Flexible sigmoidoscopy

Flexible sigmoidoscopy enables the physician to look at the inside of the large intestine from
the rectum through the last part of the colon, called the sigmoid. Physicians may use the
procedure to find the cause of diarrhea, abdominal pain, or constipation. They also use it to
look for benign and malignant polyps, as well as early signs of cancer in the descending colon
and rectum. With flexible sigmoidoscopy, the physician can see intestinal
bleeding, inflammation, abnormal growths, and ulcers in the descending colon and rectum.
Flexible sigmoidoscopy is not sufficient to detect polyps or cancer in the ascending or
transverse colon (two-thirds of the colon). However, although in absolute terms only a
relatively small section of the large intestine can be examined using sigmoidoscopy, the sites
which can be observed represent areas which are most frequently affected by diseases such
as colorectal cancer, for example the rectum.

For the procedure, the patient must lie on his or her left side on the examining table. The
physician inserts a short, flexible, lit tube into the rectum and slowly guides it into the colon.
The tube is called a sigmoidoscope. The scope transmits an image of the inside of the rectum
and colon, so the physician can carefully examine the lining of these organs. The scope also
blows air into these organs, which inflates them and helps the physician see better.

If anything unusual is in the rectum or colon, like a polyp or inflamed tissue, the physician can
remove a piece of it using instruments inserted into the scope. The physician will send that
piece of tissue (biopsy) to the lab for testing.

Bleeding and puncture of the colon are possible complications of sigmoidoscopy. However,
such complications are uncommon.

Flexible sigmoidoscopy takes 10 to 20 minutes. During the procedure, the patient might feel
pressure and slight cramping in the lower abdomen, but he or she will feel better afterward
when the air leaves the colon.

Preparation
The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough
and safe, thus the patient must drink only clear liquids for 12 to 24 hours beforehand. This
includes bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soft
drinks. The night before or right before the procedure, the patient receives a laxative and
an enema, which is a liquid solution that washes out the intestines.

No sedation is required during this procedure as long as the examination does not exceed the
level of the splenic flexure.

Rigid sigmoidoscopy
Rigid sigmoidoscopy no longer has the value it had in the past, before the advent of
videocolonoscopy (flexible sigmoidoscopy). However, it may be still useful in ano-rectal
diseases such as bleeding per rectum or inflammatory rectal disease, particularly in the
general practice and pediatrics.

For performing the examination, the patient must lie on the left side, in the so called Sim's
position. The bowels are previously emptied with a suppository and a digital rectal
examination is first performed. The sigmoidoscope is lubricated and inserted with obturator in
general direction of the navel. The direction is then changed and the obturaror is removed so
that the physician may penetrate further with direct vision. A bellows is used to insufflate air to
distend the rectum. Lateral movements of the sigmoidoscope's tip negotiate the Houston
valve and the recto-sigmoid junction.

Risks
Although generally considered quite safe, sigmoidoscopy does carry the very rare possibility
of tearing of the intestinal wall by the instrument, which would require immediate surgery to
repair the tear; in addition, removal of a polyp may sometimes lead to localized bleeding
which is resistant to cauterization by the instrument and must be stopped by surgical
intervention.
Sigmoidoscopy Introduction
Sigmoidoscopy is a procedure in which a doctor looks in your large intestine. A length of
flexible tube connected to a fiberoptic camera is used. A light is transmitted through the scope
to the tip by a bundle of light fibers. The doctor uses this light to look at your intestine through
an eyepiece or video screen.

• Your doctor may do this very safe procedure for several reasons.

o Sigmoidoscopy is the best way to diagnose colon cancer—the second most

common cause of cancer death in the United States.

o This procedure may also be used to help investigate problems such as

bleeding, abdominal pain, or diarrhea.

• Three findings are possible from this procedure.

o You are healthy, and no other studies are needed. (Even though the
sigmoidoscopy is the most important technique in the evaluation of colon cancer, a very
small percentage of people with normal sigmoidoscopy findings may later be found to
have colon cancer.)

o A diagnosis of your particular disease is made.

o You may need additional testing, consultation, therapy, or follow-up.

• Several leading medical groups recommend routine screening of men and women
aged 50 years and older for colon cancer and benign (harmless) polyps every 3-5 years.
Younger people may require this procedure if they have close relatives with colon cancer.

• A similar screening procedure is known as a colonoscopy. The basic difference is

that the tube goes farther up the colon with a colonoscopy.

Risks
The risks of the procedure include damage to the colon by the tube, bleeding, abdominalpain,
and infection.

Sigmoidoscopy Preparation
Sigmoidoscopy is well tolerated by the vast majority of people. This procedure is usually done
in a doctor's office without the need for any anesthesia or sedation.

