Common Colonoscopy Concerns Answered: Safety, Prep, and Why Screening Matters
- Mar 1
- 9 min read
March is Colon Cancer Awareness Month, and as a board-certified gastroenterologist practicing in Plano, Texas, I want to address the real concerns that keep people from scheduling their colonoscopy screening. After more than a decade of treating patients throughout the Dallas-Fort Worth area, I've heard just about every reason people put off this life-saving procedure.
Let's talk through the most common questions I hear, because understanding the facts might help you feel more comfortable about scheduling your screening.
How Dangerous Is a Colonoscopy?
The short answer: Colonoscopy is very safe. Serious complications are rare, occurring in fewer than 1 out of every 1,000 procedures.
I completely understand why people worry about this. When you hear words like "procedure" and "sedation," your mind naturally goes to what could go wrong. Here's what the data actually shows: perforation (a tear in the colon wall), which is the complication most patients worry about, happens in less than 1 in 1,000 colonoscopies. Minor bleeding that stops on its own is the most common issue, and even that only occurs in about 2-5 per 1,000 procedures.
In my practice here in Plano, I've performed thousands of colonoscopies safely. The risk of driving on Central Expressway during rush hour honestly concerns me more than the risks of the procedure itself. (And if you've ever merged onto 75 near Park Boulevard, you know what I mean.)
What I think about when patients ask about risk is this: What's the risk of not getting screened? Missing a polyp that becomes cancer five years from now is a far greater risk than the minimal complications associated with colonoscopy. Learn more about what to expect during your colonoscopy procedure.
What Does Colonoscopy Prep Taste Like?
Honest answer: The prep isn't delicious, but we have multiple options that make it much more tolerable than it used to be.
I'm not going to tell you colonoscopy prep tastes like a smoothie from your favorite juice bar. That wouldn't be truthful. But here's what's changed in recent years: we now have low-volume preps (less liquid to drink), pill-based options, and flavoring packets that help significantly.
The split-dose approach has made the biggest difference for most of my patients. You take half the prep solution the evening before your procedure and the other half 6 hours before your appointment. This method not only makes the prep more manageable, it actually leads to better prep quality and better exam results.
When someone tells me they're dreading the prep, I always say this: talk to your gastroenterologist about which option works best for you. There's not just one way to prep anymore. And yes, it's an inconvenient evening and morning. But it's temporary. If we can perform a thorough exam because your prep was excellent, you might not need another colonoscopy for up to 10 years.
Compare that to repeating stool tests or blood tests every one to three years. One challenging prep day for a decade of peace of mind? That math works out pretty well. Check out my detailed colonoscopy prep guide for step-by-step instructions.
Do I Need a Colonoscopy If I Feel Fine?
Yes, and here's why: Screening is specifically designed for people who feel healthy. That's the entire point.
This sounds counterintuitive, I know. Why screen for something when you have no symptoms? Because colon polyps and early colon cancer typically don't cause any symptoms at all. By the time you feel something, we're often dealing with a more advanced situation than if we'd caught it during routine screening.
I've had this conversation countless times in my practice:
Patient: "My spouse made me come in. I feel completely fine."
Me: "I hear you. Let's take a look."
And then we find polyps. Sometimes several. Sometimes larger ones that were absolutely headed toward becoming cancer in the next few years. I remove them during the exam. Problem solved, cancer prevented.
Those patients almost always say afterward, "I had no idea anything was there." Exactly. That's why screening works.
If you're experiencing symptoms like bleeding, changes in bowel habits, or abdominal pain, that's no longer screening. That's a diagnostic exam to find out what's causing your symptoms. The goal of screening is to find and remove problems before you ever have symptoms. That's how we prevent colon cancer, not just detect it.
Should I Get a Cologuard/Guardant Shield/FIT or a Colonoscopy?
For most people, colonoscopy is the gold standard because it both detects AND treats problems in one procedure. But let me explain both options.
If you're absolutely not going to do a colonoscopy, then a stool-based test like Cologuard or a blood-based screening test is better than nothing. I mean that sincerely. Something is always better than skipping screening entirely.
