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Details of an unsedated colonoscopy

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Posted 10/18/2007 1:24 PM (GMT 0)
I know it comes up from time to time, so I tought Id recount my experience yesterday in detail. Hope it helps those of you who are contemplating one without sedation.

Im a youngish male, with no prior abdominal surgery. I've read this makes me less likely to experience alot of discomfort.

1. finger in pooper. Uncomfortable. I thought the procedure was going to be a bust at this point, that was only his finger!
2. scope in pooper. Awkward, not uncomfortable at all surprisingly.
3. air insuflated in rectum. Awkward feeling. A backwards fart.
4. scope moves through rectum and sigmoid. No sweat, done very slowly.
5. air insuflated while in sigmoid, ascending colon. The bakward fart creeps to right side of bowel. Slight cramping. Mostly mild, transient.
6. ascending colon to transverse colon. PAIN. Severe cramping. I tell the doc its not going to happen without sedation. he asks me to hang on tad longer. I contemplate pulling scope out and strangling someone with it. The pain lasted about 30- 45 seconds and was pretty intense. Then went away completely as he moved through the transverse colon, over about 15 seconds. That was the only pain I felt the entire procedure.
7. transverse colon and descending colon. Very mild nausea and flush feeling develop, this lasts until the scope is withdraw back through transverse colon, about 3-4 minutes. Wet rag to forhead relieves me completely.
8. terminal ileum. People say they have problems here. I had none at all thankfully.
9. scope withdrawn, biopsies taken (9 or 10 total). The more the scope is withdrawn, the more normal I feel. Biopsies produce barely noticable sensation like flicking an inflated balloon or something. No pain at all.
10. retroflexing scope at rectum. Uncomfortable, not painful. Scope is so close to out, I couldnt care less.
11. scope out. farts moving forward now!

Id do it again for sure, without sedatives. I might ask to start with a very small dose of a narcotic in my IV so the 30-45 seconds of intense pain wasnt as bad. Then again, I might not, knowing it was going to be so transient, and not keep getting worse.

Good luck all!
Posted 10/18/2007 1:31 PM (GMT 0)
Well I am glad you survived with out drugs. But for me, and probably most of the women at least, I think we would all demand the drugs. Not because women can't handle the pain (we do have babies afterall), but because we have a few additional inside organs that cause alot more discomfort. I had one colonoscopy (done before my resections) that the drugs didn't work, and I was in the most excrutiating pain. Kicking and screaming and still the doc wouldn't stop. He's lucky I didn't sue, that was pure torture. Still glad that you survived though. Did they give you any results?
Posted 10/18/2007 1:36 PM (GMT 0)
Our experience of pain is so tied to our expectation, isn't it. Good for you Poobah. I suspect you feel empowered by this experience. You had good communication with your doc. He talked you through the worst -- and it is the worst -- and you were able to manage, in part, because you were in control of your experience and your expectation was that the pain was not going to last forever. I suspect that enabled you to relax better through it instead of tightening up and fighting the scope.

Thanks for posting your positive experience. While it is natural to concentrate more on the negative -- no one reports on all the planes safely landing and taking off, only they ones that crash -- sometimes, unless we hear experiences like yours, there is a danger of giving the wrong impression to those who are first timers.

I suspect your post will relieve a lot of anxiety about what's ahead for those who have never had a colonoscopy.

I always said that the worst part about my colonoscopies was the prep.
Posted 10/18/2007 1:43 PM (GMT 0)
Well, poobah, I am glad all went well for you. As for me, I will always want to be sedated for a colonoscopy. I ain't takin no chances! Plus, I have a stricture in the TI and the doc told us how he had to shove the scope through it until he couldn't get any further. Therefore, I will assume that this would hurt like hell had I been awake. Lucky for me, I seldom take even a tylenol for pain so the sedation put me completely out. Verdict: My hats off to all who have this procedure awake! But it ain't gonna be me! Bring on the drugs.............:-)
Posted 10/18/2007 2:04 PM (GMT 0)
I also had my scope without sedation, and my feelings were exactly as you described. For me the worst part is the preparation.  When I have my next scope I will do it again without sedation.

