Concerns About Modesty During Colonoscopy

What is Colonoscopy?

Colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, tissue samples can be collected (biopsy) and abnormal growths can be taken out. Colonoscopy can also be used as a screening test to check for cancer or precancerous growths in the colon or rectum (polyps).

The colonoscope is a thin, flexible tube that ranges from 48 in. (122 cm) to 72 in. (183 cm) long. A small video camera is attached to the colonoscope so that your doctor can take pictures or video of the large intestine (colon). The colonoscope can be used to look at the whole colon and the lower part of the small intestine. A test called sigmoidoscopy shows only the rectum and the lower part of the colon.

The colonoscopy may be performed in a hospital outpatient department, a clinic, an ambulatory procedure center, or a doctor’s office.

Make sure that before you consent to either traditional or virtual colonoscopy to do some research to make sure that the colonoscopy is actually necessary. Keep in mind that perforation of the colon is one of the risks of colonoscopy.

Check out a case where a lady who suffered from both severe acid reflux and constipation avoided an unnecessary colonoscopy. She changed her diet and her health problems went away.

Here are some other articles you can research:

Colon Polyps and Colon Cancer

Virtual Colonoscopy


Medical Patient Modesty does not necessarily agree with everything in the above articles. Everyone should take time to research procedures and health issues before they consent to a procedure. We cannot give you medical advice about what you should do.

Procedures for ensuring a patient’s dignity and modesty vary greatly across medical facilities for colonoscopy. Some hospitals demand that you be fully nude with no colonoscopy shorts. A woman should be allowed to wear something to cover her chest for a colonoscopy. All medical facilities should provide patients with colonoscopy shorts that only expose their buttocks. You could also wear a pair of boxers backwards if the medical facility does not have colonoscopy shorts. The other issue is that prior to colonoscopy and then for a period of time after, some patients are heavily sedated leaving them unable to either advocate for themselves or recall what happened or who provided care. For many patients, this is quite disconcerting.

Before you consent to a colonoscopy, there are two principles that should guide your discussions with your providers: 1) communicate your all your wishes and concerns to everyone involved in your procedure—even if you think they are obvious and 2) get the agreements you make with your doctor and nursing department at the hospital in writing.

There are three domains around which you should have careful conversations and record all your agreements.

Modesty Concerns

There is no getting around the fact that you will be exposed to some people for the procedure. It is the job of doctors and their assistants to make you feel as comfortable as possible. In that effort, they are likely to either skip over details of what they will be doing, or they will try to make it sound as clinical as possible. The basic truth is if you as a woman are not allowed to wear a gown and/or bra, your breasts will be exposed. If you are not allowed to wear colonoscopy shorts, your genitals will be exposed. Your buttocks and anus are always exposed for a colonoscopy. In some patients with colonoscopy shorts, some parts of the genitals still could be exposed. Keep in mind that sometimes colonoscopy shorts will tear.

If you are uncomfortable with intimate opposite sex medical care, you definitely will need to take actions to ensure that your wishes for an all same gender medical team be honored.

People Who Will Be Involved in Your Medical Care

Patients rarely consider the fact that there are a number of people in and out during colonoscopy. Your doctor will have an assistant to help with the procedure. Generally the doctor selects his/her assistant. The hospital will assign several medical personnel for the colonoscopy including nurses, anesthesiologist or nurse anesthetist (if you require anesthesia or propofol), and at least one nurse. You should be aware that nurses can take breaks in the middle of colonoscopies. When this happens, a team comes in to relieve them. This means that they could bring in opposite sex nurses to replace the same gender nurses during their breaks.

Some hospitals allow medical students to participate in procedures including colonoscopy. Keep in mind that some hospitals especially teaching hospitals still allow medical students to practice genital, pelvic, and rectal exams on surgery patients without their consent. See more information on non-consensual genital and pelvic exams.

Questions you might consider are:

1) Who is going to assist the doctor? Do not assume you know this. A doctor will often have someone in her office that does most of the procedures with her. If that person is unavailable, the doctor will call someone else and usually not bother to tell you unless you ask. If you want to have an all-female team, you must tell her that you only accept a female assistant.

2) Please list all nurses and other medical personnel that will be involved in my colonoscopy.

3) Who will be the anesthesiologist if it is required?

4) Is there any chance that medical students will be present? If so, what role will they play?

5) Can someone such as my husband, friend, or family member be present with me for the surgery?

6) Is there any chance that someone else such as an equipment representative, hospital quality assurance person or medical device representative will be present for the colonoscopy? If so, you may refuse consent for such people.

7) Is there any chance that any of the nurses could take breaks during my surgery and be replaced with other nurses?

8) Where will my colonoscopy take place?

Drugs

This is the area that perhaps is the most ignored by patients. Many patients genuinely do not want to know what is happening and want to be sedated for as long as possible—that is absolutely their right. However, if you wish to be aware of what is happening, you need to make your wishes clear to your doctor and thoroughly ask your anesthesiologist or nurse anesthetist about his/her plan.

First of all, be aware that “awake” to a doctor is different than “awake” to a layperson. Patients are often given Versed or other sedatives prior to colonoscopy to alleviate stress and help you to relax. While Versed is an anti-anxiety medication, it also has a powerful amnesia effect. It can have other lasting effects, including effects on behavior and memory for months or years afterwards. Versed is also known as a date-rape drug. It is used to make a person compliant and induces conscious sedation. It is used to make a person compliant and induces conscious sedation. It causes a person to not remember. It's a dangerous drug which is not in the best interest of patients. Many patients will not be able to remember anything while under its influence. If you’re given Versed prior to your colonoscopy, you will likely not remember who is in the room.

