Colonoscopy and Prolapse

Body: 

A colonoscopy is recommended for those over 50. My doctor is recommending one as part of a routine examination and wants to give me a referral. I presently have all my pelvic organs and hope to keep it that way. I don't know anyone who has had a prolapse and a colonoscopy. I am wondering if there are any special concerns with having a prolaspse (rectocele, cystocele) and colonoscopy since you are dealing with relatively close areas. Any information? Thanks, NFP

Hi NFP,
So glad you asked! I can't see any reason why it should be routine for people over 50 to have a colonoscopy. There should be a good reason for such a procedure to take place. Having a prolapse does not require a colonoscopy. Unless the GP can cite another good reason why you might require one I cannot think why you would need it. I haven't heard of a colonoscopy being part of a 'routine' examination. All sounds rather odd to me. I don't think I would undergo such an unpleasant procesure without much better reasons than the ones you've described above.
Good luck!
wholewomanuk

Let me explain a little more. I have had 2 colonoscopies. The first one being routine in 2001. I had no symptoms. At that time I had a tubular adenoma (polyp) removed which was benign but I understand in the time if not removed, that could turn into a serious cancer. It was recommended that I have a followup colonoscopy in 5 years. I did and no polyps. Now it is 6 years later and the recommendation is another colonoscopy. Only this time I have a prolapse which I acquired 1 yr and half ago and did not have before. I am very grateful to Christine and her holistic approach in the management of prolapse it has been of great benefit to me. And at this point I don't want to do anything to "rock" the boat. However, as unpleasant as a colonoscopy can be in the light of prevention I don't want to refuse a procedure that could pevent cancer but on the other hand cause me more difficulty where the prolapse is concerned. So I thought I would throw this out to see if anyone has had this kind of experience. I have also asked for a consult with the doctor (the same one who has done my past two colonoscopys before going through with a third colonoscopy. Meanwhile I am gathering information. Thank you for your response.

I had a colonoscopy 7 years ago, at age 54. I had some concerns and symptoms, but the procedure was negative for polyps or anything like that. It was not until 5+ years later that I "discovered" my prolapse, though in retrospect I had been having signs of prolapse for maybe a decade without knowing what it was or worrying about it. So of course, I have often wondered if an invasive procedure like a colonoscopy (including what the prep puts your system through) had any impact on my pelvic dynamics. I too would be interested in knowing if there are any opinions or research on that.

As NFP explained, colonoscopies seem to be to look for polyps, which are precursors of cancer, but which are not cancer in themselves. In the 'cut it out, then it won't turn cancerous' model, yes, it prevents cancer as a result of that particular polyp developing. However, the polyps and the cancer are both caused by the body's tissues proliferating in abnormal ways. The former is *not* the cause of the latter. Removing polyps will not prevent cancer at a different point in the bowel. Both are caused by other factors and are a sign that the body is not functioning properly. They are both inflammatory responses, rather than being the root of the problem. As you stated, NFP, the first polyp went away. Your body settled down, which is wonderful.

I think invasive and unpleasant colonoscopies are a product that is sold to us by our doctors with 'fear of the unknown' tactics of different degrees. It is an easy (for the doctor who refers the patient, and gets the results back!!); It is rebatable through health insurance. Why would a patient *not* want it??? It also reassures the *doctor* that there is no cancer or polyps in your bowel, so they haven't missed anything sinister, which protects their back. The question for the patient is whether or not they are prepared to carry the risk of *polyps* not being picked up. Bowel cancer itself can be detected by faecal occult sampling, which is non-invasive, simple and cheap, long before any overt symptoms show up. This very early cancer is very easy to detect and treat. That is a choice for each individual to make.

Is a colonoscopy likely to cause prolapse? There may be a connection, but I think it is far more likely that routine colonoscopies are offered to people around the age of fifty, an age when many women discover POP for the first time, or it worsens because connective tissue becomes weaker with menopause.

It is also *possible* that colonoscopy could shove your intestines around to a degree that weakens or stretches endopelvic fascia more than necessary. In a world where doctors think that the pelvic floor muscles are the main support mechanism for pelvic organs they might not think that potential damage to endopelvic fascia was significant in any way. This theory is borne out by the seeming abandon with which they cut through fascia during gynaecological surgery while dissecting in to the site of surgery. I do not know that this disregard *is* the case, but it makes sense to me.

Colonoscopies may be so ubiquitous that there are not many women of that age who do not have them, so there is no control group to measure against.

