Does the Thought of a Colonoscopy Scare the Poop Out of You?

By Patty Kunze, RN, BSN and Roberta Palmer, RN


Have we caught your attention by the title? Now, how many of you reading this article are due for a Colonoscopy but have put off doing so because of the dreaded colon cleanse the night before the procedure? If this is you, keep reading!

Once again the Rollin’ RNs have come across another topic from our own experiences to share with you. This story began when I went to see my doctor for my annual well exam. One of the screenings for my age group included having a colorectal cancer screen. As you might think, my doctor’s first response was to schedule a Colonoscopy. Yet knowing the challenges having a Spinal Cord Injury (SCI) presents with this screen led her and I to an interesting and eye-opening discussion that ended up with her choosing a different screening test for me. The Rollin’RNs felt this discovery was worth sharing.

Let’s define, “What is colorectal cancer?”

Colorectal cancer is a cancer that starts in the colon or the rectum. These cancers can also be named colon cancer or rectal cancer, depending on where they start.
 

Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum.

Screening tests can find these polyps, so that they can be removed before they turn into cancer. And if cancer is present, catching it early leads to better treatment outcomes.



Who should be screened?
 
The U.S. Preventative Services Task Force recommends screening beginning at age 50 with continued screening at regular intervals. (The vast majority of new cases of colorectal cancer (about 90%) occur in people who are 50 or older.) However, you and your doctor should discuss the need to be tested earlier than 50, or more often if you have any of the following risk factors:

· Personal history with cancer

· Family history of colorectal cancer

· Personal history of Ulcerative Colitis or Crohn’s Disease

· History of polyps in the colon

· History of smoking cigarettes

So if you fit the profile for a colorectal cancer screening but have been avoiding getting the dreaded colonoscopy done, know you may have options. This is especially beneficial if you have a Spinal Cord Injury and do not have control of your bowels when it comes to prepping for some of these screenings. We’ve listed the types of screens below so feel free to scroll through and find what option might work best for you and your doctor.

Types of Colorectal Cancer Screenings

 
Visualization Tests


Colonoscopy

 
This is a procedure in which a long, flexible tube-like scope with a tiny video camera is inserted into the rectum allowing the doctor a view of the entire colon. No worries, you shouldn’t feel it, as you will be sedated. The doctor is looking for any changes or abnormalities in the colon and rectum. A colonoscopy generally takes about 30 to 60 minutes and screenings are repeated every 10 years if no abnormalities are found and you do not have risk factors for colon cancer. Hooray, 10 years!

Pros:

· Doctors can view the entire colon and rectum.

· Abnormal tissue such as polyps and tissue samples for biopsy can be removed through the scope during the exam. This is important because even though not all polyps will turn into cancer, most colon cancers start as a preexisting polyp.

· Repeat every 10 years if no abnormalities are found

Cons:
· A bowel cleanse is required before the exam so the doctor can visualize the colon.

· Diet changes are needed and meds may need to be adjusted before the exam.

· Some type of sedation is used during the exam so it may take some time to wear off and another person will have to drive you.

· Cramping and bloating may occur after the exam.

Insurance Coverage: Medicare and many private insurance plans will cover the cost for a colonoscopy as a screening test. However, if during the screening a lesion or polyp is removed or biopsied, there may be extra charges for diagnostic tests and/or services. It’s important to review your coverage prior to your exam for specific details. 



CT Colonography 

 
Also known as a virtual colonoscopy, CT colonograpy is an X-ray procedure. The colon is inflated with gas to provide a good view of the colon. It is used more frequently for those who are on blood thinners or when a scope cannot pass through the rectum and colon.

Pros:

· Does not require sedation.

· Repeated every 5 years if no abnormalities are found.

Cons:

· Smaller polyps may not be seen.

· A bowel cleanse is required before the exam so the doctor can visualize the colon.

· Diet changes are needed and meds may need to be adjusted before the exam.

· Painful bloating from the gas may occur, during or after.

· If polyps are found they cannot be removed so a regular colonoscopy would need to be performed, afterwards or at a later date.

Insurance coverage: Medicare does not cover this screening at this time but many private insurance companies do cover it. It’s important to review your coverage prior to your exam for specific details.

Flexible sigmoidoscopy 

 
In this procedure, a short, flexible tube, a sigmoidoscope, is inserted into the rectum to look for polyps and cancer in the lower part of the colon.

Pros:

· Most patients do no need to be sedated for procedure.

