My colonoscopy experience - without sedation

Hello..

I just wanted to share my experience with my first colonoscopy without sedation.

To give a bit of background, i've had pancolitis for the last 16 years - Since I was 10 years old. I am 26 now. I know it is very unusual to get colitis at such a young age.

Anyway, I've had quite a few colonoscopies before. The first few were under general anaesthesia. Then I did a couple under IV conscious sedation (Midazolam). The last one I had before this was under a tiny bit of Midazolam (1.25mg) - I forgot most of the procedure but remember certain parts (when it was slightly painful).

So, I did some research and gained the courage to do it without sedation. Main points I gathered from the research:

1 - Many studies conducted on satisfaction of patients who have it without sedation. In all studies I've seen, majority described the pain/discomfort as 'Low/None'. Further, vast majority said they would do it again without sedation next time round.

2 - There are no 'nerves' inside the colon that scream when you have a scope moving around. So, just like your 'poop' moves around without you feeling it, so should the scope. Further, this means that you won't feel any 'procedures' done during the colonoscopy, such as removing a polyp or taking a biopsy. When I had mine done, the only reason I knew they were taking the biopsy is that I was seeing it on the screen, not feeling it.

3 - The colon is sensitive to 'stretching'. This generally happens when the scope is going round sharp turns. Particularly, the initial part of the procedure, when the scope has to go through the two sharp turns of the sigmoid colon. Also, it happens if the scope forms a loop inside your bowels. But, well trained doctors will know how to avoid this 'loop' but taking their time and ironing out any loops that start to happen.

4 - Pumping air into the colon to open it up may stretch it causing some discomfort. However, most centers now use CO2 which is rapidly absorbed hence discomfort is minimal.


I can confirm that the research findings were accurate. Main points from my experience:

1 - The procedure was largely painless. I would describe the whole thing as a very mild discomfort and I would definitely do it again this way.
2 - The only notable pain was in the beginning during the sigmoid colon part. The pain last for 3-4 seconds. It felt like one of those cramps you get when you eat something bad, or when you have a UC flareup. I'm sure most people here know how this feels so would definitely be able to tolerate it. The key is to remember that it will be gone in a few seconds.
3 - I hardly felt the air being pumped at all. For most of the procedure, I felt nothing inside.
4 - I was given some 'Buscupan' - this is an anti-spasm agent that prevents your bowels from cramping, etc, and stops the muscles inside from contracting, so they wouldn't be pushing against the scope. I highly recommend this for others. It carries little to no risk - nothing like sedation as it doesnt cross the 'brain/blood' barrier, hence doesnt affect the nervous system in any way.
5 - The procedure (in/out) was 15 minutes. This includes 8 biopsies.
6 - Having the procedure without sedation encourages the doctor to do it more carefully, so you will get significantly less pain so you won't have these strange memories of pain that you get when you have conscious sedation that makes you forget most of the procedure, except the painful part..
7 - I had an IV installed in case I panic, or find it painful. I think this really helps knowing that there is a 'fall back' in your head. Gets rid of the 'desperation' thoughts.

There are two many reasons I did it unsedated. Firstly, sedation carries risk. Although the risks are small, they are still there, and the outcome may be cardiac/pulmonary arrest or even death. Why take the risk when it can be avoided? Also, as I am a UC patient, I will be doing this procedure dozens of times over my lifetime. So, the risks add up and increase as you get older and also as I will be doing it many times, I wanted to get rid of this nasty phobia I get every time I am dreading it, etc. I wanted to make it a normal, routine examination which I can go in, get it done, then go home quickly. Its all mental. The hardest part of the procedure was checking into the hospital, being in a small closed room, being placed on the table, seeing the nurses and all the equipment, etc etc. Really, it is just psychological.

I highly recommend others to try it without sedation. Find a practitioner that regularly does this procedure without sedation so they are comfortable with it and well trained. Thankfully, I no longer dread the colonoscopy! Although, the preparation will always be a nightmare..

Andrina said...
Thank you for posting this. I was scoped for the first few 20 cm in my colon when I first got diagnosed. I remember the sigmoid part being painful too. I actually felt the air being pumped in. But this discomfort is there either with or without sedation (after the scope is done).

Maybe one day I'll be brave enough to have it done without sedation. I'm at the point where I need to get a scope done yearly.

I think trying it without sedation is a great investment!

