One Man’s Sedation-Free Colonoscopy (And Why You Should Try It Too)

By David C. Holzman
Guest Contributor

I’m one of an elite group of American patients. Only about one percent of us undergo colonoscopy without sedation. The big secret: it doesn’t have to be painful. And it’s probably safer than with sedation.

Like most Americans, I was ignorant of all of this until about a month ago. In my imagination, a sedation-free colonoscopy would have been painful indeed, the device snaking up my GI tract, pushing against my insides as it resisted the twists and turns. Then my best friend, Greg, who has made several suggestions that have resulted in distinct improvements in my life, suggested forgoing the drugs, as he had recently done.

Gateway to the author's colon (Courtesy)

Gateway to the author’s colon (Courtesy)

It made sense. I could drive myself to and from the hospital, and I’d be able to work when I got home.

Greg had also told me that there’s a correlation of anesthesia with loss of memory later in life. Some googling revealed that this may be true in some cases. But despite that uncertainty, that made the unmedicated colonoscopy far more compelling.

It helped to learn that Dr. Douglas Horst, who would be doing the colonoscopy, did a number of them unsedated, and even more, that he called me to discuss it, putting my mind even more at ease. (He gets top grades on several different doctor evaluation websites.)

And overall, the discomfort was minimal, hitting maybe 3-max out of 10 on the pain-meter for seconds at a time here and there, and otherwise never going beyond 2 out of 10, comparable, perhaps, to a very mild cramp. I’d much rather have another colonoscopy than an upset stomach.

The Prep: Dystopian Poison

Far worse than the colonoscopy was the “prep.” And the really bad part of the prep was the drinking of the laxative. At 7pm the night before the colonoscopy, and again at 4:30 in the morning, I had to drink 15 ounces — two cups — of the supposedly lemon-lime flavored magnesium citrate. The prep sheet from Beth Israel Deaconess Medical Center in Boston recommended putting it in the icebox prior to use, to blunt the taste, which they suggested because chemical reactions, including those involved in taste, proceed more slowly at lower temperatures. I went one better. I stuck the bottles in the freezer for the last 45 minutes. But even with ice beginning to form in the bottles, the taste was still strong and dreadful. The drink combined the wonderful fizziness of soda — the elixir of the summertime American childhood — with a cloyingly sweetened base metallic taste. There are plenty of bad-tasting medicines, but that juxtaposition of good memories with sweetness gone sickly made this stuff seem like a post-apocalypse dystopian poison.

During the 7pm episode, it took me an hour and a half to down the two cups’ worth, washing each bit down with some ginger ale in a largely vain attempt to banish the dystopian aftertaste. During the 4:30 am episode, I tried chugging it down more quickly, but it still took 40 minutes.

The magnesium citrate had to be followed with at least three normal-sized cups (24 ounces) of clear liquid, to maintain hydration in the face of the saline onslaught. The prep sheet warned that failure to do so could endanger your kidneys — just one more thing to go wrong if you failed to follow the directions in the middle of the night.

Ironically, my biggest fear—the fear that had kept me from getting the colonoscopy for the first nine years after I turned 50, was the vision I’d had of being a prisoner in the bathroom while my guts violently wrung themselves out for hours on end. Yet, the diarrhea, which began after about an hour of drinking the gag soda, was not the least bit gut-wrenching, and not particularly copious — thanks probably to the day of fasting. During the hour and a half or so that it continued, it quickly became liquid, and gradually became clear (your results may vary). While I’d set out magazines and books on the little table, as well as a radio, figuring I wasn’t going to leave the bathroom for a couple of hours, I found I was able to move around the house with impunity.

The Procedure: Up Mine

After a few more hours of sleep, I got up, and drove the 35 minutes or so in mild traffic from Lexington into Beth Israel, arriving around 9:30. I’d been afraid I might need to go to the bathroom on the way in, but the diarrhea was over.

At 10:45, Nurse Tina DiMonda rolled me into the procedure room. She installed an IV — just in case — and asked me to lie on my left side. Then, Drs. Douglas Horst and Byron Vaughn began feeding the colonoscope inside my plumbing.

In our society, and perhaps generally among our species, the rear end carries a lot of baggage, as is obvious from the various epithets and other expressions that have the word, “ass” in them. This is not helpful in the medical theater. But between my own blasé attitude, and the docs’ and Nurse DiMonda’s excellent bedside manner, during these proceedings the anal orifice became a mere porthole into the gastrointestinal plumbing. Mine might have been exposed, but it was totally safe, and I soon forgot about it, despite the fact that it was propped open, mildly uncomfortably, by the colonoscope.