Christina

Posted 10/18/2007 2:29 PM (GMT 0)
thanks for the notes. I was planning on begging my GI next week for a colonscopy with no meds, so now I am even more convinced. I would take pain any day over vomiting and headache for hours after the scope.

Posted 10/18/2007 2:58 PM (GMT 0)
Great! I think that your experience is definitely worthy of sharing. Sedation and anesthesia have nasty effects on me and if I could I would do the scope without sedation. unfortunately, I have had one scope when I wasn't even flaring and I suffered without sedation. I guess it depends on your flare status, what surgeries you have had, scar tissue etc. I have a bad reaction to the IV insertion, the anti-emetic and the sedation meds...but will live without after the pain I endured the first time.....but it was still worthwhile to try it once without the meds.
Posted 10/18/2007 3:05 PM (GMT 0)

I also have my scopes w/o sedation at my request and w/my gastro's (at first) reluctant agreement. In addition my gastro allows me to have the monitor video taped. Some of the more progressive gastro labs are actually able to provide a video taken during the scope by the equipment itself.

Women do tend to be a little more difficult for passage of the scope thru the transverse colon as ours is a bit longer than a man's and a bit more flexible. Our "extra interior organs" have nothing to do w/it.

It has been proven via "active" imaging procedures during colonoscopy that any pain encountered is caused mostly by the flexible scope shaft looping back on itself and by over-insuflation. The interior of the colon has no "sensory nerves", the pain encountered is from STRETCHING the circumference of the colon.

The colon is similar to the flexible vent hose on our clothes dryers. So there is quite a bit of lengthwise stretching as the scope moves thru as well. This doesn't cause discomfort. The scope can suction some fluids or small bits of debris out as well as the air that is insuflated during the procedure and in the suctioning process pulls that section of stretched colon back thereby shortening its length at that point again.

I also occasionally experience some mild nausea at the transverse colon, usually just about the time the scope is approaching the hepatic flexure. That is the vagus nerve getting a bit ticked off. There has been once or twice I've asked for and received a little phenergan in my IV at that point.

Number of procedures done by the doctor doing the scope isn't as important to their skill in doing them as is patience to take the time whilst passing the scope. Most all pain encountered doing a colonoscopy is a direct result of an overly aggressive doctor. Taking the time to pull back the scope sufficiently to undo the looping back on itself is important. Not over insuflating to make it easier for the scope to pass thru also requires a little more time than just going gung ho w/a lot of air to widen the "tunnel" of the colon.

I've posted these URLs several times thru the years but they bear repeating from time to time. I wish there was a way to post them as stickies,

A Study of Pain During Colonoscopy
<http://www.e-health-questions.info/html/board/index.php/action=displaythread&forum=boweldisorders&id=12&realm=default>

Why Colonoscopy Is More Difficult In Women
<http://www.e-health-questions.info/html/board/index.php/action=displaythread&forum=boweldisorders&id=13&realm=default>

Colonoscopy How To
http://www.rcsed.ac.uk/journal/vol47_2/4720010.html

Posted 10/18/2007 3:14 PM (GMT 0)
PS: I forgot to mention. Demerol or other analgesic can be given IV prior to and/or during the scope to help somewhat w/any discomfort WITHOUT the amnesia producing effects of the sedatives such as Versed, etc. so you remain awake and aware and are able to watch the scope progress thru your colon on the monitor.
Posted 10/18/2007 4:44 PM (GMT 0)
I want to ask you all of you who have had the scope done without pain meds if you had active inflammation and/or narrowing when you had it done?

Yes, pain is subjective, but it also depends on the amount of disease, inflammation, narrowing, etc. when having the test done.

I started a test once with mild sedation, but didn't remember anything and when I asked they told me it was because it was so painful for me that they gave me enough meds to almost knock me out.