You will feel the pain from the sigmoid part with or without sedation - I agree and think this is the case for most people. The worst part is that you will might have some creepy memories if you were given conscious sedation. I don't remember much of the colonoscopy I had last time, except the sigmoid part and a little bit from the splenic flexure. That is pretty much the only pain I felt this time as well.

Interesting as it is, there is no way in hell I am ever having a colonoscopy without being put out completely.

I had sedation during my last scope and I was awake anyway. I was so uncomfortable and that was with pain meds and sedation. If you have inflammation, it's really uncomfortable. I wouldn't do it without, even if I were in remission. Just no reAson to be awake for that. The best part about it is getting a nap, especially after the awful prep.

Rami said...

Marauder93 said...
Interesting as it is, there is no way in hell I am ever having a colonoscopy without being put out completely.

What would you say is the biggest reason behind this?

The pain. I had one sig on May 6 and one on June 18 (Ive had others but these are the relevant ones). The first was without sedation the second with. I couldnt last more than 30-60 seconds the first time, while for the second one I was good for the entire time. The first experience was so traumatizing, I refuse to even do sigs without sedation of some kind; let alone a colo

I suspect it has to do at least in part with the condition of your colon. My first was done during a severe flare; I came up from the conscious sedation screaming from the pain, and I darn sure remember it to this day. There may be no "pain nerves", but that doesn't stop me from getting a severe cramping when they do a biopsy. (My gyn also told me there would be no pain from a cervical biopsy, and that was a lie also.) I have severe scarring of my colon now, and no interest in seeing if it's still as delicate as it was before.

I'm not a wimp. I have a very high pain tolerance - walked on a broken leg for 2 months and on both feet with multiple fractures for at least a year. I am glad it went well for you, and it's probably worth a try for people in remission and without severe scarring.

Judy2 said...
I suspect it has to do at least in part with the condition of your colon. My first was done during a severe flare; I came up from the conscious sedation screaming from the pain, and I darn sure remember it to this day. There may be no "pain nerves", but that doesn't stop me from getting a severe cramping when they do a biopsy. (My gyn also told me there would be no pain from a cervical biopsy, and that was a lie also.) I have severe scarring of my colon now, and no interest in seeing if it's still as delicate as it was before.

I'm not a wimp. I have a very high pain tolerance - walked on a broken leg for 2 months and on both feet with multiple fractures for at least a year. I am glad it went well for you, and it's probably worth a try for people in remission and without severe scarring.

Im sorry Judy - I didn't mean to put you in a bad light at all.

I only made this post to share this experience with those that are dreading the colonoscopy as much as I was. I also hoped it would make people more relaxed about it, etc.

Its not right for everyone, but I think for those who haven't tried it, it may be a worthwhile investment as they can always switch to sedation instantly if it gets too painful.

notsosicklygirl said...
I think it's great that you were able to do it and I've seen others mention doing it without sedation but, I like some of the other, could barely get through a sig scope without sedation because of the cramping and discomfort. I got sedation last time and I am so thankful. If I weren't flaring, I wouldn't need sedation for a sig scope but with even mild inflammation, it hurts!

Perhaps it would be more suitable for the bi-annual or annual screening required for those who've had the disease for a long time (but are currently in remission).

My point is - making the colonoscopy a more 'normal' and easy procedure can potentially save lives in my opinion. For example, I delayed my colonoscopy for a while because I was dreading it. In that time, I could have developed dysplasia or a tumour that would have been caught earlier if i was more eager..

Its quite a big topic for practitioners - convincing people at higher risk of cancer (us UC sufferers) to carry out timely colonoscopies. Often, people will be like me and delay it because they are dreading the whole thing.

Interesting - thanks for your report. It sounds like my sig flex which was without any sedation at all. It was uncomfortable at the beginning, but otherwise fine. Never tried a colonoscopy without the conscious sedation. Something to think about.

beer

Thank the Lord for drugs. Sedate me up please, and as much as possible!! :)

I had a flexible sigmoidoscopy without sedation and it was the most uncomfortable feeling in the world, I hated it.

I then got a colonoscopy with complete sedation and it was marvelous. I had minor cramping afterwards but that was it.

I recognize there are risks with sedation, but they are minor, and there's also risks with having a tube up your butt. I also acknowledge that a lot of it is probably mental, but I personally would never do it without sedation UNLESS I experienced something like pulmonary arrest or creepy memories, etc. that made my mental priorities shift.

John65 said...
Do they still require you to have someone wait with you and drive you home if you go without sedation?

Nope.. thats the best thing, you can go straight away, on your own, right after the procedure.