Dr. Horst immediately launched into some jokes, and soon I felt as if I’d gone to a bar with some friends. Of course, there were some major differences, such as the spectacular view on the screen of the pinkish tunnel with the skinny ridges encircling the passageway, looking the way one might imagine a hallway down the inside of a segmented worm. What is the evolutionary reason for the ridges, I wondered. Dr. Horst said he didn’t know of one, but he’d come up with a theory if I could write it up and make him famous.

Soon, a small clump of tiny white things appeared, adhering to the inside of my colon. “Did you take a capsule?” Dr. Horst asked. “Niacin.”

Now we were approaching the first of four sharp bends in my colon, and I could feel my insides being stretched. Although the discomfort may have reached a mere 3 out of 10 on the pain-meter, it’s always more unnerving when you can’t see the source.

Now we were approaching the first of four sharp bends in my colon, and I could feel my insides being stretched. Although the discomfort may have reached a mere 3 out of 10 on the pain-meter, it’s always more unnerving when you can’t see the source, even if you know what it is.

I began making noises like those that Tigger had made when the Pooh Corner gang, trying to figure out what Tiggers eat, had tried thistle on him. Tigger, undoubtedly discombobulated by the thorny stuff sliding down his insides, had said, “Warawarawarawarawara.” A.A. Milne had his onomatopoeia down pat; and the docs knew what I was talking
about, and slowed down, maneuvering carefully around turn #1, mitigating my discomfort. Then we were off on another

A Bend In The Road

A later sharp bend in the colon occurs where the plumbing approaches the surface of the stomach from the vertical, and then turns 90 degrees to run parallel to that surface. Tina put her hands flat on my belly, pressing gently, a maneuver which prevented that unsettling stretching within, the docs rounded the bend, and we were off on another straightaway.

The rest of the half hour long spelunking expedition was uneventful, with occasional unsettling, mildly uncomfortable moments, particularly at the sharp bends, and at one point, a mild burning sensation in my anus, which turned out to be insufficient lubrication, a problem which was quickly remedied. As for the inner terrain, the cleansing had been so successful that even in the upper reaches, almost nothing was visible except for the shimmering surface of my colon, which was devoid of even tiny polyps. (Healthy colons are thus, even on 90 year olds, because the epithelium gets replaced about every three weeks, said Dr. Horst.)

Congratulations All Around

At the end (oops!), the docs and Nurse DiMonda congratulated me for how well I had tolerated the proceedings. Then we talked about the factors that influence an unsedated patient’s experience. It’s partly the doctor’s skill in guiding the colonoscope in a sensitive manner, said Dr. Horst (a skill which a doctor who has done few or no unsedated colonoscopies is unlikely to have). And it’s partly the patient’s pain tolerance. Some doctor-patient combos have great success, and others fail miserably, according to blog comments on the subject.

The caecum, colon and rectum(Images From the History of Medicine/National Library of Medicine)

The caecum, colon and rectum (Images From the History of Medicine/National Library of Medicine)

Another factor is patient expectations. I’m not particularly pain tolerant. But Greg had primed me not to expect pain. And studies show that expectations have a profound influence on pain, or lack thereof.

Moreover, I’d had my own prior experience with an analogous, though not identical procedure. In ‘98, I’d undergone a “colonic irrigation,” a sort of a new age cleansing to which all sorts of interesting claims were attached, for an article I wrote in an alternative medicine journal. There was plenty of internal pressure as my colon filled with water, and at the time I described myself as feeling bloated, as if I had mild to moderate indigestion — not what you would call a daunting experience.

It’s worth noting that the extra care that must go into an unsedated colonoscopy to avoid hurting the patient probably makes complications, such as a tear in the colon, less likely. But “since complications are rare, it would be hard to assess,” says Dr. Horst.

Not For Everyone

Interestingly, most institutions don’t even offer unsedated colonoscopies, although some will provide them if asked. Even when I came in for mine, everyone I came into contact with beforehand — a couple of nurses, the receptionist — was surprised when I told them I wasn’t getting sedation. (Probably not unlike the experience of some pregnant women who decide to forego drugs during labor and face skeptical hospital staffers.)

Dr. Horst says he performs about two to five percent of colonoscopies without sedation, “higher than the general rate because I have a small reputation for success at that.”

“Of those who start [a colonoscopy] without [sedation], probably 80 percent finish without, which reflects a self selection process — return patients who did it without meds before, and patients interested in and therefore pre committed to doing it,” says Dr. Horst. “Many years ago, I did a study. I offered unsedated scopes to all my patients. 200 patients later, 120 accepted the concept, but 50 percent of those who tried decided to take meds during the test.”

