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How to Ease the Pain of Colonoscopy

Peppermint was not “officially” discovered until 1696, but we’ve probably been using it for thousands of years. After-dinner mints are used to reduce the “gastrocolic reflex,” the urge to defecate following a meal. The stretching of nerves in the stomach triggers spasms in the colon, which makes sense because it allows us to make room for more food coming down the pipe. Peppermint, like in our after-dinner mints, relaxes the colon’s muscles. I explore this in my video What to Take Before a Colonoscopy.

When researchers took circular strips of human colon removed during surgery and laid them out on a table, they spontaneously contracted on their own about three times per minute. Isn’t that kind of creepy? But when more and more menthol from peppermint was dripped on them, the contractions still occurred but were not as strong.

If peppermint can relax the colon and reduce spasms, might it be useful during a colonoscopy, as first suggested 30 years ago? Colonic spasms can hinder the progress of the scope and cause the patient discomfort. So, researchers sprayed peppermint oil on the tip of the scope, and, in every case, the spasm was relieved within 30 seconds. Thirty seconds, however, is a long time when you have a scope snaking inside your colon. The next innovation was to use a hand pump to flood the entire colon with a peppermint oil solution before the colonoscopy, which caused the spasming colon to open up within 20 seconds. This is a simple, safe, and convenient alternative to injecting an anti-spasm drug, which can have an array of side effects.

Researchers saw similar results during upper endoscopy, with peppermint working better, quicker, and safer than drugs. Another study also found positive results when peppermint was mixed into barium enemas. But wouldn’t it be easier just to swallow some peppermint oil instead of squirting it up the rectum? Researchers looked at this alternative in a study using premedication with peppermint oil before colonoscopy. Just popping a few peppermint oil capsules four hours before the procedure sped up the entire process. Both doctor and patient satisfaction increased, because reducing colon spasms can reduce pain and discomfort as well as make the scope easier to insert and withdraw.

Pain and discomfort are not the only barriers to signing up people for colonoscopies, however. Even if peppermint oil makes the procedure go seamlessly, there’s still the dreaded bowel prep where you have to drink quarts of a powerful liquid laxative to completely clean you out before the colonoscopy. And, aside from the pain, there are also fears of complications and feelings of embarrassment and vulnerability.

Serious complications occur in about 1 in every 350 colonoscopies, including really serious complications like perforations and bleeding to death. Perforations can occur when the tip of the scope punches through the wall of the colon or when the colon is inflated too much while the doctor is pumping in air to look around. It can also happen while trying to cauterize bleeding caused by something like a biopsy. In extremely rare instances, this cauterization can ignite some residual gas and cause the colon to explode.

Death from colonoscopy is rare, occurring only in about 1 in every 1,000 procedures. But with about 15 million colonoscopies performed annually in the United States, colonoscopies may kill about 15,000 Americans every year. This raises the question whether the benefits outweigh the risks? I was shocked to find out how risky colonoscopies are, but dying from colon cancer is no walk in the park either. There’s got to be a better way, and I cover that topic in my Should We All Get Colonoscopies Starting at Age 50? video.


See more on iatrogenic (doctor-induced) risks of various medical procedures in my videos:

You can also learn more about the benefits of all kinds of mint in these videos:

And what about preventing colon cancer in the first place? See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


43 responses to “How to Ease the Pain of Colonoscopy

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    1. I think that 1 in 1000 number needs to be doublechecked. At that rate, I would have heard about some widows and orphans in my town and I haven’t.




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      1. Fencepost,
        If you click on the highlighted words “complications” and “perforations” in the blog piece it takes you to the scientific information where the data came from. From there you can look for more info if your so inclined..
        mitch




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        1. clicking on the link “rare” shows the mortality from colonoscopies was 1 in 7000 for that study in NYC. So I was right about that 1 in 1000 statement needing to be doublechecked. And now I can add that a correction should be considered.




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      2. Yes, I think it is high too. By an order of magnitude.

