Painless colonoscopy without sedation or analgesic

Posted , 8 users are following.

Let me first assure the reader that I definitely do not consider myself as having a high pain threshold and would be horrified at the prospect of having stitches, which I have refused in the past. Thank God for \"Steristrips\".

After reading many disturbing reports of colonoscopy procedures, I opted for a barium enema followed by a sigmoidoscopy, which I still wasn't exactly looking forward to but was persuaded as being necessary for a more accurate assessment. However, I ended up having an almost full colonoscopy; bearing in mind that colonoscopies are often incomplete. I was quite prepared to continue with a full colonoscopy but the clinician, having seen the barium results, considered it unnecessary.

Having changed an appointment for the barium enema (BE), which one apparently undergoes a couple of weeks before the sigmoidoscopy, I received a new appointment together with two more sachets of bowl prep (Picolax in my case - it tastes quite refreshing if you're partial to fizzy lemon juice). As I did not find this prep particularly uncomfortable before the BE, I decided to undergo the prep again for the sigmoidoscopy rather than merely have the prescribed phosphate enema at the hospital immediately prior to the procedure. My reasoning was that, firstly, if I was going to be pumped up with air during the procedure, any escaping air would be more wholesome for the staff and therefore less embarrassing for me. Secondly, if the clinician considered that exploration beyond the descending colon was necessary, they would have the opportunity to investigate further along the colon.

I attended a NHS hospital where neither sedation nor analgesic is generally given for a sigmoidoscopy, although I was offered the choice on arrival. I particularly did not want sedation (i.e. one is conscious throughout the procedure and, at best, merely forgets the procedure on recovery - somewhat like inebriation) because I like to take control of my situation and felt that more care might be taken if I were in a position to moderate or stop the procedure; I also considered that staff would be more appreciative of my not occupying a recovery bed afterwards.

I was more than surprised that, within a few minutes, the clinician had intubated the colonoscope up to the Splenic Flexure (junction of the descending colon and transverse colon) without my hardly feeling anything; as far as I understand, this constitutes a complete sigmoidoscopy. As I was experiencing no discomfort whatsoever, I advised that I was quite happy that he proceeded into the transverse colon. During this part of the procedure, he told me that he was trying to get loops out of the endoscope but all I could feel was a mild stomach. He continued on to the Hepatic Flexure (junction between the transverse colon and ascending colon) and decided that no further exploration was necessary. During all this time I could see the visual display and the progress of the colonoscope through the colon.

I accept that people experience things differently and that the practical experience of the clinician plays a large part in making the procedure as comfortable as possible. However, I believe that a relatively pain free colonoscopy can be achieved by becoming involved and interested in the subject to the point where you can discuss the finer details with the clinician during the procedure and not place yourself in an inebriated and, therefore, defenceless position unable to control the proceedings. I am sure that the clinician performing your procedure will have far greater respect for you, and therefore treat you, your fears and your discomfort (if any) with far greater consideration. Remember, if your partially zonked out you won't be able to stop the procedure even though you may desperately wish to and the clinician may not take anywhere near the care (even though you may be moaning and groaning on the table); he/she is only human and needs to get on with the next patient.

Good luck; although I don't really think you'll need it.

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  • Posted

    Everyone's experience of a colonoscopy is different and depends on many factors. Despite teaching anatomy and physiology at an advanced level, being highly educated on the structure and function of the gastrointestinal tract, working with nurses and doctors to help them achieve their academic goals, twenty years experience of teaching stress control to highly stressed people, being proficient in self-hypnosis, many experiences of other very unpleasant and painful medical tests/biposies and three cancer surgeries, my knowledge and experience was unable to ameliorate the pain of the colonoscopy. It is no one's intention to scare someone witless before having this procedure, but careful consideration should be given to adequate pain relief, especially if there has been previous abdominal surgery. If able to tolerate anaesthesia, then this would be the best option.

    I am glad that you had a relatively pain-free experience, but your experience is only pertinent to you, as mine was to me. As an insurance against what could be an excruciating experience, full pain releif should be considered, as one would not want to be in the position of undergoing a painful colonoscopy only to have the colonoscopist abandon it half-way, as is the experience of many. Consequently, this scenario could delay the diagnosis of a potentially life-threatening condition and exacerbate worry.

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  • Posted

    I strongly agree with your comments. Everyone's experience is pertinent to themselves and we all cope differently with pain. What I am appalled by is the huge amount of people writing on these types of web sites who have had very negative experiences with/during colonoscopy. I also agree that nobody wants to, or is trying to put people off having these procedures, as they undoubtedly save lives, but WHEN OH WHEN will doctors/nurses/consultants/NHS, anyone involved with these procedures sit up and take notice of all these complaints. I wonder how many complaints there have actually been to the NHS when someone has had a bad experience - I imagine not many. If people do not complain, then things will never change. I did complain about my traumatic experience with a colonoscopy which is still on-going at the moment. I didn't find it easy to complain, but what happened to me shouldn't have happened, and I'm not giving up until someone listens to me and takes notice and gives me some assurances that lessons will be learned and used to improve services for others. You are obviously a highly educated person who has a long history within the medical field - surely there must be something you can do/say to bring these concerns to someones attention?!
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  • Posted

    Well - let me tell you how very different the experience can be.

