Why I Went Without Sedation for My Colonoscopy

My gastroenterologist slipped the thin, rope-like scope several feet up my colon when I made an unsettling discovery. As he attempted the delicate maneuver to safely remove a polyp less than a half-inch in size I saw on the video screen the difficulty he faced as his target moved with each breath I took. Maybe, I thought, it would be better if I were asleep.

Credit: Adobe Stock

In the U.S., nearly all colonoscopy patients either sleep through their procedure or at least experience it under various levels of sedation. But it doesn't have to be that way.

In other countries, colonoscopies without sedation are the norm. But experts say only a tiny percentage of the 15 million colonoscopies done each year in the U.S. are without sedation.

Some medical professionals, however, are seeing an increased interest in this. More patients see an advantage to avoiding the heavy-duty intravenous drugs that bring on sleepiness and nausea and require them to arrange for a driver to take them home.

Since 2000, the increased use of colonoscopies and other screening techniques are credited with a significant reduction in the mortality rates for colorectal cancer, the second most deadly cancer in the U.S. behind lung cancer.

For those who choose to have a colonoscopy, there are two major components. Both are unpleasant. First is the prep: where the patient consumes massive quantities of laxatives with the goal of cleansing the colon through hours of diarrhea.

The second part is the exam itself where the scope is introduced into your anus and slid through the entire colon. Housed inside the scope are a camera, water, air, suction and other devices the doctor uses to hunt for polyps — the potentially cancerous growths in the wall of the colon.

To me, colonoscopy without sedation was attractive because I wouldn't have to find a friend to take off work and drive me home. And I could avoid the druggy daze sedation produces. I had a colonoscopy before, and while I remained conscious under the moderate sedation, the hours of grogginess were annoying.

Before signing up for my recent colonoscopy, I talked to others who have had one without sedation. They agreed it was feasible for the motivated patient. Still, despite the fact that I’m a nurse, I was nervous — worried that the pain would be too much.

In the patient prep room where I received my hospital gown and an IV, I texted a friend to make sure he was on standby in case I needed the ride home. While I tried to be calm, I didn't realize the extent of my anxiety until I entered the procedure room and my vital signs revealed a blood pressure 50 points above my usual.

But soon into the colonoscopy, I found reality didn’t justify the worry. My doctor was halfway through the colon before I felt my first significant sensation or movement of the scope in my abdomen. OK, I thought, I can handle this. My next set of vital signs were closer to normal levels.

The most common point patients feel pain during a colonoscopy is the entry of the scope and its first maneuvers inside. I escaped that pain. What caused the most discomfort for me was the poking I felt when the scope moved from my left side (the descending colon), across my abdomen (the transverse colon) and then reached my right flank (the ascending colon) and traveled down to where the large intestine ends and the small intestines begin.

My doctor found three polyps on the ascending colon. That meant he spent most of his time in the farthest depths and with each twist of the scope I felt dull thumps on my left side.

Watching the polyp removal was fascinating and nerve-wracking. I was impressed with my doctor's skills as he lassoed the polyps. The small tissue growths moved with my breath, and at times they slipped from the doctor's snare and he had to make a new approach. Watching it play out on the video screen, I wanted to help and asked if he wanted me to hold my breath, but he said not to bother.

It was time consuming, delicate work. A misstep can cause a tear in the bowel walls, a rare complication that means a probable trip to surgery. But after my doctor captured the third polyp, the remaining trip through my colon was uneventful. In all, my colonoscopy took about 35 minutes, a little longer than most due to the polyps.

I spent the next 10 minutes in the recovery room passing absurd amounts of gas left over from the procedure. By the time I drove myself to a nearby diner and ordered breakfast, my fellow patients were likely still in the recovery room.

My doctor, Dr. Scott Keeley of Minnesota Gastroenterology, said the issue of sedation was all about patient preference. "My emphasis is on patient comfort," he said.

There is anecdotal evidence to suggest that more people are going without sedation these days, according to American College of Gastroenterology spokeswoman Dr. Sophie M. Balzora.

"It's definitely gaining attraction," said Balzora, an assistant professor of medicine at the NYU School of Medicine. She currently does about six out of 80 procedures a month without sedation compared to about one a month five years ago.

The reasons people are going sedation-free vary. Some patients may be too obese for outpatient sedation guidelines and would require a hospital setting for sedation. Instead, those patients may choose to stay in the outpatient setting and go without sedation. Others, Balzora said, are fearful of the commonly-used sedative propofol. The drug's misuse was the main cause of singer Michael Jackson's death.

Before choosing to go without sedation for your colonoscopy, talk with your doctor. There could be medical reasons to choose the drugs. Women's anatomy can mean they feel more pain than men during this procedure. And those prone to anxiety may wisely choose sedation.

But for patients who choose to go without, the experience is almost always positive, said Dr. Jaime Zighelboim, gastroenterology chair at Mayo Clinic Health System in Eau Claire, Wis., and assistant professor of medicine at Mayo College of Medicine.

"If someone is willing to do it, most people are very satisfied and would do it again without sedation," he said.