It is a little like saying that western children's teeth are weak, when the reason why western children's teeth are weaker is because they are exposed to too much sugar and acid, compared to more 'primitive' societies. Being 'western' is not the problem. The connection is there, but it is indirect.

Being responsible for your own health care involves collecting information, assessing risks for yourself, without the assistance/interference of somebody who stands to gain from any treatment you agree to. It involves measuring risk, qualitatively or quantitatively, reading research intelligently, deciding for yourself, and either reaping the benefits or accepting the negative consequences. It also involves managing your own lifestyle, diet etc to minimise the risk of cancer.

It is not necessarily an easy path, but it does result in autonomy in your own health.

Louise

Interesting question - when I first had the symptoms of rectocele - incomplete evacuation, tailbone pain - feeling like sitting on a lump - some bleeding (haemorrhoids) - at the time I did not know it was a rectocele or that there was such a thing. This was 18 months ago. I was scared I had rectal cancer and
my doctor recommended a colonoscopy because the symptoms were concerning.
So I did have one - to tell you the truth I think my symptoms worsened afterwards - but cannot be sure it was the procedure itself.
The bowel cleanout prep they give you is pretty horrendous on the intestines and really washes you out.
The problem I had was that the first few meals I had after the colonoscopy caused me to get very constipated - probably due to the lack of moisture in the intestines (???) guessing here.
In the end because I was in such discomfort and did not know at the time I had a rectocele - I pushed harder than I would ever usually - and was terrified to discover everything fell and ballooned around the perineum, anus, etc.
It was so bad - I knew I had some tissue damage but really I had probably just been bearing down on a terribly fragile area.
So it was after that colonoscopy I discovered the real problem was the rectocele ...

If you do have the procedure take it really easy with foods after - lots of leafy greens but not too much fibre - heaps of water and no meat until everything becomes regular again.

Difficult decision - good luck xx

Takecare, that is such good advice. What advice did the Staff give you about aftercare and diet, and what to expect? I have never heard of constipation after a colonoscopy but I would imagine that the intestines would be somewhat 'upset' after what they had been through, and would need some TLC for a while.

I think colonoscopy is described as routine, not in the sense that washing your hands is routine after going to the toilet, but that it is part of a fixed sequence in diagnosis of bowel cancer, which is a possibility because of symptoms that are present. Routine means "I always do it, because it needs to be done." It doesn't mean minor, or inconsequential or that it won't be unpleasant, or that it won't have after effects.

It is one of those words which has a very specific medical meaning, which is not necessarily the same as common use. Doctors are a bit naughty using these words and terms when communicating to a patient, without explaining what they mean. Often it is the secret language of the medicos which misleads women (and men) who are trying to work out the best plan of action after any sort of diagnosis. It is often language that can gloss over risks and potential difficulties by omission.

It is OK to admit that (there is a possibility that) you do not understand the terms they are using. They (probably) know darned well that you do not understand. I have sometimes felt that I am 'having the wool pulled over my eyes' when a doctor uses technical terms when explaining a diagnosis and treatment. It is like they are showing off how clever they are, and don't want you to ask questions. I think it is called "blinding you with science".

i am trying not to be cynical when I say this. Maybe they don't even consider that their patient does not speak the language fluently, or they might not think it important that the patient understand what is said? just that the patient should obey doctor's orders?

That's why there are no silly questions, and that is why I am always suggesting that women take someone trusted along with them to take notes, and ensure that questions are asked and that clear answers are given to the patient. My mind goes to jelly when they start using big words.

Louise

I've also wondered if colonoscopy can cause prolapse as I discovered the beginning of my prolapse a couple of months after I had my 1st colonoscopy. The doctor I just saw seems to think it's only coincidence but who knows... I also wonder if my stomach issues which caused the dr. to have me get a colonoscopy were related to the begining of the uterine prolapse. No dr. ever suggested this. My colonoscopy was fine. The dr. told me to keep doing whatever it was I was doing. Issues not solved by this route...

We will probably never know, because so many women discover their prolapses at around the same time as they are getting colonoscopies. I too have felt there might be a connection, and also that at least some (but not all) of the symptoms that caused me to get the procedure in the first place were related to my already-existing prolapse that I knew nothing about. So though I don't feel it caused the prolapse, I can't help wondering if it made things any worse, and I probably won't have another.

