20 Steps to Master the Art of Surviving Your First Colonoscopy

A colonoscopy is a procedure used to allow a doctor to view and directly image the inside of a patient's large intestine. A colonoscopy is very helpful in diagnosing numerous disorders of the gastrointestinal system. Colonoscopies are used frequently to screen patients for colon cancer once they meet certain high-risk criteria. The dual use of a colonoscopy makes it a viable and economical option and technique for screening, examining, and treating intestinal abnormalities and growths. As mentioned, a colonoscopy is a common colon cancer screening method. It will help doctors diagnose a patient's condition earlier, which can then assist with colon cancer treatment. Treatment for colon cancer includes chemotherapy and surgery. Of course, this procedure can also help diagnose other gastrointestinal issues. Thus, patients can receive prompt treatment for diverticulitis, colon polyps, and other abnormalities. Of course, it is vital to understand the procedure first.

1. What It Is Used For

A colonoscopy is a procedure used to examine an individual's large intestine and rectum. This screening checks for colon cancer and other problems in a patient's intestinal tract. These problems include colon polyps and other growths, diverticulosis, bleeding in the intestines, and inflammatory bowel disease. Other problems that it can check for are the underlying cause of bowel habit changes, pain in the abdominal and pelvic regions, and intestinal obstruction. Doctors will often order a colonoscopy for abnormal results from computerized tomography scans, magnetic resonance imaging, or x-rays. A colonoscopy is also used to find the underlying cause of chronic constipation, chronic diarrhea, and unexplained weight loss. Every individual who is fifty years old or older who has an average risk of developing colon cancer should have a routine colonoscopy once every ten years. Individuals considered to be at anincreased risk of developing colon cancer should have a routine colonoscopy on a more frequent basis. When patients follow the proper screening guidelines, between seventy-six and ninety percent of colon cancer cases can be prevented or found at the precancerous stage.

2. Preparing For The Procedure

Most individuals who undergo a colonoscopy describe the most undesirable part of the process as the preparation. A key requirement for a successful and smooth procedure is the emptying of the contents of the patient's colon. Several days before the procedure, a patient needs to consume a low-fiber diet. During the last twenty-four hours before the procedure, patients should only consume clear liquids like tea, broth, and juice. The day before, the patient will drink a special liquid that stimulates unpleasant bowel-clearing diarrhea. The doctor may prescribe a strong laxative to help move the bowel-clearing process along better. This process results in forceful and frequent diarrhea. The episodes may or may not be accompanied by bloating, cramping, nausea, abdominal discomfort, and vomiting. The taste of these laxatives may be bitter and unpleasant. Thus, it is often recommended for the patient to mix it with drinks for easier consumption.

3. How The Procedure Works

A doctor who specializes in gastroenterology is the one who performs the procedure. A colonoscopy lasts for between thirty and sixty minutes. The patient will be sedated with gas or intravenous anesthesia throughout. Once the patient is sedated, a colonoscope is passed into the colon. This is a long, flexible tube with a camera on the end of it. It projects a real-time video of what is seen by the camera to a monitor. The colonoscope can bend and fit the curves of the large intestine without puncturing it. The colonoscope can also blow air into the large intestine to give the doctor a better view. If abnormalities are discovered, a biopsy can be performed using small instruments passed through the colonoscope to examine the abnormal or suspicious cells. When the doctor is finished with their exam, they will slowly remove the colonoscope. The patient is then transferred to recovery. They will stay here for an hour for observation.

4. Risks Of The Procedure

In individuals who are considered at average risk, complications occur in twenty-eight of every one thousand colonoscopies. The risk of complications increases when a doctor discovers abnormalities in the intestine. The risk also increases if the doctor has to remove a piece of tissue for a biopsy. One of the biggest complications of a colonoscopy is intestinal perforations. This is the presence of tiny tears or lacerations in the colon or rectum wall. These perforations are produced when an instrument accidentally puts too much pressure on the patient's bowel to the point of tearing the tissue. Small intestinal perforations can be managed with bed rest, antibiotics, and watchful waiting. More significant intestinal perforations may require emergency surgical repair and medication. A patient who has tissue samples removed from their colon may experience post-procedure bleeding. Post-polypectomy electrocoagulation syndrome is another uncommon complication. It is caused by colon injury during the procedure.