You should not consent to Versed because you are no longer able to advocate for yourself once you are given Versed because it causes you to have a powerful amnesia effect. Versed gives medical personnel the opportunities to do many things without your consent. Versed also legally invalidates any patient testimony regarding their treatment.

There is no reason for you to be given Versed. You should write on your consent form that you do not give consent for Versed to be administered at all. There may be other benzodiazepines that can substitute for Versed. Also, Versed is a brand name for Midazolam. If somebody just refuses “Versed”, they can still give them the generic. To play it safe, mention that you do not consent to Versed, Midazolam, or any other benzodiazepine.

All three of these areas are vital to your care and your concerns about modesty. Remember that a conversation is not enough. Once you have come to an agreement with your doctor about the issues above, you need to be sure that you write those directives on your consent form.

Versed is commonly used for colonoscopy. Many patients who had colonoscopy with Versed still experienced a lot of pain. The best options for managing pain in colonoscopy patients who want to be awake are:

1) Fentanyl, (a pain medication) and Demerol (also a pain medication) this combination has been used in cases for pain control but where the patient will remain aware and be able to view the colonoscopy monitor and/or converse with the doctor during the procedure.

2) Fentanyl and Valium – A combination of Fentanyl and Valium during the procedure often allows the patient to converse with the physician during the exam. One patient shared that experience with having Fentanyl and Valium used during his procedure allowed him to converse with the doctor after the exam and could remember the conversation. He recovered quickly and was able to leave the hospital much sooner than those given other types of sedation. He was also not groggy during the day and even went dancing later that night!

An option for patients who would like to be totally asleep during the procedure is Propofol. The disadvantage is that you will not be able to know what is going on during your colonoscopy. You should only consider this route if you have an advocate not employed by the medical facility present for your colonoscopy.

Propofol is an actual anesthesia agent, fast acting, so you won’t remember the procedure but will wake up quickly, aren’t sedated or nauseated for long periods of time, can be discharged generally within 30 minutes and many patients report feeling like they’ve had a power nap. Patients report great satisfaction with propofol and it is used generally for the following reasons: 1) It is fast acting, and short acting, which means once you are given the drug it takes affect right away, but when you wake up there are generally no long term affects like with some of the other sedation type drugs. Patients can return to activities requiring clear headedness and being aware unlike some of the other combinations in which you may be feeling ‘drugged’ for hours. Patients report less nausea with propofol than with other combinations of medications. After the procedure you will be awake and alert and able to remember your conversation with the gastroenterologist, unlike with some other combinations like Versed where you may have a conversation with your physician but will probably not remember it. Disadvantage is that propofol requires a CRNA or Anesthesiologist to administer the drug to ensure your airway and respirations are maintained during the procedure. Propofol is not a good choice if you would like to remain aware and alert and/or watch the procedure on a monitor. Cost can be an issue with propofol because some insurance companies are not reimbursing for the use of propofol.

You can consider no sedation for traditional colonoscopy. Check out One Man’s Sedation-Free Colonoscopy and Benefits of sedation-free colonoscopy.You will need to discuss issues about pain relief and sedation with your doctor.

All three of these areas are vital to your care and your concerns about modesty. Remember that a conversation is not enough. Once you have come to an agreement with your doctor about the issues above, you need to be sure that you write those directives on your consent form.

Important Tips For Patients Concerned About Modesty During Colonoscopy:

1) You should write a list of expectations that you and your doctor sign. Make several copies of the list. Then when you sign your hospital consent forms and any other form you are asked to sign, note by your signature that you have a list of expectations that are attached and have the person witnessing your signature initial that note.

Your list of expectations should be clear and direct. For example:

• I withhold consent for Versed or any sedation.
  
• Women - I withhold consent for any male medical personnel or medical students being present during my procedure or observing my procedure. If my wishes cannot be accommodated for an all-female team, the colonoscopy must be cancelled or postponed
  
  
• Men - I withhold consent for any female medical personnel or medical students being present during my procedure or observing my procedure. If my wishes cannot be accommodated for an all-male team, the colonoscopy must be cancelled or postponed.
  
  
• I withhold consent for a urinary catheter.
  
  
• My colonoscopy shorts or boxer shorts (if they are worn backwards) and gown may not be removed.
  

2) Try to get all consent forms prior to the day of surgery and read them carefully. Write in any changes or requests

2) Try to get all consent forms prior to the day of colonoscopy and read them carefully. Write in any changes or requests

3) Visit the medical facility you will be having the colonoscopy at and ask to speak to the nursing supervisor and/or manager. Discuss your wishes about who you want to be present.

4) Insist that they do not give you an IV until you have been prepped for colonoscopy.

5) It is prudent to have an advocate not employed by the hospital such as your spouse present the whole time for the procedure to make sure that your wishes are honored. This is the only way you can have a guarantee that your wishes will be honored. Remember that someone else could come in middle of your procedure including a sales representative, a janitor, or other nurses. Check out Why You Should Have a Personal Advocate For Surgery?

6) Walk out and cancel the colonoscopy if you see that your wishes will not be honored for an all-same medical team or other requests. Patients need to stand up to show medical professionals that they are not willing to compromise.

7) Find another doctor if she/he is not willing to work to accommodate your wishes.

8) Find another medical facility if they are not willing to work to accommodate your wishes.

Other Related Articles:

Do Chaperones Really Protect Patients?

What You Should Know About Sedation and Versed?

How One Woman Avoided an Unnecessary Colonoscopy

Sources:

Benefits of sedation-free colonoscopy

Colonoscopy without sedation: Patient factors alone are less likely to influence its uptake

Is Colonoscopy Your Best Bet to Avoid Colorectal Cancer?