Colonoscopy sedation is personal decision

DEAR DR. ROACH »

I have seen two of your columns in which I thought I read an implication that the decision to be sedated or not during colonoscopy was a fairly straightforward choice.

I need to point out that for many of us, an unsedated colonoscopy would be agony. It does not feel like much of a choice. We are terribly ashamed and stressed when people indicate that it’s not that big of a deal.

I was sexually abused as a child, and I am one of the many for whom colonoscopies are traumatic even while sedated. My gastroenterologist told me that she sees this all the time in patients who have a history of abuse. The tricky thing, she said, is that she needs to sedate us enough to not be in acute discomfort and stress, but not so much that the disinhibition increases our agitation.

On top of that, many of us with PTSD have pain and inflammatory syndromes like fibromyalgia.

It is hard for me to even convey how much more acutely sensitive my body is, how low my pain threshold is, after having grown up with my body always on high alert. I wish this were different, but after 63 years in this body I have learned to respect it and the underpinnings of it. I want to reiterate that according to my doctor, I am far from the only patient who experiences this.

My father had colonoscopies in the days before routine sedation. He told me that these were some of the most agonizing procedures he had ever endured. This from a man who survived the Spanish flu and rheumatic fever, faced starvation during the Depression, and fought in the Pacific in World War II.

— Anon.

ANSWER » I appreciate your writing to share your experience. Colonoscopy without sedation is not for everyone. The range of experiences with unsedated colonoscopy is dramatic: Some report no discomfort at all save some “gas pains.” I am publishing your letter to validate that there are people who have very different experiences and have much greater sensitivity to pain, especially visceral pain (from your internal organs), which is processed very differently by your brain.

I am not ashamed at all to say that when I have a colonoscopy, I am sedated, and have been very happy with the experience.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.