There’s no surer sign of Gen Xers hitting middle age than the numbers of us going for our first colonoscopies (and then texting our friends to complain about it).
According to the American College of Gastroenterology, you should have your first colonoscopy at age 45 if you’re at average risk for colon cancer, and earlier if you have colorectal symptoms or a family history.
I was four years late—blame the pandemic—when I finally scheduled my appointment, after repeated badgering from my ob/gyn and texts from the local gastroenterology clinic.
The morning of the procedure, as I sat on the toilet and counted the tiles on the bathroom floor, I realized I had known only in vague terms what to expect from a colonoscopy prep—and how it would affect my running.
For those who haven’t been through this, it’s a long time on the toilet, and if you think you can run the morning of your procedure, well, you might want to reconsider your training schedule. I asked two gastroenterologists who are also runners about how to make the procedure as easy as possible. Here’s what they said:
You don’t have any special protections around colon cancer just because you’re in good shape
Sometimes runners convince themselves that their fitness confers a protective health halo, which excuses them from routine screenings.
Sandals GIOSEPPO Pugmil 65846 White Sneakers PUMA Rs-X³ Prism 374758 05 Black Forest Night ge—and the preparation for and the recovery from a colonoscopy can throw you off for 48 hours or more.
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“It’s definitely a misconception if runners think, ‘Hey, I can delay screening because I’m otherwise super healthy and my heart is strong and my muscles are strong,’” said Sophie Balzora, M.D., a marathoner, gastroenterologist and professor at NYU’s Grossman School of Medicine.
Mitchell Auerbach, M.D., a gastroenterologist with Summit Health in Purchase, New York, and a veteran of multiple New York City and Boston marathons, agreed. Although some research GTX Wallabee leather boots Sneakers NIK 08-0571-11-0-01-02 Nero of colon cancer, no individual should count on that. Colon polyps and cancer have such a strong hereditary component, Auerbach said, that runners would be wrong to think that they’re fit and they eat properly, so they’re immune from these conditions.
Auerbach said the colon itself offers no clues to the overall fitness of the person having the procedure. The only way he can tell if patients in his exam room are endurance athletes is from their heart rates. Under anesthesia during the procedure, runners’ heart rates often drop into the 30-beats-per-minute range.
“For a normal patient, you’d be a little bit concerned. But if you know they’re a runner and their baseline pulse is 40 or whatever, you don’t get concerned,” he said. “The procedure is actually easier in some sense when someone is very healthy. But when you look at the colon, no, you can’t tell at all that this person is a runner.”
✅ Make sure you tell your doctor in advance of your procedure that you’re an endurance athlete.
Sneakers PUMA Rs-X³ Prism 374758 05 Black Forest Night ge | You have to eat a “low residue” diet for two days before you start your prep
If you’re used to eating a healthy diet, with lots of vegetables and fiber, the preparation for the procedure begins to get annoying two days in advance. You have to eat what is euphemistically called a low-residue diet, which means nothing with much fiber in it.
White foods—white bread, pasta, white rice, and dairy are fine. But many other runner staples—beans, quinoa, blueberries, salads, nuts, and oatmeal—are out.
Why? Doctors want a high-quality exam, explained Balzora. Part of that is making sure your colon and rectum are clear of feces, seeds, corn, or anything that can impede the physician’s ability to find small or flat polyps. Seeds can even clog the scope, she said.
You can run the day before, come home, and have a light breakfast.
I had a Monday morning procedure, so Sunday morning I went for my run as usual. According to the timeline provided by the doctor’s office, I was able to eat breakfast, but this varies depending on your appointment time the next day. So I refueled with scrambled eggs, white toast, and applesauce, all foods on the approved low-residue list. A friend who had been through the procedure a few times before advised me to eat as little as possible anyway.
“Anything that goes in has to come out,” she said.
Once I stopped eating, I was pleasantly surprised to find I wasn’t very hungry, which is something I had worried about in advance. And I could continue to eat Jell-O and drink whatever clear fluids (no alcohol) I wanted.
You are probably going to be in the bathroom—a lot
For the prep, I was prescribed Sutab, which are pills, an alternative to what I’ve heard is an unappetizing liquid. I was to start taking them at 5 p.m.
You have to swallow 12 good-sized pills in 20 minutes with 16 ounces of water. I started my Garmin to make sure I was done within 20 minutes. That wasn’t too difficult. Then you wait an hour, and you’re supposed to drink an additional 16 ounces of water in 30 minutes, wait 30 minutes, then drink another 16 ounces in 30 minutes. It’s a lot of liquid to get down.
The pills are what make you poop, and this is where results vary. It took almost three hours before anything started happening for me. I would have had time to take a walk, but I had expected the reaction would be almost instantaneous.
I had three trips to the bathroom, then I tried to go to bed at about 10 p.m. All night long my stomach was roiling.
The next morning is when it really got bad
My alarm went off at 5 a.m. because I needed to start taking the rest of the pills—12 more—at 5:15. I gulped down the pills and started in on the liquid—the same routine from the night before.