Recently I had a colonoscopy in the surgeons office without sedation (wasn't aware he was going to do it), and I can tell you that it was pretty uncomfortable while he was going through the diseased and ulcerated colon, but when he approached the narrow anastamosis it was unbearable and he had to stop. In the future I would prefer to be medicated.

So while you may not have much feeling inside your colon, inflammation of CD goes through the entire wall and effects the surrounding areas which can make it painful.
Posted 10/18/2007 4:56 PM (GMT 0)
Well from my experiance I have to be knocked out for just a sigmoidoscopy let alone a colonoscopy...with a sigmoidoscopy they don't even go in that far, just to the sigmoid area, but when you've got painful anal skin tags, inflammation that starts internally right at the rectom and goes throughout the colon then I will certainly not engage in any kind of "oscopy" without being totally knocked out...infact I've been put completely asleep and apparently in that state still manage to swear, complain and cry during the procedure which has really freaked out alot of GI's...that is until I expressed this to GI#4 and he gave me the right stuff to knock me out, it was the first time I DID NOT wake up in tears...see in the past when I was knocked out I was still responding to pain, as soon as I woke up I didn't remember feeling pain or anything but I'd be balling my head off and very confused about it.


:)
Posted 10/18/2007 4:57 PM (GMT 0)
Have done my last 4 scopes without sedation and the experience as just about as reported here -- mild discomfort, feeling of fullness and one or two transient periods (10-20 seconds max) of pressure-related pain related to Crohnie-2's clear description of looping, largely early in the procedure. I have never had what i would call even serious pain . . . had worse with cramps and spasms from the normal disease itself. It is also enjoyable to watch the monitor throughout and get a clear step-by-step report from the doc as he does it. On one occasion the endoscopy lab nurse told me she wished more patients would go through scopes without meds, as in her experience (and she does them all day every day) people who are fully alert actually have less reactions than those who are under meds. She said they tend to overreact to stimuli. The exceptiion of course is anyone with very active disease and inflammation, strictures, etc, who are probably going to experience more discomfort. But to describe a normal colonoscopy with terms like "excrutiating" is not accurate. The scope is actually narrower than the normal feces that pass out in the other direction every day. There have been several research papers done on sedationless colonoscopy and they show that a large majority -- usually in the 75-80% range -- of people who try one report minimal or only occaisonally moderate discomfort and would do it again. Bottom line is it saves on the bottom line . . . the cost of the meds, IV, recovery, etc. are probably a third or so of the hospital's charges.

Posted 10/18/2007 5:17 PM (GMT 0)
Hey,

My first scope was a nightmare.  I hadn't been diagnosed yet, was going through my worst flare, working on a blockage.  I was so sick for a month, couldn't eat, weighed about 92 lbs, so weak I couldn't hardly raise my head.  I was referred to a GI, who immediately decided to do a scope right there in the office (no sedation).  I was so out of it I didn't know what they were doing...but as soon as they started....OMG....I was screaming and dry heaving all over the place (my husband said that they could hear me in the waiting room, bet that disconcerted a few patients).  Anyway it didn't last long because it was quickly apparent what was going on in inside (obvisously they didn't do the full scope), and immediately sent me to the hospital and remicade treatments.  I was lucky they acted so fast and that I had a Doctor who wanted to try treating before doing surgery (his colleage wanted to do surgery right away, my husband heard them arguing about it, like I said I was out of it, I don't remember everything).

The remicade (and prednisone, asacohl (sp?), then 6MP) got me over that flare.  I was lucky to escape with no surgery.  The scope was horrible but it was an emergency procedure, because the GI's office had there own clinic, and anesthesialogist for regular scopes.  (heck they even served snacks and drinks after post scopes, I miss that place).  I guess my experience shows that if you are messed up enough a scope can be very painful, it all depends on the situation.