        It appears be a misinterpretation of the data in the cited study. My understanding is that the one in a thousand number applies to all gastrointestinal endoscopies (GIE) NOT to colonoscopies alone. And not to screening colonoscopies specifically

        While all colonoscopies are GIEs, not all GIEs are colonoscopies.
        https://www.emedicinehealth.com/gastrointestinal_endoscopy/article_em.htm

        Perhaps the NF team could review the article concerned and consider whether this figure needs to be corrected.




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        1. My concern is not dying during or soon after colonoscopy; it’s losing a part of my colon and having to wear one of those bags for the rest of my life.




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  1. My “old” GP always pushed for me to get a colonoscopy. No symptoms of any colon disease, no history of colon disease (or any cancer). Did not do any test for occult blood or the old finger up the but prostate exam.. Just go get a colonoscopy. Insurance pays for it completely so what is the problem??? 1-1000 deaths and 1-350 complications.. That’s why. I also found out that the GI guy he wanted to send me to is HIS FRIEND… I would see them at conferences sitting next to each other and going to lunch in the hospital cafeteria back when I was a hospital worker
    I smell a rat and that rat was smelling like collusion and kickbacks…. uffda..
    Mitch




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  2. Pain and discomfort with colonoscopies?? I’ve had 3 (ages 40, 45 and 50 – family history had me start so young), and aside from the prep which is annoying but not a big deal, there is no pain or discomfort. You go in, they give you some Fentanyl which knocks you out (“twilight” anesthesia), and you have the best nap of your lifetime. You wake up and feel drowsy like you just slept in on a Saturday morning. You get some ginger ale and water and you’re out of there (need someone to drive you home). You are unaware of any of it, don’t feel a thing, and have no discomfort after. Just get to go home and nap the rest of the day. I have a very twisted/convoluted colon from scar tissue from peritonitis when I was a teenager and the GI doc knows that and uses a pediatric scope on me, and goes very slowly and carefully. Never had a single problem. I love Dr. Greger’s posts/videos, but throwing a title out there that includes the words “pain” and “colonoscopy” is doing a disservice to a fairly simple, painless, preventative procedure.




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    1. Let me clarify when I say “preventative” – I know that colonoscopies don’t “prevent” colon cancer. Just early detection.




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    2. Ah, you are lucky. For whatever reason, the sedative I was given didn’t “take” very well, and I was awake for the whole thing. The drug made me very chatty, probably annoyingly so for the doctor and nurse. It was quite painful when the scope rounded the colon corners, and I was held down a bit to keep me from wiggling. All in all, not very pleasant. Oh, and I fell asleep *after* it was all over.




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          1. I was watching a PBS special about army people raising up bomb sniffer dogs and they said that the fully trained dogs were worth about $85,000.00.

            The retired people who trained those dogs, probably could be hired for much less than that, is my thought.




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            1. At the end of the show, they showed a place where the sniffer dogs were retired to. Those dogs might be able to be retrained for Colon Cancer.

              If I were an eccentric multi-millionaire, I would have so much fun trying to solve all sorts of things.




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  3. Dr. Greger, a follow up study published in 2017 did not support these findings. It found that “Peppermint oil capsules did not affect caecal intubation time when compared with placebo. Patients’ tolerance, endoscopist’s satisfaction and demand on sedation were also not affected.”

    “The effect of premedication with peppermint oil capsules (Colpermin) prior to colonoscopy: A double blind randomized placebo-controlled trial”, Arab J Gastroenterol. 2017 Dec;18(4):220-223




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  4. The findings I was referring to:

    “Just popping a few peppermint oil capsules four hours before the procedure sped up the entire process. Both doctor and patient satisfaction increased”

    These were not supported in the 2017 study which I referenced.




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    1. Good find. Thanks.

      However both were double-blind, randomised placebo-controlled trials. I wonder if the dosage used in the trials differed?




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  5. “I wonder if the dosage used in the trials differed?”

    I just read the abstracts to both articles, and neither one states the dosage.

    So we would have to pay to get the full articles.




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      1. There are also two different names of Peppermint Oil in the various studies (IBS studies, etc.)