5. Recovery Process

Patients who do not experience any complications will return home the same day they have the colonoscopy. This is because it is considered an outpatient procedure. As anesthesia or sedation is used for a colonoscopy, patients will require a ride home. Side effects of anesthesia include nausea, drowsiness, and bloating. They may take several hours to wear off. Most patients can resume their regular activities the day following their procedure. The results of a colonoscopy are usually provided to patients at their follow up appointment. This is because they are still under the effects of anesthesia directly following the procedure. If a patient has a biopsy performed during their colonoscopy, the results may not become available for at least several days. The reason is that they have to be sent to a laboratory for processing. Instructions on what to eat and what symptoms to watch for following the procedure are provided to the patient and their caregiver.

6. After A Negative Result

Despite the name, a negative result from a colonoscopy means that the doctor did not find anything abnormal in the patient's colon. In other words, there are no cancerous or precancerous lesions. After a negative result, doctors will provide patients with a recommendation on the timeline for their next procedure. This can vary between patients. However, the average timeline is every ten years for patients with no significant family medical history of colon cancer and other colon issues. This decreases to every five years if there is a family history of colon cancer.

7. After A Positive Result

Patients who receive a positive result from their colonoscopy have either colon polyps or other abnormal tissue in their colon. This abnormal tissue may indicate colon cancer. It may also be a precancerous lesion. Doctors will remove polyps during a colonoscopy and will then send them to a lab for testing. These tests will determine if the polyps are benign or malignant. They will also be able to determine if they are precancerous. Most patients do not need to be alarmed if their doctor removes precancerous polyps. However, this does alter the timeline for additional colonoscopies. This is because these patients are more likely to develop polyps again. They are also at an increased risk of colon cancer. A positive result often means that patients must have another colonoscopy sooner than if they had received a negative result. However, the precise timeline varies based on different factors. These factors include a family history of colon cancer, the patient's age, and the presence of polyps. There are also specific factors that doctors consider when they find colon polyps during one of these procedures. They include the size of the polyps and how many they found. Doctors will also consider the pathologic type of the polyps. After a positive result, patients will often need another colonoscopy in three or five years. It is rare for the next one to be in ten years with such a result.

8. Virtual Colonoscopy

Many patients know about the traditional form of colonoscopies. However, some patients may be able to undergo a virtual colonoscopy. This is a minimally invasive procedure. It will still help doctors screen their patients for colon cancer. A virtual colonoscopy uses a low dose computerized tomography instead of the colonoscope. This procedure produces many images to give the doctor a detailed view of the patient's colon and abdominal organs. A virtual colonoscopy will combine and manipulate the images to provide this view. Thankfully, this procedure does not require any anesthesia. It also only takes ten to fifteen minutes to do. Finally, many patients will benefit from a virtual colonoscopy. This is great for patients who are not able to undergo a traditional colonoscopy. It also helps patients who take blood-thinners.

9. Alternative Tests For The Colon

The most common test to detect colon cancer and other abnormalities is a colonoscopy. It is the one that most individuals think of when they consider colon cancer screening. However, it is not the only option. This is vital information, as some patients are ineligible for a colonoscopy. In addition, alternative tests are less invasive than a colonoscopy. This helps get more patients to screen themselves regularly for colon cancer and other colon problems. One alternative is fecal immunochemical testing. It analyzes a stool sample from the patient and checks for blood in the sample with antibodies. A similar alternative is fecal occult blood testing, which also involves a stool sample. Another option is a sigmoidoscopy. This is similar to a colonoscopy, though it checks a smaller part of the colon. A sigmoidoscopy is invasive and requires fasting and medication. Some patients may choose a stool DNA test, which looks at blood and specific DNA in a sample of a patient's stool. If this test returns abnormal results, patients may still need a colonoscopy.

10. Colonoscopy Timeline

The majority of patients, as discussed, should get a colonoscopy once every ten years after they turn fifty years old. However, certain at-risk groups may need to begin these tests earlier, such as at forty-five or forty years old. This applies to individuals with a family history of colon cancer and those who have had it before themselves. In addition, patients who have ulcerative colitis, Crohn's disease, or another inflammatory bowel disease should also consider starting colonoscopies earlier. Genetic conditions such as Lynch syndrome and familial adenomatous polyposis also merit starting this test sooner. Some experts also say that black individuals may want to consider colonoscopies and other colon cancer screenings earlier. The reason is that they appear to experience colon cancer more often. Patients who fall into one of these categories should discuss the appropriate timeline with their doctor. These factors will also adjust how often patients need a colonoscopy. As mentioned, this is normally every ten years. However, these individuals may need one every five or even every three years. The results they get will also dictate how often they need a colonoscopy.