With two autoimmune diseases, my motto is:  "I am allergic to myself"

Posted 10/18/2007 5:33 PM (GMT 0)
I wish I could be awake and alert during a scope. I remember barium tests that I was able to watch the barium go through and I could tell them when it hit the diseased portion because it was uncomfortable, not the pain I have with the colonoscopy. The pain from those tests didn't come until later in the day for me when the barium dried up, lol.

I was told at my last scheduled colonoscopy that I would remember, but wouldn't feel anything, but I still didn't remember. I wonder if its certain drugs that effect people differently or if my doctors just want me not to remember them yelling at me to shut up, lol.
Posted 10/18/2007 6:10 PM (GMT 0)
I have had a colonoscopy done in order to insert a balloon to dilute an almost completely obstructed TI. I have never had a colonoscopy done when active inflammation wasn't found. I have had it done with no sedation and with a bit of valium and with the whole shooting match.

I do agree, however, that there is going to be pain associated with attempts to "shove the scope through" as described by one of the posters. My biggest reason for opting for no sedation is the potential for perforation that comes from trying to get it through inflamed, strictured tissue. I want to be aware at those moments to reduce the potential of perforation that is a risk with any colonoscopy. I want to give my GI feedback so he doesn't "shove it" through my bowel wall while I'm lieing comatose.
Posted 10/18/2007 6:27 PM (GMT 0)
I wouldn't mind sleeping through if I could find other meds to be knocked out, but each time my reaction to versed gets worse. this is a very helpful thread. yp
Posted 10/18/2007 6:38 PM (GMT 0)
Thanks for posting this very detailed play by play. Very fascinating. I was 1/2 awake when they did my colonoscopy and then FULLY woke up to 4 people behind me trying to push that thing a little further through the inflammed part. =0|

I wish my Dr had the capability to video tape the procedure cause it would be interesting to see what your intestines looked like when you're in a more coherent non pain state. The only stuff I saw looked like tunnels and a pac man thing taking bits of biopsys but it was blurry because they made me take my glasses off.
Posted 10/18/2007 7:03 PM (GMT 0)
I've no doubt that if one has active disease, especially in the rectal area, a scope w/o sedation would be more painful than worth going thru. I generally preface my accounts of colonoscopy w/o sedation by saying just that and was remiss for not doing so this time. My apologies.

There are those for whom Versed is not effective or has the opposite effect of that desired. Give me Versed and then cause me the least bit of discomfort, never mind pain, and I'm gonna attack and get really nasty and hostile. The one time we made that mistake it took 3 nurses to hold me down so that the gastro could get the scope out!!!

For those who have had Versed or Valium for their scopes and STILL remember pain or unacceptable discomfort you should discuss their using diprivan (Propofol) for your colonoscopies. It is a very short acting general anesthetic and you recover from it VERY FAST! For those who prefer to not know what is going on it is a marvelous drug for colonoscopies and recovery time is so much faster than w/Versed or Valium!!! Of course, it is considerably more expensive since it is an anesthetic instead of a sedative and the majority of states still require an anesthesiologist to be present and administering it rather than "just" an anesthetist.

My aversion to sedation or even anesthetic is not the fear of perforation but rather a lack of trust in the medical profession and a matter of ceding control to them. I don't want them making decisions for me, I don't trust that they tell me everything and I don't like them knowing more about what my "innards" look like and what condition they are in than I do. I want to see for myself!!! As much as I like my gastro, I still want to see for myself. And a video of the entire colonoscopy, whether w/my videocam of the monitor or their DVD video from their own equipment, "could" possibly save me a future prep if, for instance, surgery should be necessary and the surgeon wants "to see for himself".

"Here, bub, here's the video of the scope done just last week. Its the best look you're gonna get unless I agree to your doing surgery"

Want a second opinion? But don't want to go thru yet another scope so soon? "Here you go, doc, a video of the latest scope so you can see for yourself w/o my going thru another prep".

Wanna see how my disease has been progressing, doc? Here's the videos of my last 4 scopes. Take a good look.

