Friday Q&A: Yoga After a Colonoscopy

Supported Reclined Cobbler's Pose (Supta Baddha Konasana)

Q: I have a question that may impact more than just a few of us baby boomers. I absolutely LOVE my yoga practice and am worried about how much I will be able to do after a routine colonoscopy scheduled later this month. After my last colonoscopy ten years ago, I experienced abdominal pain for several weeks. If that happens again, is it better for me to discontinue yoga until I feel better or are there just some poses I should avoid? Thanks for any advice you can give me.
A: Before diving into my recommendations for yoga practice after a colonoscopy, I thought it wise to talk about colonoscopy and what it entails. Knowing a bit more about this will allow you to get a better understanding of the typical effects of the procedure for most people. A colonoscopy is a specialized examination of the lower part of your digestive/elimination track, from the rectal opening at the pelvic floor, up through the “S” shaped sigmoid colon, up the left side of the colon proper (known as the descending colon), across the mid-portion of the colon (known as the transverse colon), and finally down the right side of the colon (known as the ascending colon). The colonoscope, a specialized device used for the colonoscopy, is tubular like a snake, a bit larger in diameter than a doctor’s stethoscope tubing, and long enough to make through the entire length of the colon. It is fitted with a camera at its tip, as well as an opening for threading a wire that has special tips on it to cut and retract tissue samples, and even to heat up tissue to stop bleeding. 
Colonoscopy was coming into its heyday when I was going through my medical school training in the early 1980s, and at that time it was recommended for anyone over 50 as a screening tool for colon cancer. Things have shifted since then as researchers have had more experience with the procedure and looking at who really benefits from such screenings. Now days, the colonoscopy procedure is less frequently used as a screening test, but some people will still have it recommended if they have a strong family history of colon cancer or microscopic blood detected on the home screening test most adults are asked to do annually after the age of 50. It is also used to diagnose persistent colon symptoms, especially pain, and abnormal bleeding.
Before the lining of the colon can be viewed successfully from start to finish, you have to clean out what normally hangs out in there! So, you will need to take liquid medication the day before the test to promote full emptying of your lower bowels. Occasionally, enemas are also needed to get things really cleaned out. The test is then done in an outpatient setting; after sedating you, the doctor will proceed to insert the device up into your colon. One problem still remains: the colon will simply collapse around the scope without something to keep it more open. So like blowing up a balloon—one of those long ones the clowns use to make hats for your kids—air will be blown slowly and carefully into your colon to stretch it out enough that a good view can be seen in all directions by your doc. And this is usually were patients will have a problem.
You see, you can touch the colon from the outside, as when having open surgery done, you can cut it with scalpel, or you can burn/cauterize bleeding blood vessels in the colon, and the colon will not register pain or discomfort. But if you distend the colon from the inside, as the doc is doing by introducing air into the colon, the colon will send messages of pain, discomfort, cramping, and distress to the brain, which you might experience after you’re out of anesthesia. Everyone’s tolerance for this is different, so some will not notice much and others will notice a lot.
If you have a lot of post-procedure symptoms like our reader, how should you approach your yoga practice? We know from studies on one particular kind of GI condition, irritable bowel syndrome (IBS—see Irritable Bowel Syndrome and Yoga), that yoga practices can have a beneficial effect on the gut function. A big part of this may be the stress-reducing effects of a regular asana, pranayama and meditation practice, but there could be more to it than that. It may be that in post-colonoscopy abdominal pain the gut’s unique nervous system, the enteric nervous system (see The Digestive System and Yoga), is triggered and on high alert, contributing to the persistent pain symptoms. Through the yoga practices that quiet the autonomic nervous system generally, you may also be able to bring the enteric nervous system back in to quiet balance, resulting in decrease in pain.
As for specifics, I’d recommend the following, which you could even start to do a week or so before your procedure, as well as afterwards:

1. Focus on gentle, quiet yoga sessions until the pain resolves.
2. Keep deep forward bends, deep backbends, deep twists, and side bends to a minimum.
3. Practice supported poses that encourage a gentle expansiveness in the belly in a slightly upright position, which encourages stuff in the colon to move down and out, on a daily basis, if possible. These poses include Supported Reclined Cobbler’s pose (shown above), Supported Savasana (shown below), Supported Reclined Hero Pose (Supta Virasana), and Supported Reclined Seated Crossed Legs Pose (Supta Sukasana). In all these poses, make sure that your torso is propped up higher than your hips, and add a little support under your head as well.
4. Incorporate mindful breath awareness, relaxing breath techniques, such as 1:2 ratio inhalation/exhalation pranayama, and guided meditations with a focus on overall body and belly relaxation into your practice.
5. Add an easy walk for 15-20 minutes a day, in nature if possible, to your yoga as part of your stress management, as your belly pain permits.
6. Communicate regularly with your GI doctor about your progress and your use of yoga along with their recommendations for treatment of your abdominal pain.

A compassionate, gentle approach to your yoga practice will not only keep you practicing regularly during this potentially difficult period, but may also speed your recovery. If any of our readers have had beneficial experiences with this in the past, please let us hear your stories.

Supported Savasana

—Baxter
P.S. Check out my video of how to practice Supported Reclined Cobbler's Pose:

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