        One is called Mintoil

        One is enteric-coated peppermint-oil formulation (Colpermin)

        Just noticed the Enteric-coated in the 2017 study.

        The other was capsules.

        I know that some of the enteric-coated things don’t dissolve as well as capsules – in real life.




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        1. I was just reading an article listing reasons enteric-coated pills sometimes fail and I laugh, because the Standard American Diet is one of the things listed.

          Things, which affect the acidity can either cause them to dissolve too early or pass all the way through.

          Wondering if the prep for the colonoscopy is one of the things, which affects acidity?




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          1. The other possibility is fraud.

            Either the first researchers falsifying information like in the resvertrol studues or the second researchers doing things to make it fail.

            I know the Cancer doctor who used enzymes said that happened.

            I remember when I was looking to see if any modern studies verified Philpott’s static magnet studies and I found things like foot insole magnets which had a positive result, but then there was a study, which the people who analyzed it said that the researcher used magnets, which were so weak that they couldn’t do anything, but it made the press as “It turns out magmets don’t work.”

            Then, when I was looking for brain plasticity devices like Dr Bach-y-Rita used, they said that even though their device worked, it was compared to something else which also works and twenty years later, I still couldn’t buy the device in America and probably never will be able to, even though it could seriously fix my step-mothers brain.




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            1. With at least one of the magnet studies, I reme them talking about them using a lesser magnet in the control group, but they said that some of the lesser magmets turned out to be nearly as strong as the test group.

              There was variability is my point.

              Supplements have such variability in amounts, so that being mishandled could be another thing to be analyzed.

              The women basketball players have had at least one instance where labs were shady.

              Listening to some crime documentaries and listening to NPR recently about innocent people in prison, things mess up so often and get contaminated etc.

              I say that, because I wonder if pharmacists are more perfect than doctors.




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          2. I am laughing, because Standard American Diet can cause enteric coated drugs to fail, and they also listed vegan.

            If acid affects it, then Atkins and Keto and meat eating in general would affect it, along with soda drinking and coffee drinking, etc.

            But if vegan also causes it to fail, what is left?

            Who can actually use those pills effectively?




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    1. Hi Robert,

      I am a volunteer for Dr. Greger. Thank you so much for your question.

      I looked up the double-blind, randomized controlled trial that Dr. Greger talks about above, in which pepperment oil appeared to make the colonoscopy process easier. The pill contained 187 mg or 0.2 ml of pepperment oil.

      However, the risks and benefits of getting a colonoscopy should be determined on an individual basis, as there are alternatives with less side effects and risk. If you haven’t already, check out Dr. Greger’s video on the weighing of the risks and benefits of colonoscopies: https://nutritionfacts.org/video/should-we-all-get-colonoscopies-starting-at-age-50/

      I hope this helps answer your question!




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  6. Just personal feeling expressed here but….I know peoples who crap about once every three days and others who crap about three times a day.

    I suspect there is no science to back my up in this but have always suspected the first mentioned were at great risk and the second not much risk at all. Considering the contents considered are to be waste things filled with any impurities we may have eaten.

    Fiber fiber fiber I think is the key to this thing to my opinion. What is the specific incidence of these type diseases with those on perhaps the typical south African diet historically in context…..I’d guess slim to none.

    So personally I would not chance that one in seven thousand. Being more of the crap once or twice a day type.
    Pain means not a thing to me and is not a part of it. I in any medical procedure to include dental work forgo any pain med topical or otherwise, part of my personal philosophy to feel it all.
    Docs will not sometimes allow that. Dentists do.

    Some docs now advocate for all males to take statins automatically upon reaching the age of forty….are we them…seems not.
    If it becomes standard procedure to recommend that in ten years or so, automatically…would I follow that lead…no.

    I do have medical family history of things to worry about…. So I worry about some things not all.
    Blanket recommendations standard procedures from the medical community. Not all that long ago this same community was advocating smoking as healthful and still they in the majority do not mention diets connection to things such as heart health.
    So in general I put little stock in their opinions. Other than that strictly backed by science like doctor Gregers generally is.