Posted 10/18/2007 8:13 PM (GMT 0)
One time when I went in for a colonoscopy (in Canada it's standard procedure to be fully sedated/knocked out for a colonoscopy, with a sigmoidoscopy it's generally done awake but a patient can request being put to sleep, it's covered under our health care system) but the one time I was in for a colonoscopy (and put to sleep of course) they woke me up and my GI at the time told me he couldn't get the scope in at all because of the severe anal inflammation and rectal inflammation right at the point of entry, so even asleep he did not risk trying to "shove" it in, so that was a relief it was just literally a pain in the ass that I had to do the prep all for nothing that time.

:)
Posted 10/18/2007 8:24 PM (GMT 0)
This is like discussing natural childbirth vs medicated childbirth. Each side can get quite emotional about it. I think it all depends on your particular problem and your anatomy. Also, it might not be the same each time as any woman who has had more than one baby will tell you that every time it is different. The same woman's first experience could be easy, the next one torture.

You don't have to have versed. I personally hate the stuff because I only hear snippets of conversation which I manage to pull completely out of context and imagine the worst. I want to either hear all of it, or none of it.
Posted 10/18/2007 9:24 PM (GMT 0)
Well I guess I"ll jump in my first scope was terrible and the second sleeping like a baby. THe second one I had the blockage so did sleep threw it and glad I did. lol gail
Posted 10/19/2007 12:34 AM (GMT 0)
PB4 don't think you can make a generalization like this is how it is done in Canada. My experience is completely different from yours. The standard of care is more a consequence of how the physicians practicing were themselves trained. That differs from universtiy to university depending upon the age, training and experiences of the professors. It also differs by type of facility. Tertiary care teaching hospitals attached to universities often operate under different standards than smaller regional centres.

As in many other things there is no one size fits all. And of course, the standard is changing all the time.
Posted 10/19/2007 1:58 AM (GMT 0)
Glad you made it through so well! I've had two scopes (one unprepped, the second the next day prepped). Amazingly the unprepped one was great, I don't remember a thing. Woke up on the second one though. I can remember being in sever pain and moving about. They were telling me to breath. It's going to be different for everyone of course. Just because someone can breeze through it, doesn't mean it's like that for all. I'm scared to death to have another one, and dread the day they want one, thanks to my last experience. We will be having a good talk about knocking me out better when the time comes.
Posted 10/19/2007 2:10 AM (GMT 0)

I'm a male, age 37. 

I had a sigmoidoscopy, with no sedation, before I ever had a colonoscopy.  And the sigmoidoscopy was horrible.  I was crying, dry heaving, clenching my teeth, moaning, just flat out miserable.  I was grabbing the rails of the hospital bed so hard that I almost broke it.  It was by far the worst medical procedure I've had done, and I've had lots of medical procedures. :-)

So there was no way I was going to do a colonoscopy without sedation and painkillers.  For my colonoscopy I was given the max dose of versed and the max dose of fentanyl.  And apparently it still didn't go very well.  I say "apparently" because I have no memory of the procedure.  But according to my GI, who had to stop without completing it, I was ready to kill him!  I guess I was screaming in pain and threatening them - though, like I said, I don't remember a thing.

For my next colonoscopy, I have to get complete anesthesia, like in surgery.


Post Edited (beave) : 10/18/2007 8:58:22 PM (GMT-6)

Posted 10/19/2007 3:52 AM (GMT 0)
its amazing to me, the variety of experiences people have had with it! I dont mean to sway people one way or the other. I know everyone is different, anatomically, and prone to experience the procedure in different ways.

I should note, my GI used a pediatric scope. To be honest, this didnt appear to be much smaller that the adult one though. He was also scopes 3 days/week, all day. So I guess hes quite adept. Super nice guy, though I bet most docs would be very considerate knowing you were wide awake and going to remember the wole thing.

Im guessing too, that when fully alert, we can calm ourselves and learn to tolerate unusual or painful sensations in a way we cant when we are semi-conscious?
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