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.


Read 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:

A Dietary Treatment for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don’t seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we’re trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There’s got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That’s where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I’ve talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There’s actually a way to harness the placebo effect without lying to patients, though. We tell them it’s a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked “placebo pills” “take 2 pills twice daily.” I kid you not.

Lo and behold, it worked! That’s how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won’t cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one’s bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don’t yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It’s never been tested, but one might assume it wouldn’t be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that “are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events.” Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer’s.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

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:

Deep Breathing Exercise for Nausea

Deep Breathing Exercise for Nausea

One of the most common fears patients express when facing surgery is postoperative nausea, which can range from minor queasiness to protracted periods of vomiting. Feeling sick to one’s stomach and throwing up after surgery is a common problem, affecting between a quarter and a half of those placed under general anesthesia, and more than half of those at high risk (women who don’t smoke and have a history of motion sickness).

I’ve explored the science behind treating nausea with ginger (see Natural Nausea Remedy Recipe), but if you’re too nauseous to eat, what do you do? Well, people are often sent home with anti-nausea rectal suppositories. Surveys, however, show that cultural and sexual attitudes may make a number of people sensitive to anything involving the rectum. Though the wording of the question researchers asked was, “are you happy to have a drug put in your back passage?” I can imagine many of the respondents thinking “well, maybe I wouldn’t so much mind, but wouldn’t exactly be happy about it,” especially when you’re feeling sick and throwing up.

For women who’ve had a C-section, they might not want to take drugs at all if they’re breastfeeding; so, researchers decided to put aromatherapy to the test. Research has shown that essential oils of both spearmint and peppermint are effective in reducing nausea and vomiting after chemotherapy, but this was after swallowing them.

Would just the smell of peppermint help with nausea? I explore this in my video Peppermint Aromatherapy for Nausea. Researchers had women take deep whiffs of peppermint extract (like you’d buy at a store) and it seemed to work. Eighty percent of the mint-sniffers felt better within just a few minutes, compared to no improvement in the placebo group who sniffed water with green food coloring, or the control group who didn’t sniff anything.

The study was criticized for being small and for not using pure peppermint oil. Peppermint extract is peppermint oil plus alcohol. Maybe it was the smell of alcohol that made people better? And, that’s actually not too much of a stretch. In 1997, researchers reported a simple, innocuous, and inexpensive treatment for postoperative nausea and vomiting—the smell of isopropyl alcohol, which is what is found in those alcohol wipes, the little prep pads that nurses swab you with before shots. They found that they could just effectively tear one open and wave it under someone’s nose and relieve nausea and vomiting in more than 80% of folks after surgery. It has since been shown to work as well as a leading anti-nausea drug, and may even work faster, cutting nausea in half within 10 to 15 minutes, rather than 20 or 25.

So, was it the alcohol, the peppermint, or both? Researchers decided to put it to the test. They instructed patients to take three slow, deep breaths, smelling alcohol, peppermint, or nothing. The smell of peppermint cut nausea in half within five minutes, and so did the alcohol. But, so did smelling nothing! So, maybe it had nothing to do with the scent; maybe it was just the instruction to take slow, deep breaths. That would make it a really cost-effective intervention. Maybe it shouldn’t be so surprising, given the proximity of the vomiting and breathing centers within the brain.

And indeed, controlled breathing was found effective with or without any scent. So, next time you feel nauseous, inhale deeply through your nose to the count of three, hold your breath to the count of three, and exhale out the mouth to the count of three. Do that three times.

Ironically, the researchers continued to advocate using those nasty smelling alcohol pads even though they themselves showed they weren’t any more effective than breathing alone. Why? Since isopropyl alcohol has a readily detectable odor, patients are more likely to think that their post-operation nausea and vomiting is being actively treated when they inhale alcohol vapors rather than just engaging in breathing exercises.


What do you think of still using the alcohol pads even though they were shown to offer no additional benefit? I have a whole video on such questions: The Lie That Heals: Should Doctors Give Placebos?

For those who can swallow, I offer more about powdered ginger in my video Dangerous Advice From Health Food Store Employees.

There’s more on aromatherapy here:

What about actually eating the peppermint? 

Of course, the best way to avoid postsurgical nausea is to try to avoid surgery in the first place. Those that eat healthy may be less likely to go under the knife. See Say No to Drugs by Saying Yes to More Plants.

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: