Colonoscopy FAQ

Is a colonoscopy painful?

Most patients experience little to no pain during a colonoscopy because sedation is used. You'll receive IV medication that makes you drowsy and relaxed — many patients don't remember the procedure at all. Some mild cramping or bloating afterward is normal and typically resolves within a few hours as you pass the air used during the exam.

How long does a colonoscopy take?

The colonoscopy procedure itself typically takes 20-60 minutes, depending on whether polyps need to be removed. However, plan for 2-3 hours total at the facility to allow time for check-in (30-45 min), the procedure, and recovery from sedation (30-60 min).

Will I be awake during the procedure?

Most patients receive sedation that puts them in a drowsy, relaxed state. With moderate sedation, you may be technically awake but likely won't remember the procedure. With deep sedation (propofol), you'll be essentially asleep. Some facilities offer unsedated colonoscopy for patients who prefer it, but this is less common.

What happens if they find polyps?

Most polyps are removed during the colonoscopy using special tools passed through the scope. This is called a polypectomy and is usually painless — you won't feel it. The removed polyps are sent to a pathology lab to determine their type. You may receive dietary restrictions and need a follow-up colonoscopy sooner than usual, depending on what was found.

At what age should I get my first colonoscopy?

The U.S. Preventive Services Task Force (USPSTF) recommends that adults at average risk begin colon cancer screening at age 45 and continue through age 75. The recommendation changed from age 50 to age 45 in 2021 due to rising rates of colorectal cancer in younger adults.

People with higher risk factors should start earlier:

• Family history of colon cancer or advanced polyps: Age 40 or 10 years before the relative's diagnosis
• Inflammatory bowel disease: 8 years after diagnosis
• Certain genetic syndromes (Lynch, FAP): As early as teens or 20s

How often do I need a colonoscopy?

For average-risk individuals with normal results (no polyps), the recommended interval is every 10 years. If polyps are found, the interval is shortened based on the number, size, and type:

• 1-2 small tubular adenomas: 7-10 years
• 3-4 adenomas: 3-5 years
• 5+ adenomas or large/villous adenomas: 3 years
• Inflammatory bowel disease: every 1-2 years

Can I get screened without a colonoscopy?

Yes, there are alternative screening tests including stool tests (FIT, Cologuard) and CT colonography. However, if any of these tests are positive, you'll still need a colonoscopy for diagnosis. Colonoscopy remains the only test that can both detect AND remove polyps in the same procedure.

What is the hardest part of colonoscopy prep?

Most patients find drinking the bowel prep solution to be the most challenging part. The solution can have an unpleasant taste and causes frequent trips to the bathroom. Tips to make it easier:

• Chill the solution — cold is easier to drink
• Use a straw to bypass taste buds
• Suck on lemon drops or ginger candy between sips
• Set a timer and drink steadily (8oz every 10-15 min)
• Start early enough to allow time for sleep

What can I eat the day before?

Only clear liquids — things you can see through: water, clear broth, apple juice, white grape juice, Gatorade, clear sodas, black coffee or tea, Jell-O (no red/purple), and popsicles. Avoid anything red, purple, or blue, as these can be mistaken for blood during the exam.

Do I have to drink all of the prep?

Yes, you should drink all of the prescribed prep solution for the best results. Inadequate prep is the #1 reason for incomplete colonoscopies and may require you to repeat the procedure. If you're struggling, take breaks, but continue until it's finished. If you experience vomiting or cannot complete the prep, contact your doctor's office.

What if I still have brown stool the morning of?

Your output should be clear or light yellow, like urine, by the morning of your procedure. If it's still brown or has particles, contact your doctor's office — they may advise drinking more clear liquids or additional prep, or they may need to reschedule if the prep is inadequate.

Can I drive myself home after a colonoscopy?

No. Due to the sedation, you cannot drive for 24 hours after the procedure. You must arrange for a responsible adult to drive you home and ideally stay with you for a few hours. Most facilities will not perform the procedure unless you have arranged a ride.

When can I eat after a colonoscopy?

You can usually eat soon after the procedure, once you're awake and alert. Start with light, easy-to-digest foods like crackers, toast, soup, or plain chicken. Avoid heavy, greasy, or spicy foods for the first day. Drink plenty of fluids to rehydrate.

Can I go to work the next day?

Most people can return to normal activities, including work, the day after their colonoscopy. However, plan to take the rest of your procedure day off to rest and recover from sedation. Avoid making important decisions, signing legal documents, or operating heavy machinery for 24 hours.

Is bloating and gas normal after?

Yes, very normal. Air is pumped into your colon during the procedure to help the doctor see clearly. Passing gas afterward relieves this bloating — don't be embarrassed, it's expected and encouraged. Walking can help move the gas through your system.

How much does a colonoscopy cost?

Costs vary widely depending on your insurance and where the procedure is performed:

• With insurance (screening): Under the ACA, screening colonoscopies are covered at 100% by most insurance plans with no copay or deductible — even if polyps are removed.
• With insurance (diagnostic): If the colonoscopy is for symptoms or follow-up, you may have copays or deductibles. Check with your insurance.
• Without insurance: Costs can range from $1,500 to $5,000+ depending on the facility and geographic location.

Is a screening colonoscopy free?

Under the Affordable Care Act (ACA), screening colonoscopies for adults age 45-75 are considered preventive care and must be covered at 100% by ACA-compliant insurance plans, with no copay, coinsurance, or deductible — even if polyps are found and removed during the screening. Medicare also covers screening colonoscopy with no cost-sharing.

What's the difference between screening and diagnostic colonoscopy?

Screening colonoscopy is for people with no symptoms, just routine cancer prevention. It's typically covered at 100%. Diagnostic colonoscopy is ordered because of symptoms (bleeding, pain, change in bowel habits) or for surveillance after previous polyps. Diagnostic procedures may have out-of-pocket costs depending on your insurance plan.

What if I'm scared or anxious?

Anxiety about colonoscopy is completely normal and very common. Some things that may help:

• Talk to your doctor about your concerns — they may offer anti-anxiety medication before the procedure
• Remember the sedation works very quickly
• Know that most patients report the experience was easier than they expected
• Focus on the benefits — colon cancer prevention and peace of mind
• Bring a supportive friend or family member

What if I'm embarrassed?

Healthcare providers perform colonoscopies every day — it's routine for them, and they've seen it all. You'll be covered with a gown and blanket, and the sedation means you likely won't be aware of or remember the procedure. The medical team is focused on your health, not on any awkwardness you might feel.

What if they find cancer?

Finding cancer during screening is uncommon but happens. The important thing to know: cancers found during routine screening are often early-stage and highly treatable. The 5-year survival rate for localized colon cancer is over 90%. Screening colonoscopy gives you the best chance of catching cancer early — or preventing it entirely by removing polyps.