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    1. Keep in mind this is a profession who in general in America at least still lops off a part of any male babies private parts at their first opportunity for no good reason or any reason really under the sun(excluding religious people who occasionally do that thing as well)….are we not they not still really barbarians?
      Trust a barbarian will I….when some villiages need pilliageing or some peoples raped or destroyed…for those things I may trust these in.
      Medical elective procedures….rarely. I must study and make up my own mind. These are savages in a savage time with a slim gossamer thread of civility to mask it all. One step from caves.
      I trust not these primitives. When they act as advanced I will trust then to their advancements. Till then most of it all is smoke and mirrors and personal gain is the game.




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    2. Yes, Ron, Dr. Greger has a risk assessment with WFPB video.

      https://nutritionfacts.org/2017/06/29/fifty-times-lower-colon-cancer-risk/

      There is such a big difference, that I agree with you that I am not willing to do a screening.

      I think some of the less invasive things might be something I might do every now and then, but if I am not having the same risks for Colon Cancer, and the test risk is anywhere near 1 in 1000 or 1 in 7000, nope, not gonna happen.




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  7. A GREAT alternative to the “dreaded bowel prep”, which is downright unhealthy, is to get a colonic the day of the procedure! I became certified by a gastroenterologist, Dr. Chris Demetriou, at GI Doctors, in a procedure called ColoLavage. “This prep only requires you to consume one small bottle of snapple that is mixed with a tasteless laxative powder the day before the test in addition to undergoing a colonic at our facility two hours prior to your colonoscopy.
    From our experience, the Colo Lavage produces better bowel cleaning, better patient satisfaction, in addition, to increase patient safety as compared to the conventional bowel prep.”




    1
      1. The “increased safety” is due to several factors:

        – Reducing the oral prep volume from 64 to 16 ounces • Less anesthesia is used meaning quicker recovery times – • The scope slides more easily due to the natural lubricating properties water – • The colon is cleaner and therefore makes it easier to see the tissues for screening

        *Juliana Benner, CCH, CNHP* Certified Colon Hydrotherapist, Certified Natural Health Practitioner (208) 850-8075 *High Stream Healing-Boise Colon Cleanse* 1617 N. 5th Street Boise, Idaho 83702 www. boisecoloncleanse.com w ww.SeacretDirect.com/stream http://www.BetterPlanetPaper.com/source

        “The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition.” ~Thomas Edison “Take care of your body. It’s the only place you have to live.” ~Jim Rohn




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  8. I found out tonight that one of the Cancer people I had tossed a note to went to the “Eating You Alive” movie.

    i am having so much fun trying to save people’s lives.




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  9. This topic is not academic for me: colon CA family history, personal history of polyps before age 60. I was wondering, is colonoscopy better for me because they can grab polyps while they’re in there? Could someone like me, who needs colonoscopies every 3 years now get by with less invasive options?




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    1. MM,

      When you’re at a higher risk of GI issues the more conservative approach, ie. every three years might indeed be appropriate. Could or will your gastroenterologist be on board with peppermint….. probably not due to the insurance issues and hospital policy. However, doe this prevent you from taking some internally 4 hours before a procedure….talk to the GI folks and get on the same page.

      Also make certain that your fully hydrated and confer with the GI folks about using the minimal doses of the preps, as Juliana’s reference (below) regarding electrolyte issues is very much a consideration.

      As to a less invasive option there are newer markers such as the cologuard test, but as you point out if there is a postive result you would need to revert to the colonoscopy procedure. I’m also assuming that your using a simple FIT test regularly ?

      May I suggest you read some very interesting work on colon cancer and prevention and I’d be remiss if I did not ask if you sequenced any of the colon cancers, from your polyps ?

      And of course there is great reasons to use the WFPB diet approach to also minimizes your risk. There is an excellent set of videos at: colon+cancer

      Dr. Alan Kadish Health Support volunteer for Dr. Greger http://www.CenterofHealth.com




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