    First of all like most Canadian soldiers I have a very high tolerance to pain. I have burned moles and warts off of my skin using thermite. I have also removed cysts with nothing but a hobby knife and paper towels. I find this what I consider mild paid.

    Well I had 2 colonoscopies without any meds and the pain was preposterous, nearly unbearable and I almost passed out. When the colon starts cramping (yours obviously didn't so yeah, that is 100% _ZERO_ pain it feels like having a poop if you dont cramp)

    but when it _does_ start cramping up it is out of this world painful. I have ulcerative colitis so my bowels are in fairly rough shape and maybe that is why mine cramps up - but wow - the pain is the worst thing I have every felt in my life and I have gone thru painful events that would make some people pass out just from watching it -- and I can handle those with a smile. Colonoscopy hurts way worse than stitches without painkiller, way worse than being burned witha blow torch for 2-3 minutes (and I have endured both - and would do so again in a heartbeat before another drug free colonoscopy)

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  • Posted

    I had a colonoscopy on Thursday, 2 days ago, I have previously had 3 endoscopies ( tube down throat) which weren't pleasant but in no way painful.I read posts on here and wasn't sure what to do about sedation.In the room with a nurse before the procedure, he told me that there were 3 choices, gas and air, sedation with a needle or nothing. He advised me if I wanted to watch the procedure(which I did)to have gas and air as it can be slightly painful and you could stop the procedure for a couple of minutes,the doctor and nurses don't mind.

    I was advised to take a few breaths of the gas and air before they started and off we went,it was quite painful but not anything I couldn't cope with, till the first turn. My god I was in agony, my toes were curled up involuntarily, my heels were digging into the bed, I wanted to scream! They told me to turn on my back but I couldn't move, so the woman doing the procedure slapped my leg and told me not to fight her!! My god, I couldn't move never mind fight her.It went on and on, then she said she had found a polyp, it took more time to remove that,the nurse was a bit fluffy and didn't help, and the lady taking care of my obs was tutting, I felt a fool and was embarrassed but just wanted to get away.

    I found out then that the lady doing it wasn't a doctor but a nurse, she advised me that should I have one again to have sedation,and that with a different person doing it, it may not hurt????. She said that she had removed 2 polyps and found nothing ominous, except I had severe diverticula disease.Was she saying that it was her fault it hurt, I have no idea?

    I must state that I am far from soft, I've had 4 children naturally, no pain relief( supposedly the worst pain in the world,numerous other procedures, a hysterectomy which involves bad after pain, but nothing has touched the pain I had on Thursday, I feel as if my body is in shock, I know my brain is. I hate doing things like this and frightening people before they go through it, I don't know why I had so much pain, but don't risk the pain,ask for everything possible, drugs, drugs, drugs, don't risk trying it without, what's the point?

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    • Posted

      according to this paragraph below - she should have stopped if you asked her to:

      "British Society of Gastroenterology (BSG) guidance states that, if an unsedated patient demands that the procedure is abandoned, then the colonoscopist must recognise and respect that consent has been withdrawn and terminate the procedure immediately.18 If a sedated patient appears to withdraw consent through verbal or physical actions, the colonoscopist may pause and see if cooperation may be regained. However, if it is clear that the patient continues to withdraw consent and patient safety may be compromised, the procedure should be terminated"

      This is another reason why you might want to refuse sedation again in the future - I did and had a good colonoscopy experience. I also researched the colonoscopist to make sure they were well experienced. I opted for pain killer (Fentanyl) & (boscopan) bowel relaxant, without sedation.

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  • Posted

    I had my second colonoscopy a couple weeks ago.  The first was performed under a general anaesthetic and I had no pain / no recollection.  I'd do that again.

    This second one ended up being a sigmoidoscopy: it was with some meds (but I don't know what,) and I think the meds caused me to fall asleep.  I remember nothing except waking in agony and shouting at the poor medical personnel to stop.  Unfortunately I wasn't in clear mind.  All I knew is that I woke up in great pain, feeling something that I can only describe as a boot kicking up my diaphragm.  So I vaguely remember saying STOP! STOP!  I also have a vague memory of the doctor saying "Well, then you'll need to have a CT scan."  And me agreeing to this. (As if I were in my right mind!)

    I'm sorry that I stopped the procedure without giving it a rest and a second try.  Couldn't the doctors pull back for a minute and let a patient recover his/her wits before discussing things?!

    I think that due to my hollering, they upped the meds and I fell asleep again.  When I came to, I was being delivered to the private recovery room.  I slept for an hour or two, had lots of gas and then was basically myself again.

