By: Ganesh Kakarlapudi, M.D.

So, you’re soon going to turn 45; a good year to cross several items off your bucket list: see the Grand Canyon, run half a marathon, and get your first colonoscopy.

Yes. When it comes to colonoscopies, 45 is the new 50.

Medical research concludes that all men and women of average risk should undergo their first colonoscopy screening for colorectal cancer at the age of 45. People at higher risk might be advised to go earlier. These risks include:

• Inflammatory bowel diseases such as Crohn’s or ulcerative colitis.
• A family history of colorectal cancer or colorectal polyps.
• Genetic or hereditary conditions that can lead to gene mutations, such as Lynch syndrome.

We know. There are plenty of things you’d rather do for a day than prepare for a colonoscopy. But the result is worth the inconvenience. The rate of colorectal cancer among people ages 45 to 49 has been rising about 2% a year since 2000, and people younger than 50 now account for nearly one in 10 cancers.

The American Cancer Society expects nearly 107,000 new cases to be diagnosed in 2024. The average survival rate (across all stages) is about 65%.

Explaining Colon Cancer: the Slow-Growing Culprit

A colonoscopy is a procedure to look for abnormal cell growths before they develop into cancer. Many of these growths are called polyps.

Polyps are slow-growing, and most are harmless, but the chances of some becoming cancerous increase as the cells continually divide and potentially mutate. This prolonged pace is why colonoscopies are so effective: They discover and remove the polyps before they become a health risk.

Your gastroenterologist can do this by threading a slim scope equipped with a video camera into your colon. (Don’t worry, you will be sedated.) The camera sends images to a monitor that the doctor examines in real time.

Symptoms of colon cancer include blood in the stool and changes in bowel movements.

What to Expect When You Prepare for Your Colonoscopy

Colonoscopy preparation begins several days before the screening, with gradual diet modifications to ease the cleansing process. Here’s how to prepare.

Five to seven days before your screening:

Your doctor will ask you to go on a low-fiber diet to eliminate harder-to-digest foods. These foods include raw vegetables and fruits (ripe bananas are OK), nuts, seeds, and red meats. Eggs, pasta, yogurt, chicken, and fish are OK. Your doctor’s office will provide a list of “do” and “don’t” foods.

If you can, shrink your portion sizes.

On the day before your screening:

You’ll need to avoid solid foods and any liquids that are red, orange, or purple (the dye discolors the colon), as well as dairy. You can drink light-colored Gatorade, soft drinks, black coffee, and tea. You also can consume clear broths and fruit juices (without pulp), light-colored popsicles, lollipops, and Jell-O. Again, your doctor will provide a list.

If you’re concerned about the taste of the prep medication, be assured it has improved in recent years, as have the dose sizes. Some prep kits measure just six ounces (plus water) and are taken in split doses. Your doctor will provide a timeframe based on your appointment, but many patients drink the first dose the previous day and the second dose the morning of the screening.

Your first dose can take one to three hours to kick in, after which you’ll need to make frequent bathroom trips (expect very watery stools). Continue drinking clear fluids. The laxative can dehydrate you, which could make you light-headed and headachy. Electrolytes will help.

The prep will likely work through the night. By the time of your second dose, your system should be nearly clean. You will know you’re ready when your waste is clear.

On the day of your screening:

Wear easy-to-slip-on clothing and shoes. When you arrive for your colonoscopy, the care team will ask you to change into a discreet robe and give you some time to relax. Once you are in the examination room, you’ll receive intravenous sedation, lie on your side, and wake up in recovery, usually within an hour.

You might awaken feeling blissful, as many who undergo “twilight sleep” describe it. You’ll also be unable to drive, so you must come to the screening with a reliable ride home. Once you’re clear-headed, the doctor will share the initial results.

If the doctor finds polyps or lesions during the screening, they’ll be removed and sent for a cancer analysis. Typically, you’d receive results in a week.

Until then, you can go home and eat what you want but do take it easy for the rest of the day.

We Have More Colonoscopy Resources for You

Some bucket list items make good sense because they have long-lasting benefits. Like a half-marathon, a colonoscopy takes a lot of preparation, but most everyone is happy they did it.

Talk to your physician or a gastroenterologist about your best options.

You can learn more about what to expect from colonoscopy prep on our blog that dispels common myths about colonoscopy preparation. Or read about early colon cancer prevention.