Still, Dr. Horst’s figures, and the fact that in Europe very roughly half of all colonoscopies are unsedated, suggest that far more people would be happy to forgo sedation. For doctors, the unsedated procedure is slightly slower, and more difficult. And for the hospital, and/or the insurer, it’s in the hundreds of dollars less expensive.

Although I had looked forward to a full afternoon of hard work after the colonoscopy, I conked out soon after I arrived home, and had someone not called me an hour later, I think I would have slept all afternoon. It’s not surprising. I’d spent two and a half hours on prep in the middle of the night, and the stress of quaffing the magnesium citrate had undoubtedly further drained me. Nonetheless, when I have to get my next colonoscopy, 10 years from now, I’ll definitely opt out of sedation.

David C. Holzman writes from Lexington, Mass., on science, medicine, energy, environment, and cars. He is Journal Highlights editor for the American Society for Microbiology and won a Plain Language/Clear Communication Award in 2011 from the National Institutes of Health.

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  • davidvachitis

    Two days before a recent colonoscopy, I learned that I was going to be given Versed and Demerol. Versed is an amnesic/hypnotic, which means you’re awake for the whole procedure but don’t remember any of it. I adamantly refused this drug, and since I had to drive myself home from the procedure I refused the Demerol (pain med) as well. When I went for the procedure, I was psychologically and emotionally prepared to be in considerable pain although I never questioned my decision. This was my first colonoscopy and I had no idea what to expect, so I was expecting the worst.

    I was pleasantly surprised that absolutely everyone in the hospital was fine with me getting the procedure without sedation and I was never questioned or patronized in any way. A saline IV drip was started, which is needed in case something goes wrong like a bowel perforation and immediate IV access is needed for fluids and meds. I was told to lie on my left side and I felt the doctor insert the scope into my rectum. I asked him to turn the monitor so I could watch the procedure with him. It was fascinating! The only discomfort was a bit of crampy gas from time to time, which
    happens since they have to blow air in to expand the bowel to visualize
    it and advance the scope. The doctor answered my many questions and basically narrated the entire procedure, letting me know where the scope was in the colon all the way along. The whole thing was over in about 10 minutes.

    At least to me, there is absolutely nothing traumatic about this procedure. Far from it, I found it very interesting. I know that not everyone’s anatomy and pain tolerance is the same, but for me, meds are totally unnecessary for this procedure. But, I don’t like my awareness impaired in any way and I certainly do not want some creepy drug that makes me forget 30 minutes of my waking life. I know that’s not a big deal to most people but it is to me.

    By the way, the bowel prep isn’t as bad as it’s made out to be, either. Imagine fasting for a whole day, then drinking a half gallon of watery, slightly slippery Gatorade that gives you diarrhea. I didn’t experience any cramps; I was just on the toilet every 30 minutes for about 3 hours. By the time I went in for the procedure the next day, I felt a little weak, but that was all.

  • mo

    I am driving a friend and was hoping to get an average of how long you all spent in the hospital? She has to be there at 6 even though apparently the procedure is at 9. Wondering what time she would need to be picked up by.

  • Jordan Wadd

    I had to get my endo/colonoscopy done without sedation and it was extremely painful the most painful experience I had in my entire life, although it didn’t take too long. Fortunately I got it done though as they found polyps, that were able to be removed. Although now I have to get checked up every 2 years. I am 30.

  • Keith

    Just had my first, with no sedation last week. What a breeze. In the two spots where I could feel the probe pushing against my abdomen, at the turns I suppose, it was easy enough to adjust my abdominal muscles to shift things around a little and everything continued smoothly. Felt kind of like a bad case of gas at those spots. If I had been sedated at all, this may have gone entirely different. My doctor said this was only the second time in 25 years that he had done one without sedation at all, but after some careful prodding was willing to give it a try. We even visited other parts of the system, appendix entrance and small intestine, and got to view a diverticulum. A very educational experience with no sedation after effects. I suppose that many people are fearful of this and the muscle contractions from that fear could complicate the procedure. They are likely the same people who fly white knuckled. In both cases, the “pilot” has an incentive to return us safely to ground. I told the doctor that as long as he didn’t perforate a bowel, we would both be fine. LOL

  • Alfredo Mercuri

    anyone know a doctor in NYC who does sedation free?

  • catalinda8

    Thank you for this article. I’m waiting for my insurance company to force me into a colonoscopy this year or else they raise my rates (which is completely wrong, IMO). I had two babies with no meds, have a high pain tolearance, and frankly, they can shove whatever they like up there, but the one thing on this planet that terrifies me is sedation. So this sounds like the way I might go if I have to.

  • Howard Weinstein

    Or John E, if you could as well. I am just trying to find a physician that will do this. Thanks again!

