What is the colon and a colonoscopy?
First of all, the colon and rectum together make up the large intestine. It is involved in the end stage of digestion – the stomach digests the food, nutrients are absorbed in the small intestine and then the waste products move to the colon for removal from the body.
A colonoscopy is typically a one-day outpatient medical procedure to screen for colon and rectal cancers. This process allows doctors to look at the inner lining of the large intestine. In conjunction with anesthesia, a patient’s large intestine is inflated with air and a thin tube with a video camera is inserted into the rectum and carefully threaded through the entire colon. A colonoscopy helps to find ulcers, tumors and polyps, bleeding and areas of inflammation. Biopsies (taking of small amounts of tissue for lab examination) are collected, if necessary, and polyps and lesions are removed from the colon.
Experts recommend colonoscopies to check for cancer and polyps in the colon, seek the cause of blood in stools, find an explanation for sudden weight loss, discover what is causing chronic diarrhea and check out why there is an iron deficiency anemia in the patient. It is also advised that if an abnormal result comes back from a different colon cancer detecting test, a colonoscopy for further examination should be scheduled.
Difficult colonoscopies a gender issue?
Researchers find that physicians said that about 31 percent of women and 16 percent of men were noted as having had a technically difficult colonoscopy. “Difficult” procedures are defined as: insertion time is longer than normal; examination not completed; significant mortality with this practice, and patient reports of significant pain and discomfort. Colonoscopy completion rates for women ranged from 88 to 96 percent, for men the percentage ranged from 94 to nearly 100 percent. More women than men stay at home the day after, which may be another indicator of a difficult colonoscopy. Some, researchers and physicians, mostly men, chalk that up to a lower pain threshold in women. However, it is coming to light that the colons of men and women differ anatomically, possibly accounting for the differences in numbers of reported difficult screenings.
Discovered Anatomical Differences
Women have been found to have longer colons than men though their stature is smaller. This may be the major factor contributing to difficult colonoscopies. Imagine the large intestine as a plumbing pipe. One opening is the anus and the originating end is called the cecum. Okay, so the part of the pipe that is the rectum travels up in the body for about eight or nine inches. Then there is about a 45-degree bend downwards then back up to the left ribs where the transverse colon takes a right all the way across the body, to the right side of the rib cage. Then the colon takes a downward twist to the cecum.
More women than men have longer transverse colons. Further, more women (62 percent) have transverse colons that dip to the pelvis than men (26 percent). One report described this part of the colon in women as “angulated and tortuous.” Also, as the transverse colon travels over the pelvis, over the uterus and into the lower left side of the body, looping or bends in the intestine occur, especially in women. Looping is also a problem in the area above the rectum, known as the sigmoid colon, as there is an acute bend.
These loops make it difficult to insert the video camera tubing into the colon for examination, which at times adds to the patient’s discomfort. Also, these bends are difficult to exam thoroughly and add to the procedure time for the physician. These loops are often home to infections and inflammation in the colon.
Some women with hysterectomies report higher pain and discomfort levels than the average patient – a disincentive to have another colonoscopy in the future. It has been found that women who have had hysterectomies, have adhesions around the colon in the pelvic area. Adhesions are bands of scar tissue that develop after abdominal or pelvic surgery which may adhere to close-by organs. It is one of the commonest complications of this type of surgery.
Women’s Preferences Affecting Colonoscopies
Many women feel embarrassed just talking about a colonoscopy. But as important a screening procedure this may be to one’s general health, some women simply avoid it. And if her male physician doesn’t recommend the screening, it is highly unlikely that a woman will bring it up for discussion either. Especially if there is no family history of colorectal cancer. But beware, 85 percent of cases have no family history of colorectal cancer.
Studies have found that women who have a female practitioner are more likely to comply with physician-ordered tests such as breast and cervical cancer screening with an average increase of 40 percent for PAP exams and 33 percent for mammography screenings. When asked about preferences for endoscopists, 30 percent to nearly half of the participants wanted a woman to perform the procedure on them.
This is especially important for African-American women. This ethnic group is ten percent more likely to get colorectal cancer than whites. But because the cancer is found in advanced stages, the mortality rate for African Americans is 44 percent higher than found in Caucasians. So it is recommended that blacks get cancer screening earlier than the stated 55 years of age for the first colonoscopy. Most researchers agree that African Americans and men should get their first screening at 45-years old because of the earlier growth of polyps and lesions.
When to Say No to a Colonoscopy
Women should know that colonoscopies are not recommended for pregnant women unless NOT having one will hurt the mother or fetus. Circumstances that may warrant a procedure in a pregnant woman are severe, chronic diarrhea with no apparent cause, GI bleeding, or a malignancy. Colonoscopies should not be performed on those with placental abruption, ruptured membranes or imminent delivery.
Armed with this knowledge, women should feel more empowered when discussing health issues with their physician, whether male or female. But if you are a woman hesitant about scheduling a colonoscopy, remember colorectal cancer is as preventable as it is deadly. With early intervention, a patient’s prognosis can be bright.