I had a colonoscopy a couple of years ago. I think I was 33 or 34 or so. The doctor I went to did them all of the time. He gave me 4 dulcolax tablets to take, 2 earlier in the day and the other 2 in the afternoon. Then I mixed a bottle of miralax with 2 quarts of gatorade. I tried to eat very light a few days before doing the "emptying". That was okay. I thought it was going to be horrible, but it was fine. I told him (the doctor) a million times before that I had the rectocele (and the other prolapses) so don't poke through anything in there. I laughed when I told him, but he knew I wasn't kidding. He removed 1 small polyp. Everything went well for me.

Hi Mom30

I can only think that some of the characteristics of prolapse, particularly rectocele, mimic those of bowel cancer, eg incomplete emptying and constipation. I see rectocele, constipation and incomplete emptying as a kind of syndrome (if that is the right word); a group of symptoms that co-exist and tend to feed off each other. If I was a doctor I would want to ensure that there was no tumour causing blockage before I put the symptoms down to rectocele. If a woman has a tumour that would prevent her emptying completely, and made her feel constipated because of a blaockage, surely that could be picked up by a faecal occult test?

Is there a doctor out there who can explain why colonoscopy is used so much?

Sure, it is nice to know that there was a polyp, and that it had been removed, but I wonder how many of us carry bowel polyps that will never turn into cancer? Only mass screening and testing again, maybe 20 years down the track, would give an answer to that. Medical trials don't usually go for as long as that. I imagine trials involving colonoscopy are funded by the companies that make the colonoscopy equipment. Would they really be interested in funding the second lot of screening if there was a possibility that it would show that polyps often regress, and often don't turn cancerous?

Louise

AALouise

Louise

Thank you NFP for raising this issue. I am 49 and at my last OB visit, my OB recommended a colonoscopy. (I have bladder prolapse) I have to say I am very much aligned with Louise on this one. My feeling is that colonosopy is an invasive procedure and not one to be undertaken lightly or just because it's something you're supposed to do at the age of 50. I understand that in removing polyps there is a danger of perforating the colon and that becomes very problematic (I think this also happens more than is reported). Of course, everyone needs to make health decisions based on a review of their symptoms, medical background, etc so I have no intention to tell you to do or not do it. What I would like to suggest is that you do some research and discerning before you make a decision on how to proceed (in other words, don't do it just because your doctor tells you to).

Johns Hopkins has issued health alerts on colon cancer which presents some alternatives to colonoscopy. (Louise noted one of them and there seem to be a few others, although they may not be in wide use and colonosocopy does remain the gold standard, even according to Hopkins) Here is a link to a listing of those alerts on colon cancer:

http://www.johnshopkinshealthalerts.com/alerts/colon_cancer/

In addition to perusing the Hopkins site, I also believe in honoring your intuition-- what does your gut instinct tell you to do? Also, if you are religiously inclined, you could pray over this decision as well.

Good luck to you.

Monica

I had a colonoscopy not because of a scare of bowel cancer, but because I had other numerous symptoms including rectocele. ie. diarrhea, constipation, hair loss rashes, belly aches, etc. At age 22, I had the same doctor request I have colonoscopy done when an endoscopy came back clean. I was not interested in that! lol!! So I chose to live with pain. I would walk around with Tums in my pocket as a child hoping it would help. Never did. I would always get a super bloated belly doubled over in pain and nobody could ever figure out why. So, I figured I would go for the colonoscopy just to see if there's anything wrong (my dad has diverticulosis). In the end, he just told me to stick with a gluten free diet, which I had already decided to do. Much better.

I really don't think I would bother with colonoscopy unless I truly felt there was a need for it. Hope that helps:)

My father and his father had colon cancer so My doctor ordered colonoscpy to me at the age of 34, I had two small adenomas polyps and removed. After 3 years came clean. Now I due third one. But I had prolapse 2.5 years ago. Now I am so afraid. I not willing to go for a procedure. I hope I am making a right decision.

Hi Everyone, New to WW. I have had a cystocele, uterocele, and rectocele, for over 15 years. I am 58 y.o. with stage 3 prolapse and wear a cube pessery. I am a registered nurse. I am fit, eat very well...no sugar, flour, artificial sweetners. I do not think that the medical profession is out to get me, but I do believe I need to be an educated consumer, especially about my health. At age 53y.o I had a routine colonoscopy. The colonoscopy saved my life. I had stage 2 colon cancer....no symptoms, no signs that I thought were anything other than just my normal ....the tumor had gone through 2 layers of my colon but not into any lymph nodes or any adjacent organs. I had half of my colon removed. If I had not had this colonoscopy, I don't even want to think about it. It did not make my prolapse worse. Perhaps it prevented me from having a hysterectomy because colon cancer can metastisize to the uterus. I am so grateful to my doc for telling me to have it. I am so grateful to my gastroenterologist, and I am so grateful to my surgeon....he's a "rock star".