  • Howard Weinstein

    Michele, if you can share the physician that did your sedation free colonoscopy, I would truly appreciate it. Thanks so much!

  • Diane Bowman

    Just had my colonoscopy this morning and decided last night I would not have the sedation, found your blog this morning and that sealed the deal. No sedation and there was really nothing to it, the pain got intense at the curves and from the air but they told me to breathe through it and I did great.

  • Jennifer

    I joined the no-sedation club yesterday, following my husband’s positive experience last month. I don’t even describe what I felt as “pain” at all…just very MINOR discomfort, more like a small cramp or gas, at a few points during the process. In both of our cases the doctor talked during the entire procedure and let us know if he thought pain was coming up (for example, when he was at one of those “tight turns”, etc.) As a woman, the doc told me beforehand that some of the turns were different/tighter and could be more painful than for a man, but he didn’t discourage me — just wanted me to have all the info with which to make a decision.

    We also knew we had the option to opt for sedation at any point during the procedure. For me, I was quite a bit more reticent than my husband to go without sedation, even though he did it with no issues. Knowing I could still get sedation part way in helped. The nurses and doc were very impressed I did it because so few people do colonscopy’s without sedation. But I’m 100% serious when I say that pulling the IV tape off my arm hurt a hell of a lot more than any part of the colonoscopy!

    FYI, we’re in Seattle and our procedures were at The Polyclinic (on Broadway). We’re 52.

  • adamrussell

    Id think it safer because I can tell them when something feels wrrrrrong! I mean seriously, if the bowel is about to be perforated you want to be awake to ask them to lighten up! Better than waking up a half hour later to hear them tell you “sorry”.

  • Marilyn Hoffman Fuss

    I just had a second one today. A second colonoscopy without sedation. And my colon is stiffer because I had 33 rounds of radiation last year. It was a piece of cake just as it was the first time. The doctor and the nurses and the anesthesiology dept. didn’t think I could do it. It was easy-peasy.

  • gfish66

    I’ve had 4 colonoscopies and was always out. I intend to go without sedation the next time around, I never knew it was an option. One question I have – I’ve had 5-10 polyps removed each time I’ve had the procedure. Yeah, I’m a special case. Mine take longer than others, no doubt, and I am wondering what it feels like to be awake while polyps are zapped. Just wondering…

  • dougary

    Date: 03-17-14…. I just had my first colonoscopy this morning, no anesthesia at all.
    I’m 56 yo male in good health and reasonably good shape. I told the staff that I wanted to do it without any anesthesia and they were a bit surprised. The doctor highly recommended going without sedation.

    The procedure was very much like the author of this story described. I estimated the pain to be about a 3.5 on a 1 to 10 scale. The doctor joked through the entire procedure which put me at ease. The staff were always kind and helpful before, during and afterwards. The actual procedure from the time he entered my rectum to the time he pulled the scope out was about 15 minutes.

    They did find one small polyp that was painlessly removed. Afterwards I drove myself home and had lunch. Then I went to work. I had some residual cramp discomfort for about 3 hours from the air they pumped in. But otherwise it was very easy. In the future I will be going sedation free for this procedure.

  • CJShahmeran

    I plan to have my first drug-free colonoscopy next week. I’m a control-freak, and would prefer to remain conscious for all the reasons folks here have mentioned. I also don’t have anyone to drive me home, so drug-free is the only practical option. I’m looking forward to being conscious this time and seeing how the process works first-hand. Last time, my only memory was the commemorative photos. Hopefully I’ll get a good nursing staff that doesn’t make insensitive comments, because I would really hate to feel the need to put someone in their place while I’m in such a vulnerable situation. Oh, and before I forget — whether one accepts sedation or not, they will most likely get charged for it anyway. I’m told that the procedure code for the insurance company includes the cost of the sedation.

    • dougary

      It’s a piece of cake. I just had one this morning … no sedation whatsoever.
      The worst part of the whole experience was not being able to eat for nearly a day and half

  • Crabpaws

    I had a colonoscopy yesterday with no drugs at all. I’m a small woman. There were a few intense pangs lasting only seconds, but it went fine. The gastroenterologist was amazed. She said my colon was relaxed, which made it easier. She had plan B drugs ready in case I found the pain “unbearable.” She praised me as brave about 20 times. I watched the entire thing on the color monitor. It was fascinating.

    I hated the fasting and laxative but the discomfort of the colonoscopy itself was not a big deal. Keep calm and breathe deeply, you can do it. Attitude is everything.

