Dear FAP,
I am very concerned about your comment. Although it is true that, for most people, the sedation/painkiller mix used here in the U.S. (typically versad + demerol or fentanyl) is not absolutely necessary to do a colonoscopy, it is a vast and scary generalization to say that this is "dangerous and unnecesary" and that doctors insist on drugs only so that they can do exams "roughly and quickly." That said, I do think that many people just grab the drugs without truly considering the potential side effects and problems, which I don’t think is a good way to do things.
I do know numerous people (my mom is one of them) who routinely do colonoscopies without any drugs at all (either sedation or painkiller), and their docs have never insisted that they use drugs. Although most patients do prefer to have the sedation (I've noticed the doc sometimes raises his or her eyebrows when you say you don’t want drugs), doctors often insist on sedation for other, very good, reasons.
There are physical and safety reasons for using sedation - your colon has a bunch of muscles down there, and probing it with a scope can cause involuntary muscle reactions. Think of it in the same way that if someone hits you, you flinch - not because you want to, but because you have an involuntary reaction. Even if someone doesn't ever touch you but just walks up unannounced, you might be physically startled. If your colon "flinches" or is "startled" during a colonoscopy, it has a tendency to clinch up and/or become restricted, and that can increase the chance of perforation. By sedating your muscles, it actually decreases the chance of this kind of thing happening. Saying that an unsedated patient will “never” have his/her colon perforated is simply incorrect - it can and does happen to every type of patients, sedated and unsedated. Perforation is uncommon during a colonoscopy, but an important possible complication to keep in mind - and to be accurately informed about.
I also disagree that doctors insist on sedating patients simply so that they can do a rough, quick exam. The length of the exam depends on so many factors, and it can actually take less time, not more, to perform a colonoscopy with an unsedated patient – it depends a lot more on the patient and what is going on in the colon than whether a patient is sedated or not.
I’m quite sure that it is true that some doctors prefer to do the exam on patients receiving sedation (in the same way some oral surgeons prefer patients to be "under" to have their wisdom teeth removed) - but if you are uncomfortable with that and want sedation, find a doctor who will do it without if yours won’t. Most will not only understand your concerns, but will be very happy to do it either way. I think most doctors are simply used to giving sedation and don’t necessarily think to offer the option without; I don’t think most are trying to ram something down your throat that you don’t want.
However, be prepared that if a doctor expects complications, s/he may strongly suggest (or even require) a patient to have sedation/pain meds. For instance, if you have a history of polyps that need to be removed or if your doc expects to need a biopsy, these extra procedures can cause additional “trauma” to your colon and pain to you, which can mean a physical reaction in your colon whether you mean to do it or not. And this is something that can cause a level of discomfort or pain that patients do not want.
I think you are treading on very shaky ground here to suggest that being sedated is "dangerous and unnecessary." That is not true for many, many people - and should be their choice. Some people need actual anesthesia rather than just sedation (for instance my best friend who has Crohn's and can expect complications during every colonoscopy such as scarring, adhesions, multiple biopsies, etc.) - and anesthesia can also be safer than performing a procedure with no drugs at all.
To me, the bottom line is that I think that patients should have the choice of whether to be sedated or not during a colonoscopy, if it is safe given their situation. I believe everyone should be educated about all of their options and potential side effects of any choice. If you are educated about all of these issues and choose to not use drugs, that is your choice - but it is not everyone's, and that is okay, and even preferable, for many people.
Hannah
Hannah K. Vogler
Co-Founder, The Colon Club
cousin of Amanda Sherwood Roberts
dx 1/99 Stage III at age 24
died January 1, 2002 at age 27