Messy & uncomfortable business
9 out of 10 colon cancers can be cured if they’re caught early, and in Canada we have a whole system in place to help you meet that goal.
Colon cancer screening starts at age 50 for people at average risk. We are seeing a rapid rise in colon cancers in younger patients though and in the US screening now starts at age 45.
Fewer than half of Canadians are up to date on their colon cancer screening. For average risk people, the test is far easier than you imagine. See your primary care provider or call 811 to have a FIT test kit mailed to your home. The kit includes a cardboard poop collector to put in the toilet bowl and a collection wand to scoop a little sample of poop. Then you mail it off to the lab.
Don’t freak out if your FIT result screens positive. 96% of people with abnormal FIT results do not have cancer. 10% of people will screen positive and those folks will be booked for a colonoscopy to look for cancer or precancerous polyps in the bowel.
The most important thing about the FIT test is that it must be repeated every 2 years until age 74. A single normal result is not fully reassuring - one test won’t catch all the cancers, so DO NOT MISS your 2 year follow-up test. FIT tests only work if you actually do them.
What about people under 50 who are worried about cancer? If you have any rectal bleeding, new onset diarrhea that lasts more than 2 weeks, less than 3 bowel movements per week, black stools, or pencil thin poops go to your doctor and request colonoscopy. All of these things require a thorough diagnostic exam regardless of age.
If you have had a parent or sibling with colon cancer, you’re considered to be at increased risk. Colonoscopy is recommended to start at age 50 or 10 years earlier than the age of your relative’s diagnosis, whichever is younger.
The great thing about colonoscopy is that the physician can remove precancerous polyps or early cancers and prevent the need for bigger surgery in some cases. The procedure does have a small risk of bowel damage though and requires IV sedation, which is why FIT is recommended as a starting point for people at average risk. A single normal colonoscopy means no screening is required for 10 years in average risk people.
Emptying your bowels for optimal visualization during colonoscopy is a messy and uncomfortable business, but I have some techniques to make it more tolerable for you.
Book your scope for the afternoon so you're not on the toilet all night doing your prep. Ask for the cranberry flavoured Pico Salax prep (not PEG). Request a prescription for Zofran to take in case you experience nausea. While you’re at the pharmacy, pick up diaper cream with 40% zinc like zincofax plus to protect your bum. Make sure you’ve got a heating pad or barley bag at home to help with cramping. Avoid using ibuprofen or naproxen, but Tylenol is ok.
The day before your procedure you can have a light breakfast and lunch but no dinner. You can eat white bread, rice, pasta, mashed potatoes, cheese, eggs, lean meat, peanut butter, yogurt, cake and cookies. Avoid salads,nuts and veggies. Drink lots of clear fluids. White wine is ok! 🥂
Start with half your prep at 5pm the day before, then take the other half of the prep 5-6 hrs before your appointment. Stay close to a toilet.
Mix 3 sachets of cranberry Pico Salax with cold white cranberry juice. Chill for an hour, remix and drink FAST through a straw. Having a white or yellow Lifesaver in your mouth while drinking the liquid through a straw helps.
Chase it with clear Gatorade or salty chicken broth. The more clear fluid you drink the better you will feel. You can drink coffee, tea and coke. Order pho and just drink the broth. Try fever tree ginger beer, lychee juice and club soda, G zero glacier Cherry, white cranberry mixed with peach Bubly, pineapple coconut juice mixed with pineapple Bubly, and mint tea.You can eat gummy bears, popsicles and jello while prepping for a colonoscopy! ABSOLUTELY NO RED OR PURPLE LIQUIDS OR FOODS. Orange, yellow and green are ok.
Stop drinking all fluids 2 hours before your test. Congrats! You have completed your bowel prep. A colonoscopy may not be pleasant, but it can save your life.