  • madcapzany

    I have had to undergo several colonoscopies, and during most of them I woke myself with my own screams. Great for you, if you can do it without sedation. Perhaps it is only folks with a healthy bowel that do not experience pain, and folks with bowel issues such as Crohns, diverticulitis, ibs, etc., do experience pain…or maybe it is something to do with different sensitivities in the tissue.
    I am surprised to see so many positive comments here about not having sedation. If you search ‘colonoscopy pain’, you will find no end of accounts similar to my own.
    Best of luck to all who try it…but, as for me, I will NEVER try it. Nevereverevereverever. Ever.

  • Ellie Smith

    Everywhere else in the world it is done without sedation. That includes endoscopy.. No offense, but only Americans fuss and make big deal out of it. It is funny to read about worries and experience sharing. The less you know, the less warnings reach your brain, the easier it will be. My endoscopy was with sedation, I did not know about that in advance, otherwise I would have refused, cost more than $4K. In Ukraine it takes 10min and $12.

    • madcapzany

      And of course everyones experience is the same as yours, virtually pain free , which validates your allegation that Americans just make a big deal of something that doesn’t hurt, right?
      Hmmmm…have you ever thought that there may be different reactions to this procedure, and that many people have intense pain during a colonoscopy, or are you certain that your view is the only one?
      I would suggest avoiding making blanket judgements based on your own experience, as it is clear that you do not have a large enough frame of reference to make these statements.
      Yes, the human body, when healthy, often has amazing healing properties, that much is true.
      Sadly, there are many who are not so fortunate…and are not blessed with a healthy bowel, yet you have completely disregarded that fact.
      Not cool.

  • Michele Morgan

    I am 54 and just this morning had my first colonoscopy without sedation, the only thing you need to be brave for is the prep and drinking the Movi Prep. The procedure was a piece of cake. The doctor expalined everything he was going to do and It was not painful at all. If you have ever had an enema it felt like expansion bloating and releasing thats it. There was one turn that was a little uncomfortable but basically in one breath it was over. In my opinion there is no need to have sedation for this. My advice is that during the prep you drink alot of water in between, and while you are waiting for your next run to the toilet you put a hot pad or hot water bottle on your belly. It was very soothing. When I got home I massaged my belly passed some gas and was good as new. Took a nap with my hot pad and now I am back at work in just a few hours. No reason to support the drug companies. Find a doctor that will work with you and enjoy watching your colon on the big screen. I was very lucky all clear and healthy.

  • Lindy

    I just had a colonoscopy done without the Versed sedation, though I did do the Fentanyl for pain. I couldn’t even tell I was on pain med as my level was a six, but it was intermittent and short lived and I was able to function the rest of the day with no problems. Lucky me, I don’t have to go back for 10 years and I will go without sedation then as well. The prep solution sucks!

  • JD Shevell

    PS, I list Versed as an allergy. They wouldn’t dare give you a medication that you’re allergic to.

  • JD Shevell

    How do you find a doc who will work without sedation? Ask. Doctors work for us, not us for them. So long as what you’re asking for isn’t dangerous or unethical, there’s no reason for them to balk.

    Sedation let’s them work faster therefore be more profitable. Not at my expense.

    • dougary

      I would say this… if your doctor advises against going sedation free then find another doctor who will. If the doctor is any good at what he’s doing he will not have a problem doing it without sedation of any kind.

  • Astyanax66

    HOW do I find a gastronenterologist who will agree not to use sedation? I have had terrible reactions to Versed and Demerol in the past–I list that I shouldn’t take them, but honestly, I don’t trust anyone not to use them. I’m not scared of the pain–had an 8.5 pound baby with no medications at all–but I am absolutely terrified of the drugs. How did you folks find someone who would agree? Thanks!

    • Crabpaws

      The staff at the endoscopy center said unsedated colonoscopy was rare but they’ve done it before. Phone around for gastroenterologists who will cooperate. Sensitivity to the drugs is a valid reason to go unsedated.

  • SecondTrip

    this was very informative and useful. I had my first colonoscopy 5 years ago at 43 due to family history. I didn’t plan on doing it without sedation but after trying for well over an hour to get a line on me in my arms, hands and even feet; i was told i would have to reschedule. I was determined after doing the cleanse to get it done. I didn’t want to do the prework for nothing. So i asked can i do it without? Do people do it without? They explained that it certainly was not the norm, but if i wanted to try i could. The pain was rather intense (for me higher than a 3 out of 10) at the turns, but the straight aways were just pressure. Now I am getting ready for second colonscopy next month, and i am pretty sure i am just going to do it without again. Thanks for posting your details… it was helpful

  • John E.