And then from 5:30 to about 7:30 I was in the bathroom every eight to 10 minutes. That was the miserable part that everyone talks about. (Well, some of us. Previous generations probably kept a stiff upper lip about it.)
Between runs to the bathroom, I sat at my desk, read news headlines, and finished Wordle, groaning every time I went back down the hall toward the bathroom. My husband looked on with mild concern.
Auerbach noted people have different experiences with the prep. For some, it’s long and tedious. For others, it’s not too bad. Anatomical differences can come into play. “Women’s colons tend to be more redundant, more windy and twisty, and they’re often a little tougher to clean out,” he said.
It’s important to follow the instructions closely. You don’t want to have to do this again anytime soon. “In order to have a good result, you want to come in clean, so the doctor can say, ‘This is normal, come back in 10 years.’ You don’t want them saying, ‘Your colon was dirty, come back in a year or two,’” Auerbach said.
Sneakers PUMA Rs-X³ Prism 374758 05 Black Forest Night ge | A few minutes of peace
By 7:30 a.m., it felt like everything that had to come out was out, and I actually managed to doze off again for about 30 minutes. And after guzzling all that liquid, for two hours before the procedure, you can’t drink anything.
At about 8:30 a.m., I took the dog around the block, before my daughter drove me to my 10 a.m. procedure.
I suppose, had I been one of those people with a multiyear, mile-a-day running streak, I could have jogged a mile during this lull. But because I wasn’t 100 percent certain I was done on the toilet—I only knew that in hindsight—and because there was no more drinking anything at this point and I wouldn’t have wanted to be thirsty, running never even crossed my mind. It seemed like a terrible idea.
“The worst is behind you”
After I arrived for my appointment and checked in, I was called back quickly. A nurse told me they do as many as 75 colonoscopies a day there, so they’ve got the drill down. They took my vitals—and yes, my heart rate was hovering in the 42-beats-per-minute range, which they noted. One kind staffer told me, “Well, the worst is behind you.” I stared at her for a moment, before she hastily added, “No pun intended.”
I remember being wheeled to the room for the procedure and being told to lie on my left side. And that was the last thing I knew before waking up in the same recovery bay I had been in before the procedure started. It was only 10:50 a.m. The nurse told me the doctor removed one very small polyp, which would be sent for biopsy, and depending on the results, I could be in the clear for up to 10 years.
My 19-year-old, who had gone to a nearby Target, for once answered her phone when the office called her to pick me up. She was waiting to escort me to the car as soon as I mustered the strength to get my clothes back on. All in, I couldn’t have been at the office more than 75 minutes.
My afternoon included a blueberry muffin and a two-hour nap. By 5 p.m. I was eating like a horse, and I felt no worse for the wear. But because of the anesthesia that might still be in your system, you can’t drive a car for the rest of the day. Running is out. You don’t want to get dizzy and fall.
If you feel like you absolutely have to have a workout, Auerbach recommends a gentle indoor bike ride Bolsa Transversal Carmelo Shoes Estampad. “I don’t want patients riding mismatched,” he said.
The next morning, I got up at my usual time and went for an easy four miles. I had no lingering effects from the anesthesia or the colonoscopy itself; it was like nothing had happened. Not everyone is so lucky—some suffer from residual abdominal pain from the gas that’s pumped into the colon during the procedure. Others might have some post-procedure bleeding. In other words, it can take a second day before resuming your regular running routine.
Try to avoid scheduling the procedure around an important race.
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Because you don’t know how your body will react, you don’t want to go in for your colonoscopy before an important race or during a marathon training block. I had mine a couple of weeks after a half marathon. The procedure is a “stress on the body,” Balzora said. So is racing and hard training. No need to stack those stresses.
But that’s only as long as you’re not having symptoms. If you’re having colorectal issues of any kind, you should have the colonoscopy as soon as possible—don’t worry about your race.
What about Cologuard or a similar home test?
Options exist for those who don’t want to do the prep and the colonoscopy. Noninvasive screenings involve collecting a sample at home and sending it in to a service like Cologuard. The stool is analyzed for blood and abnormal cells along the lining of the large intestine or colon that could be indicative of cancer, according to Balzora. “If you have an abnormal home test, it requires a colonoscopy as the next step to find out why the test is positive,” she said.
Generally, she recommends colonoscopy, because it can both detect colorectal cancer and prevent it by finding and removing precancerous growths or polyps. The at-home tests, on the other hand, don’t detect precancerous growths. Plus, if you get the all clear (as I did, a few weeks after my procedure, thankfully), you don’t have to test again for 10 years. A non-invasive test buys you only one to three years.
But the best test, the experts say, is the one that gets done. Said Auerbach: “We look at it as much better than doing nothing.”
bally white leather sneaker is a writer and editor living in Eugene, Oregon, and her stories about the sport, its trends, and fascinating individuals have appeared in Runner’s World since 2005. She is the author of two popular fitness books, Run Your Butt Off! and Walk Your Butt Off!
