon. This is actually a type of test called an endoscopy . An endoscopy is any test that involves inserting a tube with a camera inside your body.

Why do we need to have a colonoscopy?

There are three main reasons for having a colonoscopy. Sometimes all three of these reasons can be met in a single test.

1. Prevention and Early Detection (Screening): Detecting a disease that may develop in the future, especially colon cancer, without any symptoms.

2. Diagnosis: Find the exact cause of a symptom you are already experiencing (e.g. stomach ache, blood in the stool).

3. Treatment: If any problem is found during the examination, treat it on the spot.

Let's look at each of these in a little more detail.

1. Detect diseases early, even if they are asymptomatic (Screening)

Many people have their first colonoscopy for this reason. As they age, the risk of developing colorectal cancer increases exponentially. The most dangerous thing about this cancer is that it often doesn't show any symptoms in the early stages . By the time symptoms appear, it may be too late to treat it.

A doctor may usually recommend a colonoscopy for you in these cases:

• If you are over 45 years old and have not had this test before.
• It's been 10 years since this test was last done.
• If a polyp was removed during your last colonoscopy.
• If anyone in your family (mother, father, siblings) has had colon cancer .
• If you have a hereditary condition (e.g. Familial Adenomatous Polyposis - FAP or Lynch syndrome).
• If you have a chronic inflammatory bowel disease such as Inflammatory Bowel Disease (IBD).

2. Find the cause of the symptoms (Diagnosis)

Sometimes you may have certain symptoms. Your doctor needs a clear view to find out exactly what's causing them. A colonoscopy can see the inside of your large intestine much more clearly than other scans.

A doctor may suggest a colonoscopy if you have symptoms like these:

• Blood or other discharge from the anus for no apparent reason.
• An unexplained change in your bowel habits (e.g., persistent diarrhea, constipation).
• Persistent stomach ache for no apparent reason .
• Weight loss without reason.

During this test, if the doctor sees a suspicious area, he can take a small piece of tissue (a biopsy) and send it to the lab. This can help confirm the exact nature of the disease.

3. Treat at the same time as the test.

This is one of the biggest advantages of a colonoscopy. If the doctor sees any problems during the exam, they can probably treat them right there.

• Polyps Removal: Polyps are abnormal, small growths that form on the walls of the colon. Most of these are not cancerous. However, some can become cancerous over time. Therefore, if a doctor finds a polyp, they will remove it (a `polypectomy`). This can prevent cancer from developing in the future.
• Wound healing: Minor bleeding areas can be sealed.
• Injection: You can inject medicine directly into the required areas.
• Removing obstructions: An obstruction in the intestine can be removed or widened.

How to prepare for the test? (The Prep)

This is the most important part of the whole process and the part that will require you to work a little harder . For the test to be successful, your colon must be completely clean. It's like sweeping and mopping a house. If there is any stool left in your colon, the doctor won't be able to see clearly. If that happens, the test may need to be postponed, and you may have to go through this preparation process again.

Your doctor or hospital will give you a set of instructions to follow. It is very important to follow them exactly. Usually, it goes like this:

1. Diet: You will be asked to eat a low-fiber diet for two to three days before the test. This means staying away from things like greens, lots of vegetables, and fruits, and eating things like bread, rice, and soup.

2. Liquid diet: The day before the test, only liquids are allowed to be eaten. For example, water, salted porridge, clear soup, and smoothies.

3. Laxative: The evening or night before the test, you will be given a liquid to drink. This is the hardest part. After you drink this, everything in your intestines will pass out as stool.

• Yes, you will have to go to the bathroom a few times. Be prepared for that, grab a book or something, and relax. Think of this as something you need.

If you do this correctly, your colon will be completely clean by the day of the test.

What happens on the day of the test?

You cannot go to the hospital alone on the day of the test. You must have someone with you who can take you home. This is because it takes about 24 hours for the anesthetic drugs used for the test to fully wear off. Therefore, you will not be able to drive.

When you go to the hospital, you will be given a hospital gown to wear. Then a nurse will put a small cannula (IV line) into a vein in your arm. Anesthetic and pain medication will be given through it.

Are you awake when you do this? Does it hurt?

This is the biggest problem for many people. No, you won't feel any pain. You can choose from two types of anesthesia.

• General Anesthesia: This puts you to sleep and you won't be aware of it until the test is over.
• Conscious Sedation: This puts you into a light sleep-like state. You may feel awake, but you may not remember it later.

However, you will not feel any pain, even if a piece of tissue is removed from your intestines. You may feel a little pressure and a feeling of fullness when the tube is inserted and a little air is blown in to get a better view of your intestines. But it is not unbearable pain.

After the test and results

The test usually takes about 30 to 45 minutes . It may take a little longer if something like polyps are being removed. After it's done, you'll be monitored for about an hour until you wake up from the anesthesia.

After you regain consciousness, the doctor will come and tell you what was seen during the examination. If a biopsy was taken and sent for testing, it may take a few days or a week or two for the results to come back.

After you go home, rest well for a day or so. You may feel a little bloated and uncomfortable in your stomach, but that will go away after a while. You can eat normally as soon as you feel hungry.

Remember that these risks are very small. The benefits of a colonoscopy far outweigh these risks.

Are there no other methods instead of colonoscopy?

Yes, there are several other methods for detecting cancer.

• Fecal tests: A stool sample is checked for hidden blood or DNA changes linked to cancer. These should be done every one to three years. If these tests show a problem, the next step is a colonoscopy.
• Virtual Colonoscopy: This is a special CT scan. This does not involve inserting a tube into the body. However, it still requires cleaning the colon, just like a regular colonoscopy. If polyps are found, a regular colonoscopy will be performed again to remove them.

Despite these options, colonoscopy is considered the "Gold Standard" because,

• It's very sensitive . It can detect even the smallest difference.
• It diagnoses and treats the disease at the same time . If another test shows a problem, a colonoscopy is still required to confirm and treat it.
• If the results are good, it may take about 10 years to get the next test .

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