    I would absolutely agree with the post above. There was mild discomfort, nothing more. Even when the doctor found a polyp and yanked it out, there was only the sensation that the end of somebody’s finger was poking my belly, nothing more. Several staff members came in, mid-procedure, to gawk I’m sure, at the one patient per year who refuses drugs. I think it even helped the doctor in that I could inhale and exhale on command to allow the scope to more easily get around the corners. It was easy and very, very interesting to watch live on TV. I have no plans to use drugs in future for something as basic as this procedure.

  • Mog theDog

    David, thank you for exposing “the big secret” so more people can reap the benefits of sedation-free colonoscopy.

    I had my first colonoscopy four days ago (this was the rite of passage into age 50 screening exam), and I opted to skip the sedation. I was surprised to learn how challenging it was to find a doctor who would do the exam without sedation, but the one I finally discovered turned out to be a gem.

    After explaining in graphic detail what he was about to do to me, the doctor dimmed the lights, put on fantastic mood music, and then proceeded to give me the most amazing tour of the “majestic colon” that rivaled a trip to any of the 100 most magnificent places on Earth.

    Sedation-free colonoscopy does not have to take longer, and it is not necessarily more painful if one has a colon with more twists and turns than normal. My doctor went from rectum to cecum in an amazing 4 minutes and 14 seconds, and during this time I experienced only mild discomfort and no pain whatsoever.

    The return trip took just shy of 14 minutes and included a few stops to capture some Kodak moments, which the doctor printed out for me to take home and post on Facebook or use for Christmas cards. It also included one wave of pain that lasted about 4 or 5 seconds, just enough time for the doctor to back up the scope and show me the muscle spasm that caused the pain.

    Several nurses came in to watch the procedure, and when the youngest of them saw that I was in no pain and that I was enjoying the scene on the screen, she said with the excitement of a child, “That is so cool! I want to do that, too!”

    Indeed, it was “cool” and I do want to do it sedation-free again. Uhhh, just not for another 5 years.


  • Colleen

    Thank you for this David Holzman. I had a colonoscopy overseas without sedation and I had avoided having a routine 10-year follow-up here because I was certain that I did not need and did not want sedation. I was able to make an appointment with Dr Horst, and had a routine colonoscopy this week without sedation. He was great, and the nurse helping was wonderfully warm and supportive. Everyone else I encountered in the endoscopy facility — though friendly — seemed to think I was out of my mind. They were overtly skeptical that it is possible to endure this experience without medication. The anesthesiologist insisted on doing his spiel despite my assuring him that I’d done it before and i could do it again calmly and without heroics or hysterics.
    In fact there were moments of discomfort both times, but so what? The absolute worst part was starting the compulsory IV (twice!) which was ultimately not needed. There were brief moments when I couldn’t keep up a constant stream of conversation, but Dr Horst was very considerate and in no hurry, which makes it entirely bearable. I’m glad I don’t have to go through it again for another 10 years or so, but honestly, what is the big deal about brief, transitory abdominal cramping?

  • Washingtonian

    Just had my first colonoscopy yesterday; did it without sedation (just 1 mg of lorazepam).
    Discomfort was minimal, drove myself home, changed and an hour after the procedure ended I was in my office. Amazingly easy. It was also interesting to watch the video stream of the procedure.

    • Really now

      Uh, lorazepam is sedation! It is a benzodiazepine. Look it up. Sorta like being a little pregnant, not possible. Not saying what you should take or not take, but really.

  • hurtpatient

    Th so-called “sedation” is just chemical restraint; it’s not to keep you comfortable, it’s to prevent you from communicating your pain and discomfort..and they hope that the amnestic effects of Versed will make you “forget” the abuse until you get home….

  • PLT

    Great article!

    Both of my colonoscopies were without sedation. at my request. Sedation / anesthesia brings unpleasant hangovers and I prefer to avoid adding unnecessary chemicals to my body. Plus, the procedure is quite fascinating if the doctor enjoys teaching (as mine does).

    First time, I was all psyched up to do calming breaths and other coping techniques, but hardly needed them. It was far easier than expected, with only a few twinges like brief gas pangs. Second time was even easier, since it was done in the doctor’s stand-alone facility, thus avoiding outpatient hospital hassles.

    Based on my experience, unsedated colonoscopy is definitely worth considering for those interested.

  • PRex

    My husband had a colonoscopy many years ago (over 10) and did not have sedation. He watched the monitor and really had no discomfort at all; just a little pressure here and there.