11. Colonoscopies Can Be Preventative, Not Just Diagnostic

One of the most powerful—and often overlooked—benefits of a colonoscopy is that it’s not just designed to find colon cancer, but also to prevent it entirely. During the procedure, doctors can detect and remove polyps, which are small growths on the inner lining of the colon. While most polyps are benign, some can gradually become cancerous if left unchecked. By removing these polyps on the spot, a colonoscopy interrupts the disease before it even begins. That makes it one of the few cancer screening tests that actually reduces your future risk of developing cancer. Unfortunately, many people delay the test, assuming it’s only needed when symptoms arise. But by then, polyps could have progressed to more serious stages. Early and regular screenings are crucial. When done on schedule, colonoscopies have the potential to save thousands of lives each year by stopping colorectal cancer in its tracks—before it ever has a chance to grow.

12. You May Be Awake—But You Won’t Remember It

If the idea of being fully awake during a colonoscopy makes you nervous, you’re not alone—but here’s the reassuring truth: most colonoscopies are performed using conscious sedation, which means you’re technically awake, but deeply relaxed and unlikely to remember anything about the procedure. You'll be drowsy, calm, and pain-free, often drifting into a twilight state where time passes quickly. The combination of sedatives and pain relievers ensures that you feel little to no discomfort while remaining safe and responsive if necessary. Some patients opt for deeper sedation or general anesthesia, which results in complete unconsciousness, while others—especially in certain countries or with virtual colonoscopies—choose to forgo sedation altogether. Your provider will discuss the best option based on your health history, anxiety level, and preference. The key takeaway? Even though you're not technically "asleep," most people are pleasantly surprised by how easy and forgettable the experience actually is.

13. Your Diet Before the Procedure Matters More Than You Think

Many patients think the only thing that matters before a colonoscopy is the infamous bowel-cleansing drink—but your diet in the days leading up to the prep is just as important. Doctors typically recommend a low-fiber diet for three to five days before your procedure to reduce residue in your intestines. This means cutting back on raw fruits and vegetables, seeds, nuts, whole grains, and anything difficult to digest. Why? These foods can leave behind material that obscures your doctor’s view during the exam, potentially hiding polyps or abnormalities. A cleaner colon means a more accurate procedure—and fewer chances that you’ll need to repeat it due to poor visibility. Planning ahead can make your prep day much smoother. Stick to easy-to-digest meals like white rice, eggs, chicken, and cooked vegetables before switching to clear liquids 24 hours out. It’s a small but important step that helps ensure your results are as clear as possible.

14. A Clean Colon Means a More Accurate Exam

The quality of your colonoscopy is only as good as your bowel prep. If your colon isn’t thoroughly cleaned out, your doctor’s view will be obscured, and small polyps or signs of early cancer could go undetected. In fact, poor bowel prep is one of the leading reasons that colonoscopies miss early-stage colorectal cancer. It’s also the most common reason doctors recommend repeating the procedure sooner than expected. Think of the prep process—however unpleasant—as a way of setting your doctor up for success. The better they can see, the more accurate the screening. This includes drinking the full amount of the prescribed prep solution, following the timing instructions carefully, and adhering to dietary restrictions beforehand. While it’s not the most enjoyable part of the process, a clean colon allows your doctor to perform a thorough and potentially life-saving exam. When it comes to prep, doing it right the first time really matters.

15. Women May Have a Slightly Different Experience

While colonoscopies are generally safe and effective for everyone, women may have a slightly different experience due to anatomical differences. The female colon tends to be longer and more curved than the male colon, which can sometimes make the procedure slightly more challenging or uncomfortable—especially during insertion of the scope. Women who have had abdominal surgeries, hysterectomies, or pelvic scarring may also experience added sensitivity or resistance in certain areas of the colon. However, these concerns can usually be addressed with the right preparation. It’s important to choose a gastroenterologist with experience treating a wide range of patients, and to be open about your medical history and any anxiety or discomfort you may have. Providers can adjust sedation levels, use different scope techniques, or even offer alternatives like virtual colonoscopies. Understanding these gender-specific nuances helps ensure a more comfortable and personalized experience—and encourages more women to stay on top of this vital screening.

16. It’s Normal to Feel Gassy or Bloated Afterward

One of the most common side effects after a colonoscopy is feeling gassy, bloated, or experiencing mild cramping—and it’s nothing to worry about. During the procedure, your doctor gently inflates your colon with air or carbon dioxide to create a better view of the intestinal walls. This distension allows the camera to navigate easily and spot any hidden polyps or abnormalities. However, all that air has to go somewhere. After the procedure, you may pass gas more frequently than usual as your body expels it. This can feel a bit awkward, especially in the recovery room, but it’s completely normal and even encouraged. Walking around, sipping warm liquids, and avoiding carbonated beverages can help relieve discomfort more quickly. In most cases, this bloating passes within a few hours. If it lingers beyond a day or worsens, be sure to contact your provider—especially if it’s accompanied by pain, fever, or significant swelling.

