Dr. Adam Hafemeister of Austin Gastroenterology outlines some of the reasons why someone might need to have a colonoscopy prior to age 50, as recommended by the American College of Gastroenterology. If a person has a family history of colon cancer, or even colon polyps, screening should typically begin at age 45. Other reasons a colonoscopy might be needed is when a person is experiencing an unexplained change in bowel habits (constipation and/or diarrhea), blood in the stool or black stool, abdominal pain & bloating, unintentional weight loss.