  • suebee

    Colonoscopy is a life-saving procedure that can easily be done without noxious and sometimes dangerous “sedation”. So-called “conscious sedation” is anything but something to make you comfortable and sleepy; it’s a chemical straightjacket that forces patients to lie imobile, in agony, unable to communicate..but the Versed usually causes temporary amnesia so that some “forget” the pain…..until later, then they suffer PTSD and nightmares. “sedation” is an invitation to patient abuse, especially during colonoscopy..treat the patient rougly, she won’t remember until she gets home…etc. any decent gastro will do the exam without drugs..just write “I’m not consenting to sedation” on the consent form and you will survive with your brain and memory intact.

  • jrice

    I’ve finally found a gastroenterologist nearby who will do a unsedated colonoscopy because I do not tolerate anesthesia well. In 2011 I had carpal tunnel surgery with only local anesthesia and recommend it. Thanks for sharing.

  • me10544

    Thank you, thank you, thank you. I came across this post a few days ago when I was freaking out in advance of my first colonoscopy. I am not a hero nor do I try to play one during medical procedures. However, I do want to stay of clear mind – call it a female-wanting-control kind of thing.

    Your post helped me find the strength to go sans sedation today. I opted to get a ride to the office in the event that I chickened out but felt I could do it. The nurse that checked me in was great but the nurse that assisted during the procedure was not a treat. I’m pretty sure she thought I was trying to be a hero and was very cold to me. Both nurses and the doctor asked repeatedly if I was sure that I didn’t want sedation and stated, “it isn’t general anesthesia”.

    Within 25 minutes we were done. Done! It was uncomfortable and at one point I winced, but I did it. The nurse and doctor congratulated me and said I was brave. I think what they were really thinking is that they would never do it without sedation – not so much that I was brave.

    I found it funny that the nurse in the recovery area had to take a few minutes to figure out how to edit her normal discharge instructions since I opted for no sedation. In fact, she said that she would guess that less than 5% of people go without sedation. It’s hard to believe that after the experience.
    After 5 minutes and a few embarrassing toots later, I was able to leave. The doctor said I need to book another colonoscopy when I turn 50….I can handle that…I’ve got 16 years to go!

    Thank you again for sharing your story as it gave me the strength I needed!

  • Tim

    I recently had my sixth colonoscopy and I have never wanted to get sedated in any of them. Two were done in USA and the rest here in Finland. In USA, the doctor was surprised that I did not want any drugs and the doctor here was rather surprised that anyone would even need them. Here they also do not see any need to continuously monitor the blood oxygen or the heart rate. It simply is not necessary as no drugs are administered. After all, the prep is the hardest part of it all, drinking the fluids and not being able to eat almost anything for a day or so. During the actual procedure, the only discomfort I had ever encountered was the bloating as air was pumped in to allow the device to proceed. Even that part was reduced to almost nothing the last time around when, instead of regular air, the doctor used carbon dioxide for the same purpose. No bloating feeling at all, quite amazing. This whole experience is so much easier than any dental procedure, by far. In my opinion, if anybody has any painful experiences with this, drugs or no drugs, they better change the doctor next time.

  • krvabob

    Had a sedation-free colonoscopy Tuesday. Showed up at 8am, procedure at 9, was home eating by 10:30. No real pain….just a bloated, cramping sensation that was easily tolerable. Doctor and nurse were wonderful about keeping me engaged in conversation, taking my mind off the discomfort. I’ve had Versed for other procedures, but try to avoid it, since it results in a full day of recuperation (and for many folks, vomiting). If you can put up with 20 minutes of mild unpleasantness, non-sedated is the way to go.

  • steve

    I just completed my first ever colonoscopy and I chose to do it without sedation. The staff told me what to expect and what to do when I experienced any discomfort. When the doctor reached the area that was supposed to cause the greatest discomfort it turned out to feel no worse than a mild cramp and it was over quickly. The greatest benefit of not being sedated was watching the procedure on the monitor and having the doctor point out various structures in the bowel. The amount of dialog I had with my doctor made the time go fast and it was over in no time. There is no doubt that my next colonoscopy will be done without sedation, and yes, the prep was was the worst part.

  • Gus

    I had a colonoscopy today unsedated and it was absolutely fine. I called my best friend a few nights ago, who is a is a Gastroenterology doc and although he did not tell me what to do, when I asked questions about sedation he said that he does a small percentage of procedures without sedation with no issues. He told me that I might find it uncomfortable from the air used to inflate the colon and maybe at a few sharp turns. I also read this and a few other blogs and decided to go drug free.

    I thought about my friend and how much respect I have for him and trusted what he said. The nurses were kind and supportive and my Doc was great, and I decided to put my trust in them. I got to talk to the nurses and Doc during the procedure and watch it on tv. Slightly uncomfortable at times, but I just remembered what my wife said “it’s just a small camera up your butt.” And for anyone who has watched a child being born (or given birth) this does not even compare.