    Today I received the prep for my CT scan (3 bottles of Omnipaque) and the paperwork saying I will be having a "virtual colonoscopy" or pneumocolon scan and the warning that my colon will be pumped full of "lots" of air, and that I may have discomfort for hours afterwards.  Is this going to be as bad as the pain from the colonoscopy?  Am I actually going to have to face the pain one way or the other?  Because if it's as bad, I would have rather finished last time!  The other thing that worries me is that a CT scan is basically extended exposure to x-rays and that it can up my chances of cancer.  I would like to have known this before agreeing to it!

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  • Posted

    And if you have enough drugs you won't remember a thing...bliss!
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  • Posted

    Hi Geebee,

    I checked this discussion because I had done extensive reading about colonoscopy procedure - all aspects - including without sedation. 

    I did this because I was scheduled for a colonoscopy to investigate colorectal bleeding + anaemia. I had the procedure this morning and wanted to feedback on my experience, because I know how anxious it can feel doing research before the first time you experience the procedure.

    I too, thankfully, can report that I had a painless colonoscopy which was completed fully and without sedation. I write this to offer another experience - but in no way do I discredit the true accounts that othe's have testified to here and elsewhere. My motive is to let others know that it is possible for some.

    Even though I went in already decided against sedation - I asked the prep. nurse what she'd recommend from her experience witnessing patients having the procedure. She said some feel pain with the sedative and some dont - she also said that this is also the case for those who don't have any sedative - some do have pain some don't.

    I wondered how it is that the medical profession state 'some discomfort' yet there are so many testimonies of 'the worse pain ever!' My conclusions were that if sedative is not going to prevent pain, why have it? So I focused on the 'pain' exclusively in my options for the procedure. Just like you, I did not want to be 'out of it' and confused and forgetful, whilst at the mercy of the medics. It rang true to me that this scenario would allow rushed and unconsidered actions.

    Focusing on pain, I asked if I could receive fentonyl, which is an alalgysic (pain releiver), without the sedative (versed, medazolam or any other benzodiazepan). They said yes they could do so - and did. I did not use gas and air or anything else (except Boscopan, to relax the colon itself)

    Women have longer colons which means this procedure can be difficult, especially if they have had a hysterectomy. In my case I have Uterine Fibroids and mentioned this to the Dr before doing the procedure and he said it may make it a little harder to get around if things are obstructed. I am also a small woman, 5ft and 9 stone & I have had 3 children; I am now 50 yrs old.

    I had 75 micrograms of Fentonyl and 10mg of Boscopan immediiately before the procedure started.

    The Dr got all the way to the first bend before I felt any discomfort - then I felt him infrate air and was a little anxious because I know this is where other say the pain intensifies. The colonoscopist (Dr) asked if I was OK - he could see me tense, I said yes and the baloon effect of pumping air was a little uncomfortable, but not excessive. After that point he managed to get all the way to the appendix without me feeling any more discomfort. He told me that was the worst part over and that I was doing very well - I thought, no you are! The he said the next part was to remove it and double check for any abnormalities or areas of concern (polyps etc)

    On coming back out, he took 6 biopsy's - no polyps found and everything normal. He did see a slight hemeroid on withdrawal (anal) on the way out. I felt only a slight tugging on one of the biopsy's.

    I can ony offer my own experience in order to inform others who may be having the procedure and wonder what to expect - I myself nearly frightened myself out of the procedure after all that I had read. I was referred for the colonoscopy due to rectal bleeding, dark red & mixed in wih stools + anaemia, so was obviously concerned about possible colorectal cancer (no polyps, results of biopsy soon - but basically given the all clear in terms of suspected colon malignancy). 

    Main points for consideration

    - I specifically asked for painkiller (Fentanyl)

    - No sedation, so I could be aware and part of decisions to proceed etc.

    - Researched the person doing the procedure - opted for a Consultant who does frequent colonoscopy procedures (Asked who was scheduled to do it, researched his on NHS Choices, list of consultants). Modesty made me want to choose a woman - but his credentials outwayed, and it was minimum pain and skill that I focused on. I did have a choice depending on hospital and date - was on a fast track 2 week referral list, due to symptoms.

    My humble advice would be to

    a) focus on skill (the colonoscopist) - to minimise pain & the chance of missing polyps etc.

    b) Focus on pain relief medication instead of sedative. This way you are fully aware to work with the Dr and to be considered every step of the way. You will remember all the images of your colon and be reassured that you were treated with consideration and due care. 

    c) Just a thought - but I also wondered whether some of the pain reported may be related to the conditions people present with crohns, diverticulitis, previous bowel surgery etc. I'm no expert, but I wonder if this should be considered when deciding the type of painkiller or sedative options? We're not all the same and possibly this may also affect the pain experienced.

    If you are really worried about this procedure - I hope this helps. If you have suffered painful colonosopies in the past, I hope this helps going forward too. I really appreciate all of the feedback each person here has given - it helped inform my own choices. I was glad to have had only mild discomfort at one point, but I know that was not guaranteed.

    All the best in your individual journey smile

     

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  • Posted

    No pain here during my first colonostomy, no sedation as I wanted to see what was going on, and had an engineer's curioisty with the equipment and the process. Was asking questions all the time, and chatting to the nurses during the process, and looking forward to the next one in 3 years time
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