As we age, we know there are some things we should take care of to ensure our health, and that includes getting a colonoscopy. When do you really need one, though? Is it 40 or 45? Or earlier? Some factors come into play, such as your family history and your poop — regular (and normal-looking) bowel movements are typically a sign of good health. But if you’ve experienced gastrointestinal issues, such as constipation, or noticed blood in your stool, you might need a colonoscopy sooner than recommended.

“Typically, those 45 to 75 years of age should receive a colonoscopy screening regularly as the risk for colon cancer increases during this age frame,” Jessica Shepherd MD, Chief Medical Officer at Verywell Health, tells Scary Mommy. “Someone could get a colonoscopy before reaching age 45 if they’re experiencing unusual symptoms or have other gastrointestinal issues that require further examination by a colonoscopy. This can be anything from chronic constipation to rectal bleeding or obstruction.”

Getting a colonoscopy can seem scary, but it’s an important screening test for colorectal cancer that can save your life. Here’s what you need to know before you book your first one.

What is a colonoscopy?

“A colonoscopy is a medical procedure that can be used as a screening test for colorectal cancer or as a diagnostic test for people with digestive symptoms,” Dr. Folasade P. May, MD, Ph.D., MPhil, and co-leader of Stand Up To Cancer’s Colorectal Cancer Health Equity Dream Team, explains to Scary Mommy. “The procedure occurs at a medical facility with a doctor and involves a scope (camera with a light) that is inserted into your rectum to visually examine the colon and rectum. It allows the doctor to look for abnormalities of the digestive tract that may be causing symptoms.”

It also allows the doctor to look for and remove polyps, says May, which are small growths on the wall of the colon or rectum. “Polyps are not usually harmful, but a small proportion of them have the potential to progress into cancer,” she explains. “The reason why colorectal cancer screening works is that doctors can remove colon and rectal polyps before they have a chance to become cancer.”

May notes that there are other effective screening tests for colorectal cancer, including tests you can o in the comfort of your own home. “At-home screening tests involving collecting a small sample of your stool to check for non-visible blood and/or DNA that occurs with polyps or cancer,” she says. “If a person chooses to be screened with a test other than a colonoscopy, any abnormal test results must be followed up with a timely colonoscopy. Talk with your medical provider to determine which screening test is right for you.”

What is the right age when someone should get a colonoscopy?

According to May, your first colonoscopy should happen if you develop concerning digestive symptoms or when you reach screening age, whichever occurs first. The American Cancer Society, Stand Up To Cancer® (SU2C), and the U.S. Preventive Services Task Force recommend routine screening begins at 45 for individuals at average risk for colorectal cancer. However, says May, if there is a history of colorectal cancer in a first-degree family member (mother, father, sibling), she recommends screening at age 40 or 10 years before the age of the youngest family member diagnosed with the disease (whichever is earlier).

“For example, if a first-degree family member had a diagnosis of colorectal cancer at age 42, you should begin screening at age 32,” she says. “We screen people with a family history of colorectal cancer early because that family history may increase your risk of colorectal cancer.”

Additionally, your risk for colorectal cancer may increase if you have certain inherited genetic syndromes, May points out, such as Lynch syndrome and familial adenomatous polyposis or a personal history of chronic inflammatory bowel disease. She recommends speaking with your medical provider about the appropriate time to begin colorectal cancer screening if you have any of these risk factors.

Even though everyone should be screened for colorectal cancer, May points out millions of people in the United States are not getting screened as recommended. “Screening rates are lowest in medically underserved communities, and there are significant disparities in colorectal cancer as a result,” she says. “In the U.S., American Indians, Hispanic people, and Black people have lower screening rates than white people. Additionally, Black people suffer more cases and deaths from colorectal cancer than any other racial or ethnic group in the U.S.”

May says many organizations, including SU2C, are working towards improving colorectal cancer screening in medically underserved communities. For example, SU2C Colorectal Cancer Health Equity Dream Team, which she co-leads, is establishing and implementing comprehensive at-home stool-based colorectal cancer screening programs in three SU2C Zones with low screening rates: Boston, Los Angeles, and Great Plains Tribal Communities in South Dakota.

Screening should occur until age 75, says May. “For people 76 to 85 years old, you and your medical provider should decide whether to be screened based on previous screening history, life expectancy, overall physical health, and personal preference,” she explains. “Screening stops after you reach 85 years old.”

Signs You Need a Colonoscopy

Aside from being in the age range for screenings, there are other factors you should pay attention to that may need to be examined via colonoscopy. Both May and Shepherd recommend reaching out to your doctor if you experience the following:

• Sudden changes to your bowel movements.
• Rectal bleeding.
• Chronic constipation or abdominal pain.
• Weakness and chronic fatigue.
• Unintended weight loss.
• Low iron levels.

What to Do Before Your First Colonoscopy

If you’re nervous before your first colonoscopy, Shepherd says that’s perfectly normal. She advises speaking with your doctor and asking them any questions so that you’re fully informed and prepared for the day of the procedure.

“Don’t be afraid to ask anything or bring up concerns you have; that’s what doctors are here for,” she says. “Being nervous before the procedure is normal but know that it’s over pretty quickly, and you can return to your normal routine within a few hours after.”

May adds, “Just do it! Screening for colorectal cancer is essential, so the key is to just get it done. If your colonoscopy reveals an abnormality, you will have the best chance of health in the future if it is found early. If your colonoscopy is normal, you will not need another one for 10 years.”