But here's how those tests work in practice:
If the test is positive, you need a colonoscopy to figure out why. So you've taken the test, gotten a concerning result, worried about it, and now you're scheduling the colonoscopy anyway.
If the test is negative, that's great news. But you'll need to repeat it in one to three years. And again after that. And again after that. That also doesn't take into account the percentage of false positive and false negative results.
With colonoscopy, we're looking directly at your entire colon. If we see a polyp, we remove it right then and there. That polyp can't turn into cancer now. One procedure provides up to 10 years of protection, depending on what we find and your individual risk factors.
Think of it this way: would you rather take a test that might indicate a problem (requiring a colonoscopy to investigate), or get the comprehensive exam that both finds and fixes issues in a single visit? For patients in the Dallas-Fort Worth area wondering about their options, I've written a detailed comparison in my post about positive Cologuard results.
When Should I Get a Colonoscopy?
Current guidelines recommend that average-risk adults begin colon cancer screening at age 45. This is a change from the previous recommendation of age 50, made because we're seeing colon cancer in younger people more frequently.
Here are the current recommendations from the American College of Gastroenterology and American Gastroenterological Association:
If you're at average risk:
Start screening at age 45
Continue regular screening through age 75
After 75, discuss with your doctor whether continued screening makes sense based on your overall health
You should start screening earlier if you have:
A family history of colon cancer or polyps (especially if a first-degree relative was diagnosed before age 60)
Inflammatory bowel disease like Crohn's disease or ulcerative colitis
Certain genetic syndromes like Lynch syndrome
A personal history of polyps or colon cancer
For patients with a family history, I typically recommend starting screening 10 years before the age when your relative was diagnosed, or at age 40, whichever comes first.
Good news: If your colonoscopy is normal and you're at average risk, you probably won't need another one for 10 years. If we find and remove small polyps, the interval might be 5 to 7 years.
We personalize the timing based on what we discover during your exam. Learn more about who qualifies for colonoscopy screening.
What Happens If I Don't Get Screened?
Without screening, precancerous polyps can grow undetected and develop into colon cancer. This is exactly what we're trying to prevent.
Colon cancer is one of the most preventable cancers because we can find and remove polyps before they ever become cancerous. That opportunity doesn't exist with most other types of cancer. With colon cancer, we have this incredible window to intervene early.
In my decade-plus of practicing gastroenterology in Plano and the surrounding communities, I've seen the dramatic difference screening makes. I've caught cancers at stage 1 when they were completely curable with surgery alone. I've removed thousands of polyps that never got the chance to become cancer. And honestly, those success stories are why I keep writing posts like this every March (and plan to continue to as long as I am in practice).
The patients who wait until they have symptoms? Those conversations are much harder. I don't share this to scare you, but to give you the honest perspective of someone who sees both scenarios regularly.
A Personal Note (and an Honest Admission)
I recently created a video about colon cancer screening using AI tools. I'm going to be completely transparent with you: my video editing skills are pretty much nonexistent. My kids laughed when they saw it. But the message I was trying to convey, in my admittedly clunky way, is something I think about constantly.
We're all incredibly busy. Between work obligations, family responsibilities, trying to navigate traffic on the Dallas North Tollway, and everything else happening in our lives here in the DFW Metroplex, healthcare appointments fall to the bottom of the list. I do it too. I understand.
But I've spent over a decade seeing what happens when we catch things early versus when we don't. And I've learned that somehow, we find time for the things that truly matter.
Is scheduling a colonoscopy inconvenient? Absolutely. Does it require taking time off work, completing an unpleasant prep, and spending a morning at our procedure center? Yes. But dealing with advanced colon cancer that could have been prevented? That's an entirely different level of inconvenient.
So if my slightly awkward AI video convinces even one person to pick up the phone and schedule their screening, I'll gladly accept being teased about my lack of film-making abilities. Some things are worth looking a little silly for.
How Do I Schedule a Colonoscopy in Plano?
Ready to schedule your screening? Contact our office at (972) 737-9251 or schedule an appointment online. We serve patients throughout Plano, Frisco, Allen, McKinney, Prosper, and the entire Dallas-Fort Worth area.
