Online Resources for Flexible Sigmoidoscopy Clinic

Patient information: Flexible sigmoidoscopy

  INTRODUCTION

  INDICATIONS FOR FLEXIBLE SIGMOIDOSCOPY

  PREPARATION

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INTRODUCTION

If your doctor has determined that you should have a flexible sigmoidoscopy, you may have some questions and concerns about the procedure. This handout will provide information about flexible sigmoidoscopy and answers to questions that patients often ask.

Flexible sigmoidoscopy is a safe procedure that will give your doctor information other tests may not be able to provide. A flexible sigmoidoscopy is an examination of the lower (distal) part of the gastrointestinal tract, which is called the colon or large intestine (bowel), using a flexible tube that is approximately the size of your finger. It is performed by an endoscopist, a doctor or other health professional with special training in endoscopic procedures. The sigmoidoscope is inserted into the anus and advanced through the rectum, sigmoid colon, and descending colon. The procedure usually takes from five to fifteen minutes.

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INDICATIONS FOR FLEXIBLE SIGMOIDOSCOPY

The most common reasons for flexible sigmoidoscopy are to evaluate the following:

  • As a screening test in people over age fifty to detect colon polyps or colon cancer
  • Blood in the stool or rectal bleeding
  • Persistent diarrhea
  • After radiation treatment to the pelvis when a patient has lower gastrointestinal symptoms
  • Evaluation of the colon in conjunction with a barium enema
  • For the medical management of colitis (inflammation of the colon)

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PREPARATION

Your doctor will provide you with specific Instructions on how to prepare for the examination. The instructions are designed to maximize your safety during and after the examination, minimize possible complications, and provide the endoscopist with the best look at your colon.

It is important for you to read the instructions ahead of time and follow them carefully. Call your doctor or the endoscopy unit if you have questions.

Bowel cleaning — The lower part of your colon must be cleaned to permit the endoscopist to see the inside lining of your colon. Specific instruction will be given to you. Although the specific method used varies among endoscopy units, it usually involves consumption of a clear liquid diet, laxatives, and the administration of enemas shortly before the examination. As an example, one regimen involves restricting solid food for at least one day before the procedure. Patients are allowed to drink only clear liquids, such as juices without pulp, bouillon, ginger ale, etc, and eat only clear Jello. Patients are given instruction on taking laxatives the day before the procedure, and an enema the day before and the day of the procedure to clear the area of any residual stool.

Medications — Some medications, such as aspirin products and iron preparations, should be discontinued for one to two weeks before the examination. Aspirin makes you more likely to bleed, while iron coats the colon, making it difficult to see the lining. If you take a blood thinning medication, consult with your doctor as to whether you should stop taking it. Most medications for high blood pressure, heart disease, lung disease, and seizure disorders are important and can be taken the day of the examination. Check with your doctor about medication for diabetes. Because you will not be eating normally, you may have to adjust your usual dose. If you take antibiotics before dental procedures, ask your doctor if you need them before flexible sigmoidoscopy.

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WHAT TO EXPECT IN THE ENDOSCOPY UNIT

Prior to the colonoscopy, a nurse will prepare you for the examination. The nurse will take a history to determine what you already know about the procedure and whether you understand why the examination is being done. Other questions that you should be prepared to answer include:

  • Have you taken the laxatives prescribed and followed the clear liquid diet?
  • What medications do you take?
  • Do you have any medical problems?
  • Do you have allergies to medicines or latex allergies?

The consent — A doctor will review the examination with you, including possible complications, and will ask you to sign a consent form (giving permission to perform the test). Feel free to ask any questions you may have about the examination.

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THE PROCEDURE

The flexible sigmoidoscopy will be performed with you lying on your left side with your legs in a curled position. The sigmoidoscope has a lens and a light source that permits the endoscopist to look into the scope or at a television monitor where it is magnified many times so the endoscopist can see minute changes in tissue.

The endoscope contains channels that allow the endoscopist to take biopsies (small pieces of tissue) and to introduce or withdraw fluid or air. Biopsies do not hurt; the lining of the colon does not have that type of pain sensation. However, you may experience some cramping as air is introduced through the scope and as the scope is passed through twisty segments of the colon. The air is needed to permit the endoscopist to advance the scope and see the lining of the colon. Do not be embarrassed about releasing the air through your rectum. Let the endoscopist know if you are are uncomfortable since air can also be removed through the scope. Because the procedure is so brief, and discomfort only mild, pain medications or sedation are not routinely used.

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COMPLICATIONS

Flexible sigmoidoscopy is a safe procedure and complications are rare, but can occur:

  • Bleeding can occur from biopsies or the removal of polyps, but it is usually minimal and stops quickly or can be controlled.
  • The scope can cause a tear or hole in the tissue being examined, which is a serious problem, but, fortunately, very uncommon.

The following symptoms should be reported immediately:

  • Severe abdominal pain (not just gas cramps)
  • A firm, distended abdomen
  • Vomiting
  • Fever
  • Bleeding greater than a few tablespoons

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AFTER FLEXIBLE SIGMOIDOSCOPY

Although patients worry about discomforts of the examination, most people tolerate it very well and feel fine afterwards. You should be able to return to normal activities after the examination. Unless you are given other instructions, you should also be able to eat as usual after the examination.

You should contact your doctor about the results of your test if you have any questions and especially if biopsies were taken. The endoscopy team can give you some guidelines as to when your doctor should have all the results and whether further treatment will be necessary.

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WHERE TO GET MORE INFORMATION

The discussion above is available on the internet in the Patient Resource Center at UpToDate's home page (www.UpToDate.com) where it will be updated as needed every four months.

Additional information about this procedure can be found at these websites:

  • National Library of Medicine
   (http://www.nlm.nih.gov/medlineplus)

  • The American Society of Gastrointestinal Endoscopy:
   (http://www.asge.org)

Visit the UpToDate home page.