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Q: If you have been informed that you are a poor candidate for a colon exam due to a torturous bowel, what are your options for colon screening?

Thank you for your question because colon cancer and colon screening is an important topic to discuss.  Colon cancer is the 2nd leading cause of cancer death in the United States.  The great news is that death can be prevented if the cancer is caught quite early.  Due to this fact, doctors require that men and women over the age of 50 years old get a colonoscopy (aka colon exam) at least once every 10 years.  The sad news is that most people don’t realize that just getting a colonoscopy done can save their lives, hence why colon cancer kills at such a high rate!

What is a colonoscopy?  It is a procedure where a long tube (that has a camera attached to it) is inserted through your anus into your colon.  This tube is pushed through your entire colon as the gastroenterologist (colon doctor) looks around for abnormal tissue (polyps).  If found, the polyps are cut out and sent to a laboratory for analysis.  Most of the time, the tissue is normal, but sometimes the cells are cancerous. If you’re lucky, all the precancerous cells would have been removed during your first colonoscopy, therefore no further treatment would be needed.  In this case, you should get a repeat colonoscopy sooner than later to ensure that there is no more growth. If all the cells weren’t removed, further treatment in the form of either surgical removal and/or chemotherapy would be done to eradicate any possible remaining cancer cells.  As said earlier, anyone over 50 years of age should get a colonoscopy once every 10 years.  Those who have a higher risk of getting colon cancer (i.e., a family history of colon cancer, previous history of having polyps, history of inflammatory bowel disease) may need to have a colonoscopy before the age of 50 and/or more frequently.

What is a tortuous bowel?  A tortuous bowel is a bowel that has several bends and twists in it.  It becomes a problem when a doctor needs to perform a colonoscopy because these “kinks” can prevent the doctor from going further into the colon with their tube.  People with a tortuous bowel may also have problems digesting their food.  Bloating, excessive gas, irregular stools and occasionally dermatological rashes are very common in individuals with this condition.  The most important thing a person with tortuous bowels can do is change their diet.  Eating foods with more fiber or even taking fiber supplements can help in producing stools that are softer and can slowly work their way through the tortuous bowel.  Drinking enough water will also help in producing softer stools and also pushing the stools more easily out of the body.

Side note: Many people feel that they drink enough water for the day, but I am here to say that it is not true!  The Food and Nutrition Board recommends that women should get about 2.7 liters of water and men get about 3.7 liters of water through beverages and/or food.  To put that into perspective, an average bottled water that you buy in the store contains about 0.5 L of water.  So, women should consume about 5 bottled waters daily, while men should consume about 7 bottled waters daily. Remember, this also includes the water you get in food.

So, you have a tortuous bowel and are told that a colon exam is not for you?  You are right.  You may not be a good candidate for a traditional colonoscopy, but there are other options out there.   There are some specialized colonoscopy tubes that are designed to be used for tortuous colons.  Not every medical center has these tubes, so it may not be an option in your area.

Virtual Colonoscopy (aka CT colonography) is a less-invasive option where an imaging scan of your colon is done in a way that doctors can literally look inside the wall of the colon and search for any polyps without using a tube to go in.  It is a great tool for those who have tortuous colons.  A downside is that it may not show the smallest of polyps.  In addition, if they find a polyp, they will have to do a colonoscopy to get it out.

Another option is a flexible sigmoidoscopy.  It is like the colonoscopy in that a thin flexible tube (with a camera attached) is inserted to your anus; however, it does not view your entire colon so any cancer or polyps further in the colon would not be seen.

Testing your stool for blood is another way for doctors to see if there is a need for a complete search for polyps in your colon.  Although a positive test can suggest you may have polyps in your colon, it does not rule out other causes (ie, stomach ulcers) that may also cause blood in your stools.  In addition, this test does not erase the need for a colonoscopy or an alternative imaging to look at your colon.

If at all possible, talk to your doctor about your risk of getting colon cancer.  It is a cancer that can be prevented if detected early and colonoscopy can save lives.  For those who can’t get a colonoscopy, there are other options that you can discuss with your doctor.

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