As a board-certified gastroenterologist and medical device consultant, I stay current on the latest colonoscopy techniques and quality standards. Our practice uses advanced technology to ensure the most thorough and comfortable screening experience possible. Learn more about our practice and our approach to digestive health.
Frequently Asked Questions About Colonoscopy
How long does a colonoscopy take?
The procedure itself typically takes 20-30 minutes. With preparation time and recovery from sedation, plan to be at the procedure center for about 2 hours total.
Will I be asleep during my colonoscopy?
You'll receive sedation (usually propofol) that puts you in a comfortable, sleep-like state. Most patients don't remember the procedure at all and report feeling no discomfort.
Can I drive myself home after a colonoscopy?
No. Because of the sedation used during the procedure, you'll need someone to drive you home. You shouldn't drive, operate machinery, or make important decisions for the rest of the day.
How much does a colonoscopy cost?
Most insurance plans cover screening colonoscopy at 100% for patients who meet age and risk criteria, with no copay or deductible. Diagnostic colonoscopies may have different coverage. We recommend checking with your insurance provider before your appointment.
What if the doctor finds polyps during my colonoscopy?
If we find polyps during your exam, we remove them immediately if they are small or medium-sized using specialized instruments passed through the colonoscope. The polyps are then sent to a lab for analysis. Most polyps are benign (non-cancerous), but removing them prevents them from potentially becoming cancer later. Larger polyps are biopsied and tattooed, with a plan for removal formed after review f the pathology specimen. Read more about understanding your colonoscopy results.
The Bottom Line
I'm not trying to guilt anyone into scheduling a colonoscopy. The concerns people have are real and valid. Nobody wakes up excited about this particular appointment.
But here's what I know after practicing gastroenterology in the Dallas-Fort Worth area for over a decade: Colon cancer is incredibly preventable. We can literally stop it before it starts by finding and removing polyps. That's not true of most cancers. With colon cancer, we have this amazing opportunity to intervene before there's even a problem.
The risks of colonoscopy are minimal. The prep, while not pleasant, comes in multiple options and is temporary. Feeling fine isn't a reason to skip screening because that's exactly who we want to screen. And while other tests have their place, colonoscopy remains the most comprehensive option that can both detect problems and fix them at the same time.
If you're 45 or older and haven't been screened, or if it's been 10 years since your last colonoscopy, I hope you'll consider making that call. Talk to a gastroenterologist. Ask questions. Figure out what works for you.
March is Colon Cancer Awareness Month, but really, any month is a good time to potentially save your life. The excuses will still be there next month and the month after that. But so will the opportunity to prevent cancer.
And that's worth a day of inconvenience.
References
American College of Gastroenterology. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. American Journal of Gastroenterology. 2021;116(3):458-479. https://journals.lww.com/ajg/fulltext/2021/03000/acg_clinical_guidelines__colorectal_cancer.14.aspx
Shaukat A, Kaltenbach T, Dominitz JA, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2020;158(4):1131-1153. https://www.gastrojournal.org/article/S0016-5085(20)30082-2/fulltext
American Cancer Society. Colorectal Cancer Screening Guideline. Updated 2023. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html
American Gastroenterological Association. AGA Clinical Practice Update on Risk Stratification for Colorectal Cancer Screening and Surveillance. Gastroenterology. 2023. https://www.gastrojournal.org/article/S0016-5085(23)04771-6/fulltext
Johnson DA, Barkun AN, Cohen LB, et al. Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2014;147(4):903-924.
Rex DK, Boland CR, Dominitz JA, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. American Journal of Gastroenterology. 2017;112(7):1016-1030.
Warren JL, Klabunde CN, Mariotto AB, et al. Adverse events after outpatient colonoscopy in the Medicare population. Annals of Internal Medicine. 2009;150(12):849-857.
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DISCLAIMER: Please note that this blog is intended for Informational Use only and is not intended to replace personal evaluation and treatment by a medical provider. The information provided on this website is not intended as a substitute for medical advice or treatment. Please consult your doctor for any information related to your personal care.
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