• Your doctor may require you to use a strong laxative (called a bowel cleanser) to
clear your bowel of fecal contents before sigmoidoscopy. Several medications are
available for bowel cleansing, includingpolyethylene glycol 3350 (GoLYTELY,
NuLYTELY), magnesium citrate, (Citroma), and senna (X-Prep). These medications
produce diarrhea, which can be uncomfortable, but unless the bowel is empty of stool, the
test can be limited and may need to be repeated at a later date. Your doctor may also
 require a special diet, such as a clear liquid diet, starting 1-2 days before your scheduled
sigmoidoscopy.

• Some people also need to use an enema (liquid is forced into the colon through
the anus) before bedtime.

• The next day, you may take your normal medications.

• About 1 hour before the procedure is to begin, you will need to have an enema. The
clear diet and enema help clear the intestine so your doctor can see well.

During the Procedure

• The doctor will have you lie down on your left side with your knees bent and pulled
up slightly toward your head.
• The doctor will examine your rectum first with a finger lubricated with special jelly.
The tip of the scope is then lubricated with the same jelly and slowly inserted into your
rectum.
• The doctor will slowly advance the tube through your lower intestine. In order to help
the doctor see, a small amount of air and water may be placed in the intestine through the
end of the scope. If the doctor encounters a suspicious area of intestine, he or she may
remove a small piece of the tissue for analysis. This is done with the same scope and is
known as a biopsy.
• The doctor will end the procedure and tell you the outcome of your study.

After the Procedure

After the procedure, you may experience mild abdominal cramping and gas as a result of the
air that was placed in your intestine. Some people may have slight rectal bleeding due to
minor irritation and trauma from the insertion of the sigmoidoscope.
Sigmoidoscopy is an internal examination of the lower large bowel (colon) and rectum, using
an instrument called a sigmoidoscope.

How the Test is Performed

During the test, you are positioned on your left side with your knees drawn up toward your
chest. A gastroenterologist or surgeon will perform the test. First, the doctor does a digital
rectal exam by gently inserting a gloved and lubricated finger into the rectum to check for
blockage and to dilate (gently enlarge) the anus.

Next, the sigmoidoscope -- a hollow tube through which the doctor can see-- is inserted into
the rectum. Air is introduced into the colon to expand the area and help the doctor see better.
The air may cause the urge to have a bowel movement.

The sigmoidoscope is advanced, usually as far up as the sigmoid colon or descending colon.
Then, as the scope is slowly removed, the lining of the bowel is carefully examined. The
hollow channel in the center of the scope allows for the passage of forceps for
taking biopsies or for other instruments for therapy.

Sigmoidoscopy may be done using a rigid or flexible scope. Ask your doctor which procedure
you are having.

How to Prepare for the Test

You must sign an informed consent form. You will wear a hospital gown.

On the morning of the procedure, eat a light breakfast and then use a cleansing enema about
1 hour before the sigmoidoscopy.

Infants and children:

The preparation you can provide for this test depends on your child's age, previous
experiences, and level of trust. For general information regarding how you can prepare your
child, see the following topics:

• Infant test or procedure preparation (birth to 1 year)

• Toddler test or procedure preparation (1 to 3 years)
• Preschooler test or procedure preparation (3 to 6 years)
• School age test or procedure preparation (6 to 12 years)
• Adolescent test or procedure preparation (12 to 18 years)

How the Test Will Feel

There will be pressure when the scope or fingers are introduced into your rectum. There may
be a feeling of the need to have a bowel movement during the procedure. There may be
some bloating or cramping caused by the air or by stretching of the bowel by the
sigmoidoscope. Biopsies cause no discomfort.

After the test, you will expel the air that was introduced.

Why the Test is Performed

This test can help diagnose:

 • Bowel obstruction
• Causes of diarrhea
• Colon polyps
• Diverticulosis (the presence of abnormal pouches on the lining of the intestines)
• Inflammatory bowel disease

This test can also be used to:

• Determine the cause of blood, mucus, or pus in the stool

• Confirm findings of another test or x-rays
• Take a biopsy of a growth
• To screen for colorectal cancer

Normal Results

Normal findings show that the lining of the sigmoid colon, rectal mucosa, rectum, and anus
appear normal in color, texture, and size.

What Abnormal Results Mean

Abnormal results can indicate:

• Anal fissures
• Anorectal abscess
• Bowel obstruction
• Cancer
• Colorectal polyps
• Diverticulosis
• Hemorrhoids
• Inflammatory bowel disease
• Inflammation or infection (proctitis)

Risks

There is a slight risk of bowel perforation (tearing a hole) and bleeding at the biopsy sites (the
overall risk is approximately 1 in 1,000).