17. Colonoscopies Aren’t Just for People Over 50 Anymore

For decades, colonoscopy guidelines recommended beginning routine screenings at age 50. But that’s changing—the new standard is age 45, reflecting a concerning rise in colorectal cancer rates among younger adults. This shift means that people in their mid-40s, even without symptoms or risk factors, should talk to their doctor about scheduling their first colonoscopy. Those with a family history of colon cancer, inflammatory bowel disease, or known genetic mutations may need to start even earlier. Unfortunately, younger individuals often dismiss early signs of colon issues—like rectal bleeding or unexplained changes in bowel habits—as something less serious. This leads to late diagnoses and more aggressive disease. Colonoscopies, along with other screening methods, can catch problems before they escalate. Starting earlier improves outcomes dramatically, and the procedure is usually covered by insurance once you meet the age threshold or have qualifying risk factors. It’s not just for seniors—it’s a smart step for anyone in midlife.

18. Results Aren’t Always Immediate—And That’s Okay

While many patients expect instant answers, the results of a colonoscopy aren’t always available right away—and that’s completely normal. If your doctor didn’t find any abnormalities, they might tell you immediately after the procedure once you’ve recovered from the sedation. However, if biopsies were taken or polyps were removed, the tissue samples need to be analyzed in a lab. This pathology process typically takes a few days to a week. During this time, it’s important to be patient. Waiting can feel stressful, but it doesn’t necessarily mean something is wrong. In fact, most polyps are benign or precancerous, and early removal often prevents future issues altogether. Your doctor will call or schedule a follow-up to discuss the findings and next steps. In the meantime, try not to jump to conclusions. A delay in results is usually just a sign that your care team is being thorough—not that there’s cause for alarm.

19. Colonoscopies Are Covered by Most Insurance Plans

One of the best things about colonoscopies? They’re often free—or at least significantly covered—if you meet standard screening criteria. Under the Affordable Care Act in the U.S., most private insurance plans, as well as Medicare, are required to cover the cost of routine colon cancer screenings starting at age 45. This includes the procedure itself, anesthesia, and even the bowel prep kit in many cases. However, it’s important to note that if your doctor removes a polyp or performs a biopsy during the exam, the procedure may be billed asdiagnostic instead of preventive. This can result in unexpected out-of-pocket costs. To avoid surprises, call your insurance company ahead of time to confirm coverage, and ask your doctor whether your colonoscopy is likely to remain preventive based on your history. Regardless of cost, the long-term value of early detection and prevention is priceless—financially and medically.

20. You May Need One Sooner If Symptoms Appear

Even if you're under 45 or not yet due for a routine colonoscopy, certain symptoms warrant a closer look—and in many cases, a full exam. Persistent changes in bowel habits, such as diarrhea, constipation, or narrow stools, could indicate an underlying issue. Rectal bleeding, blood in the stool, unexplained weight loss, fatigue, or abdominal pain are also red flags. Don’t wait for your next milestone birthday if something feels off. Colon cancer can develop at any age, and early symptoms are often subtle or mistakenly attributed to stress, hemorrhoids, or diet. If you experience these symptoms consistently, your doctor may recommend a diagnostic colonoscopy, even if you’re younger than the typical screening age. Remember: the goal is early detection. The sooner a problem is found, the more treatment options and better outcomes you’ll have. Listening to your body—and acting on what it’s telling you—can truly save your life.

A Life-Saving Look Inside

A colonoscopy isn’t just a routine test—it’s a powerful tool that can detect, prevent, and even help treat some of the most serious conditions affecting your digestive health. While the idea of prepping for and undergoing the procedure may seem intimidating, the peace of mind and potential life-saving benefits far outweigh the temporary discomfort. With expanded awareness, evolving screening guidelines, and new technology like virtual colonoscopies, patients today have more options and better outcomes than ever before. Whether you’re preparing for your first screening or helping a loved one understand what to expect, knowing these 21 key facts can make the entire process feel a lot less overwhelming—and a lot more empowering. Take control of your health, start the conversation with your doctor, and remember: when it comes to preventing colon cancer, knowledge (and screening) truly is power.