· Only takes about 20 minutes.

· Abnormal tissue samples for biopsy can be removed through the scope during the exam.

· Repeated every 5 years if no abnormalities are found.

Cons:

· A bowel cleanse is required before the exam so the doctor can visualize the colon.

· Diet changes are needed and meds may need to be adjusted before the exam.

· Only the rectum and lower part of the left side of the colon can be visualized so any abnormalities in the upper colon won't be found.

· Additional tests might be necessary if an abnormality is detected.

· May cause cramping or bloating.

Insurance Coverage: Medicare and many private insurance plans will cover the cost for a flexible sigmoidoscopy as a screening test. However, if during the screening a lesion or polyp is removed or biopsied, there may be extra charges for diagnostic tests and/or services. It’s important to review your coverage prior to your exam for specific details.

Stool-Based Tests

Fecal Occult Blood Test or Fecal Immunochemical Test 

 
Fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are lab tests used to check stool samples for hidden (occult) blood. With this method, a stool sample is taken at home then sent to a lab to be checked for blood, which could signal the presence of cancer or an advanced polyp.

Pros:

· Stool sample collection can be done at home.

· There's no need to do a bowel cleanse.

· There's no need for sedation.

Cons:

· The tests may fail to detect some polyps and cancers.

· Certain foods and medications might need to be avoided for several days before the test.

· If blood is detected, additional tests might be needed to determine the source.

· The tests can suggest an abnormality when there is none. (False-positive result).

· This test needs to be done yearly.

Insurance coverage: Medicare and many private insurance plans will cover the cost for these screening test. As always it’s important to review your coverage for specific details.

Stool DNA test (sDNA) 

 
The sDNA test uses a sample of your stool to look for DNA changes in cells that might indicate the presence of colon cancer or precancerous conditions. The sDNA test also looks for signs of blood in your stool. For this test, you collect a stool sample at home and send it to a laboratory for testing. (Cologuard is an sDNA test.)

Pros:

· Stool sample collection can be done at home.

· There's no need to do a bowel cleanse.

· There's no need for sedation.

· You can eat, drink and take your medications as normal before the test.

· Repeated every 3 years if no abnormalities are found.

Cons:

· The test may fail to detect some polyps and cancers.

· If abnormalities are found, additional tests would be needed.

Insurance coverage: Medicare and many private insurance plans will cover the cost for Cologuard, which is an sDNA screening test. As always it’s important to review your coverage for specific details.

Now that you’re aware of the available options, have a discussion with your health care provider (HCP) to discuss the best options for you.

As for me, my doctor and I took into consideration my SCI and decided Cologuard (an sDNA test) was a good fit for me. I was thrilled I didn’t have to go the route of a colonoscopy and I’m good to go for 3 years before I have to have another colorectal screen. In the end (no pun intended), the important thing is to get screened!

It’s all good, so keep on rollin’.

Roberta, RN and Patty, BSN, RNC

The ROLLIN’ RNs ™

References:

https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm

https://www.mayoclinic.org/diseases-conditions/colon-cancer/in-depth/colon-cancer-screening/art-20046825

https://radiology.uchicago.edu/sites/radiology.uchicago.edu/files/uploads/PtEducation/Virtual%20Colonoscopy%20Status%20of%20Medicare%20Reimbursment.pdf

https://www.healthline.com/health-news/dreading-colonoscopy-other-effective-tests-for-colon-cancer-032015#9

https://health.usnews.com/health-news/patient-advice/articles/2016-09-21/which-colon-cancer-screening-test-is-best
 

About the Authors:


Patty Kunze has been a Registered Nurse since 1983.  She holds a Bachelor’s of Science Degree in Nursing and worked several years in a Spinal Cord Injury Unit at the local Veterans Administration Medical Center as a new graduate.  She has been a flight transport nurse for Neonatal Intensive Care, an assistant manager of Labor and Delivery, and an instructor of nursing students. In 2009, she was involved in an auto accident which left her paralyzed (T3-4 complete paraplegic) from chest down.  But she continues her nursing career while sitting in her wheelchair as a nurse paralegal and writing articles for others with spinal cord injuries as The Rollin RN ™.




Roberta Palmer has been a Registered Nurse for 20 years.  She has knowledge in Family Practice, Allery and Immunology, Special Pharmacy Medication and Counseling, and she is a RN Health Coach. In 2014, she was involved in an ATV accident which also left her paralyzed (T3-4 complete paraplegic) from chest down.


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