    I usually do not comment on blogs, but I found this one helpful and hope that I can add my experience and maybe help someone else making a decision about whether to be sedated or not.

  • bananas

    It is interesting to me that no one else has reported having a similar experience after the procedure was finished. See below – I could not hold down anything, even sips of water, for about 18 hours afterwards. I’m curious how frequently this happens to people. It was easily 10 times worse than prep: after 24 hours of only clear liquids, 22 hours of nothing! PLease share if you’ve had a similar reaction.

    • Tommy

      Two things that aren’t clear to me from this article and the responses.

      Tho first I should say that at 60 I am now finally planning on having a colonoscopy and plan to do it without sedation, tho I might not find it that easy to find a gastroenterologist who will do it w/o sedation.

      1. Sedation and analgesic are two different things and I assume those who have had it w/o sedation usually (versed) at least had an analgesic (painkiller) usually meperidine or fentanyl.
      2. I agree with some who posted that Magnesium citrate drink doesn’t taste bad at all. It does come in different flavors too. I’m also surprised that the person only had to drink a Magnesium citrate drink. I think it’s only considered a laxative and from my research it seems like Gastroenterologist insist on something which tastes much worse and is a much stronger solution like GoLytley (polyethylene glycol).

      • Millerx5

        No, Drug free for me meant drug free!! The nurses did their best to bully and scare me, but I stood my ground.

      • SecondTrip

        no totally drug free

  • Martian Minisculio

    I’m always puzzled by reports of intense trouble with the prep. Pain is very variable, I know, as people have different “pain thresholds,” but the prep doesn’t involve pain. Neither I, nor my partner, who has to have them every year or two, nor anyone I’m close enough to to discuss colonoscopies (kudos to Mr. Holzman for talking about it to all of us!) has anything like this hellish tale of prep to tell, nor is the taste of the flavored magnesium citrate so awful to them. (The stuff you had to drink, in greater quantities, before the mid-90s, was admittedly a different story.) It takes me about one minute to drink it, as opposed to the writer’s 90 minutes! I mention this because many people reading this story about the prep will be so put off they’ll never get around to that colonoscopy, sedated or not.

    • David C. Holzman

      It’s good to get your perspective on the mag citrate. Maybe some people won’t find it that bad. Maybe yours had a better flavoring.

      • sj

        The prep was bad for me, the worst part. I have reflux, and almost immediately the solution caused a major reaction. I also experienced nausea, which made drinking the solution extremely uncomfortable. By the end, I was in great discomfort. The diarrhea wasn’t bad, and the colonoscopy (with sedation) turned out to be the easiest part. I was told that a pill that can be swallowed is in the works, but several years away.

  • bananas

    If only I had known this was available! I never asked – or maybe never listened. Yesterday I had the identical procedure at the same hospital. I found the prep pretty miserable but it went more easily for me than you. The terrible part came right afterwards – I vomited the little cup of apple juice the nurse gave me post-procedure, got home and made a light snack which I vomited, tried drinking a little tea 3 hours after that and vomited, then tried warm water which came right back up. Finally I decided to give up and sleep. I was fantasizing I’d have to call a friend to take me to the ER for an IV to keep me alive, but around 3 a.m. I woke and found I could hold down a little water! At 5 I dared a soft boiled egg! I’m going to survive this. I’m certain this was a reaction to the sedation. And I know I could have managed without it, having had natural childbirth and doing well at the dentist’s without novocaine. Imagine if I’d read this piece a couple of days ago. A lesson for the future. Thank you.

  • jtilbe

    No doubt there would be fewer perforations among sedation free colonoscopies.

    When I had my first colonoscopy it started with light sedation. But the doctor. was so rough, causing so much pain, he ordered more drugs to knock me out completely. I think some doctors rush through the procedure. A recent article showed very different statistics among doctors regarding the number of polyps found / missed and the number of perforations. I wish all doctors who do colonoscopies would release their statistics.

  • riverwaif

    I had unsedated and, though it is claimed to be more painful for women than men, found the pain tolerable and, like your experience, coming in short waves. What I unfortuantely did not experience was a suppotive nursing staff…they treated me like I was a side-show freak for refusing sedation and were clearly displeased when I uttered any “wa-wa” sounds…one technique I use for coping with pain.

  • Donna Maderer

    Wow — good to see this. I’ve had a couple of friends who’ve said the procedure was mind-bogglingly, horrifically painful even under sedation (mild sedation). I’ve had another couple of chums who didn’t have sedation and said ‘it’s just mildly uncomfortable.’

    I too found the prep the worst part of the whole experience but I opted for the drugs and slept through the whole thing.