HI everyone and NFP. My father died from bowel cancer and my brother has had a new miss with a pre cancerous polyp being found when he had a colonoscopy. So we both routinely have colonoscopies.I have one every five years and will continue to do so until I am 75 when you can stop having them. I have a stage 2/3 cystocele depending on how much exercise I do or don't do, and like you I was really worried about having the colonoscopy this time. However the gastroenterologist said that there would be no problem and it wouldn't affect her activities. She said it would be fine so I went ahead with it. The preparation was OK and the two days after the colonoscopy my cystocele was the most inside it has been since I got it 5 months ago with my completely empty bowel. I am ten days later however having to be careful with what I eat and I am trying to drink lots of water because I am usually really regular and have no bowel problems, but this last few days, about a week after I had the colonoscopy I have been very dry and have not been able to get back into my usual bowel routine. I suppose you could say that I am slightly constipated. Mind you, I have also had a really busy ten days, with lots of travel, work and other activities where I haven't eaten my normal diet or had as much as usual to drink. Also I have not had my daily walk nor have I done my Wholewoman exercises. Today for the first time the bulge is sticking out a little bit. So tomorrow I will get back to normal diet, lots of water and fruit and will start my walk and exercises again.
So to sum up, the colonoscopy prep does dry you right out and you do need to be really careful to maintain your diet and fluids until you are back to normal bowel wise. This is something I have not usually had to worry about after previous colonoscopies so i didn't think about it. The actual colonoscopy itself doesn't do anything. It is the drying out of the preparation and in my case not being careful with my diet, fluids and exercise. I do have complete peace of mind too, that I don't have bowel cancer.

Hi,
Great post you are share here.Some preparation have to be taken before colonoscopy.The colon must be properly cleansed of feces. The standard way that this is done is by not eating the day before, consuming clear liquids, and drinking a large amount (2 to 4 liters) of an intestinal cleanser which causes diarrhea throughout the day.
Thanks,
Preparation for colonoscopy

Because of mesh erosion I had surgery to remove which was preceeded by an MRI which revealed severe diverticulosis in my large bowel. The urogynaecologist who has over 40 yrs experience advised me to have a colonoscopy. Well, I had just had a ~5 cm piece o f mesh removed from my flesh where the failed sacrol colpopexy was infected. I did not really want a colonoscopy. My family doctor who is quite elderly for a new physician did not feel a urogynaecologist Knew about the bowel necessarily and suggested I have an annual foecal occult sampling. He said., even though 2 of my aunts have died(mom and dads sisters) from bowel cancer, I have 15 siblings who have not had any such disease so leave the colonoscopy alone. Sunday, I visted with a co-worker who had her bowel cut and almost died (was sent home with cut bowel) after a colonoscoy and polyp removal- now she has 2 hernias to deal with- ) I am 65, she is about 50. I have often wondered how successful a colonoscopy could be for me since I am quite messed up in the abdominal area- not something the first surgeion who went in there pointed out to me as an after conditition of surgery...

My Gastroenterologist suggested me to go to the Urogyn once. My doctor was concerned about the procedure with prolapse. One way I have a strong family history and another way I am not willing to take a risk of procedure. i am bit confused and puzzled.

This has been on your mind for a while. Why not talk it over with your doctor. If colon cancer is part of your family history (your father and your brother) it will be an ever present worry at the back of your mind. That you have already had polyps removed does not seem to have allayed your worry. You fear more will grow. The American Cancer Society "Guidelines for the Early Detection of Cancer" recommend, beginning colonoscopy at age 50. With your history the doctor has brought this on earlier to age 34. Perhaps if you talk things over with your doctor, there may be other early symptoms that you can be on the lookout for, not as an everyday anxiety, but as a reassurance that presently you are ok. Being afraid to face the truth, or delay discovering it, is a very human thing to do, but life is very sweet smit and sometimes a sacrifice even a worsening prolapse (I've lived with uterine prolapse stage 3-4 for over twenty years before discovering WW and it has helped me no end even at this late date after such a long period) which you will be able to mend by applying WW principles after any colonoscopy.