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A colonoscopy is a type of endoscopy, meaning it uses an endoscope to examine your digestive tract to investigate and diagnose disease. Your physician may need a colonoscopy to: 

• Look into symptoms like pain, nausea, difficulty swallowing, bleeding and changes in bowel habits. 
• Further investigate findings in a physical examination like tenderness, a mass or signs of nutritional deficiency. 
• Explore the digestive tract after lab results show a low blood count, anemia or other issue. 
• Check into concerns if your personal or family medical history puts you at an increased risk of certain disorders. 
• Screen for risk of disease and colorectal cancer.

Colonoscopy is the most effective way to find adenomas — colon polyps that are more likely to form into colorectal cancer. It also allows the gastroenterologist to remove any suspicious polyp. That’s why colonoscopies are done more than other, more limited endoscopic examinations (flexible sigmoidoscopy), colon X-ray (barium enema) or chemical testing for invisible traces of blood in the stool (fecal occult blood testing, immunochemical or DNA testing like Cologuard).

Colon cancer is the third leading cause of death in the United States, but highly preventable. Colorectal cancer usually has no noticeable symptoms until advanced stages and then it’s much harder to treat. Detecting and removing polyps greatly reduces the likelihood of developing colorectal cancer in the future. If cancer is present, detecting it early before symptoms occur can increase your chances of survival.

Colonoscopy is a safe, low-risk procedure when performed by a well-trained physician. At the Iowa Clinic, all of our gastroenterologists are highly experienced and have undergone specialized training in order to provide high-quality, safe colonoscopies. 

We also have extensive safety policies in place to ensure there are no infections and follow strict COVID-19 precautions. The infection rate in our Endoscopy Center is zero.

Screening colonoscopy exams are recommended for men and women starting at age 45. If you have a family history of colon cancer or polyps, screenings may start at an earlier age. Individuals with other conditions such as Crohn’s disease or ulcerative colitis are recommended to have more frequent screening.

For men and women without a family history or other risk factors, a screening colonoscopy should be repeated every 10 years. Should your physician find or remove polyps during your screening, you may be asked to return sooner than 10 years based on what type of polyp was removed. Age is one of the biggest risk factors for polyp formation and colorectal cancer, so that is another reason you may need to get your next colonoscopy sooner.

Guidelines have been developed as a way to make recommendations for screening colonoscopy based on known risk factors for colorectal cancer. The risk factors used for this “risk stratification” are age, family history of colorectal cancer and past history of colorectal adenoma or cancer. Risk stratification is not an exact science, but the guidelines are based on the known characteristics of colorectal cancer and the opinions of knowledgeable experts. 

You’re considered average risk if you don’t have: 

• Family history or personal history of colorectal cancer or colorectal adenomas
• Complaints about your bowels (passing blood with a bowel movement, recent change in bowel habit, unexplained weight loss or abdominal discomfort)
• Findings on physical examination suspicious for an abnormal growth in the rectum or mass in the abdomen
• Unexplained iron deficiency anemia

It’s important that you talk to your primary care provider if you have a family history of colorectal cancer or adenomatous polyps to see when you should schedule your colonoscopy. If someone in your family has had colorectal cancer or adenoma, you’re at higher risk for getting those too. There are also several known genetic traits that may be inherited which increase the risk for development of colorectal cancer.

In some families, there are genetic traits that greatly increase the risk for developing colorectal cancer. The Hereditary Non-Polyposis Colorectal Cancer (HNPCC) Syndrome is of particular concern because it accounts for 6 to 8 percent of colorectal cancer deaths in the United States. HNPCC may be suspected if the family history includes three or more relatives in two or more generations (at least one a first-degree relative), one of whom developed colorectal cancer before the age of 50. There are additional factors that can be taken into account, including a family history of endometrial cancer, small intestine cancer, and cancer of the ureter or renal pelvis. Under current guidelines, it is recommended that individuals at risk for HNPCC should undergo colonoscopy every one to two years starting at age 20 to 25 — or 10 years younger than the age of the earliest diagnosis of cancer in the family, whichever is earlier. Those individuals who inherit a gene for HNPCC are at high risk (85% or more) of developing colorectal cancer, and cancers develop more rapidly than is typical for most colorectal tumors.

A less common genetic trait is characterized by the development of colorectal adenomas early in life and the development of hundreds or even thousands of adenomatous polyps that carry a high risk for colorectal cancer at a young age. Under current guidelines, it is recommended that individuals at risk for familial polyposis coli begin screening with flexible sigmoidoscopy between the ages of 10 and 12.

Colon polyps, or colorectal polyps, are noncancerous growths in the lining of your bowel. They are most common in adults over 45 years of age and in individuals with a family history of polyps. No known cause exists for why we develop polyps, but if not removed, some polyps can develop into cancer.

Polyps are not the same. Two common types exist: hyperplastic or adenomatous. Hyperplastic polyps are not at risk of developing into cancer. Adenomatous polyps, however, are a risk factor and thought to be the origin of almost all colon cancers. Many adenomatous polyps will not turn into cancer, but it’s not certain which ones will or will not, so removal is recommended for any polyp found on colonoscopy. Any polyps found and removed during colonoscopy will be sent to the lab for evaluation. Your physician will let you know the type of polyp removed and when to follow up with your next colonoscopy.

Not at all! Your bowel’s lining is not sensitive to cutting or heat so colon polyp removal is painless. While uncommon, some individuals may experience small amounts of bleeding from the site of polyp removal, but almost always this can be stopped during the colonoscopy.

When you receive sedation for your procedure, you are considered legally impaired. To ensure your safety, you must have a responsible adult and licensed driver to drive you and ensure you make it into your home. Because sedation can impair your judgment and reflexes, you may not drive or work for 12 hours after your procedure.

Yes! You may experience some mild nausea or feel groggy after your procedure. You also may not have a full appetite, but you may eat. We advise that you avoid greasy or spicy food right away to avoid nausea or upset stomach. We prefer you pick a light meal.

Because your bowel was completely emptied and you did not eat solid food a day before your procedure, you may not have a normal bowel movement for a couple days. This is nothing to be alarmed about.

Yes, life returns to normal the day after your procedure. You will be able to work, exercise, eat and drive as you normally do.