What to Expect at Your First Colonoscopy

March 18, 2026

Colorectal cancer is a rising cause of death in the United States, but early detection can make a big difference in treatment and prevention.  

For most people, doctors recommend starting regular screenings at age 45. If you have a family or personal history of colorectal cancer, certain types of polyps, or inflammatory bowel diseases like Crohn’s or Ulcerative Colitis, you may need to start screenings earlier or more often. 

“Colonoscopies are the most accurate and effective screening procedure for colorectal cancer,” WVU Medicine Gastroenterologist Dr. Vishal Gupta said. “Additionally, we are able to not only detect but also remove clumps of precancerous cells called polyps.” 

Despite the benefits, many people are nervous about that first colonoscopy. 

“Technology has come a long way, and colonoscopies today are safe, minimally invasive, and painless,” Dr. Gupta said.  

If you’re getting close to screening age or your doctor has recommended a colonoscopy, here’s what to expect before, during, and after the procedure.  

Before Your Colonoscopy 

“Before a patient has a colonoscopy, we have to make sure the colon and rectum are clean and clear so we can get an accurate image and results,” Dr. Gupta said. “We’ll prescribe a bowel prep laxative and recommend diet and sometimes medication changes in the days leading up to the test.” 

As you prepare for your first colonoscopy, you should plan to: 

  • Eat a lower fiber diet, avoiding whole grains, raw fruits and vegetables, nuts, and beans, in the days leading up to the test.
  • Eat only a clear liquid diet with no solid food the day before the test.
  • Take the bowel prep laxative and stop eating or drinking the night before your procedure, per your doctor’s instructions.
  • Make transportation arrangements early to make sure you can get to and from your appointment safely. 

During Your Colonoscopy 

Colonoscopies are often outpatient procedures that take about a half an hour to complete.  

“You’ll lie on your side while we perform the procedure,” Dr. Gupta said. “Colonoscopies are not painful, as we use sedation.” 

Here’s what to expect during the procedure:  

  • Your doctor will insert a small fiberoptic colonoscope into the rectum and then add air for a clearer exam.
  • If doctors locate a small polyp, they typically remove it to be checked for cancer.  
  • Samples of larger polyps, tumors, or other abnormalities found will be collected for further examination.
  • At the end of the procedure, your doctor will carefully pull the colonoscope back out of the rectum. 

After Your Colonoscopy 

Your care team will monitor you for any complications for about half an hour after your colonoscopy. You may feel minor bloating, gas pains, and cramping from the air used during the procedure, but these are normal and typically brief.  

You’ll be able to go home within a half hour, and your providers will give you instructions about diet, when to start taking medicines again, and possible signs of complications. 

Your doctor will go over your results with you before you go home, providing you with a written report and photographs. 

"A negative result is actually a good thing – it means we didn’t find any abnormalities, and you’re all clear,” Dr. Gupta said. “A positive result means we found polyps or some other issues. Polyps can often be benign, so this just means we’ll need to analyze your results further and go from there.” 

 If we take any biopsies or samples, a follow-up will be needed to go over the results and figure out any next steps. This may be over the phone or in-person depending on results. 

“Overall, a colonoscopy is a safe and effective procedure that can have a lifesaving impact,” Dr. Gupta said. “Our goal is to answer your questions and make you as comfortable as possible.” 

Berkeley Medical Center is one of America’s 100 Best Hospitals for both Gastrointestinal Care and Gastrointestinal Surgery, providing cutting-edge and patient-centered care to the Eastern Panhandle.  

Learn more: Gastroenterology and Hepatology | WVU Medicine

 

 

Featured Expert

Dr. Vishal Gupta