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What is Flexible Sigmoidoscopy?

Flexible sigmoidoscopy is an examination of the lower part of your large bowel using a flexible camera.

The flexible sigmoidoscope is a special camera, which can examine the left side of the bowel and only takes about 5-15 minutes. It provides a lot of information about the left side of your large bowel.

Why has sigmoidoscopy been arranged for me?

You will have seen your specialist, with concerns about your bowels. This may have been a little bleeding, or your bowel habit has changed and does not seem to be returning back to normal. You may have tummy pains/ aches. Your specialist has asked for this examination as part of his/her investigations into the cause of your symptoms.

Do I really need flexible sigmoidoscopy?

This examination has been arranged to have a look at the lining of the large bowel. It provides the opportunity to take samples of tissue called biopsies if the endoscopist thinks the bowel lining does not look normal. This does not mean there is a serious problem, they just want to know if it is normal or not.

Sometimes small benign (not cancer) growths are found during flexible sigmoidoscopy. These are called polyps. These are generally removed there and then. We do know that some polyps, if left for some years, have the potential to change into cancers (especially large ones).

The benefits of this examination are that it is quick, examines the part of the large bowel where most bowel problems occur and that biopsies and polyps can be removed at the same time. Most people can carry on with their day or return to work, after this examination.

It does have its limitations in that it only examines one half of the large bowel. A normal result does not necessarily mean that there is no problem with the large bowel. Therefore, this examination may be part of a series of investigations.

Are there any alternatives to flexible sigmoidoscopy?

Yes. There are special x-rays, which can be done. These x-rays can tell us if the bowel looks normal or not, but they cannot always tells us what the problem is. If there is a problem, then we will need to be able to take biopsies. This is not possible with x-rays.

A shorter camera called a rigid sigmoidoscope can be used. In fact, you may have already had this done in the clinic. As the name suggests, it is straight and does not bend. It does see the first part of the large bowel called the rectum, but no further. Biopsies can be taken, but if polyps are found then generally further camera tests are needed to deal with them.

How do I prepare for this examination?

You will be sent information before the procedure or the doctor will tell you about the procedure. Share the information, if you wish, with your partner and family so that they can be of help and support. There may be information they need to know.

To be able to see the lower part of the large bowel, this part will need to be free of faeces/ stools. Depending on why the flexible sigmoidoscopy is being done, this will either be an enema or a strong laxative, in the form of a drink.

If you have any special needs, disabilities or personal reasons for not being able to give your enema please contact your doctor; so that alternative arrangements can be made.

I take tablets; do I still take them on the day?

Yes, please take all your tablets as normal. This is especially important if you have heart or chest problems.

If you take iron or warfarin tablets, please let your Doctor know, special arrangements are sometimes needed.

If you have had an operation on your heart or arteries which involves the use of an artificial part such has a heart valve or graft, please tell your doctor.

In these cases antibiotics (one or two doses) are given intravenously before the sigmoidoscopy and an antibiotic to take by mouth, a few hours after the examination, may be given to you.

If you are allergic to any antibiotics, let the Doctor know!

What happens to me during the procedure?

 You will need to remove your lower clothing and a place to do this will be provided, ensuring your privacy. You will be asked questions about your general health.

 Your blood pressure, pulse and oxygen levels will be checked before your sigmoidoscopy. Your endoscopist (the person doing the examination) will discuss the examination with you and discuss any information or questions you or your family member has. You will then be asked to read and sign your consent form.

You are then taken through to the examination room and asked to lie on your left side on the examination trolley. Your belongings will be put in a plastic bag and will be with you all the time.

Once on the examination trolley you will be asked and helped to lie on your left side with your knees tucked up as close as you can get, to your chest. This will help the camera get past the first few bends.

You can watch the examination on the TV screen if you wish. Do not hesitate to ask questions during the examination.

How will I feel? Will it be painful?

To help get around the bowel; air is gently passed into the bowel though special channels within the camera. To help the camera around the bowel, the endoscopist will examine your bottom first with a finger. This allows the endoscopist to feel the first few centimeters of the bowel. This part is sometimes not seen by the camera.

Air opens up the bowel so that the endoscopist can see where he/she is going. This will cause the bowel to stretch. You will experience a variety of feelings!

The first is usually a feeling of wanting to go to the toilet. You will be convinced you need the toilet. Please do not worry; you will not make a mess! It is just the stretching of the bowel and usually settles down as the camera travels further into the bowel.

However, bloatedness and sometimes a tightening of the tummy muscles often replace this feeling. This varies from person to person. It can catch you by surprise. Instinct tells you to hold your breath until it passes. Please try not to. Breathe normally and steadily. The feeling does not last very long and disappears once the examination is finished.

If it gets uncomfortable let the endoscopist know. The team can stop, remove some air and then carry on to finish. Most people find this works and are able to tolerate the examination until it is finished.

Some people do not tolerate this test very well due to a variety of reasons. The test may be too painful. You do have the right to withdraw your consent at any time. If you wish to stop, tell the team and the examination will be stopped.

Sometimes because of the importance of the examination, the endoscopist will stop and discuss your decision with you. If you still wish not to proceed then your wishes will be respected.

How long will the examination take?

Usually this examination takes about 5-15 minutes. The shape of the bowel varies from person to person and for some it can be difficult to get round. If this is the case, it may take longer.

Samples of tissue may be needed or a polyp removed, again this can prolong the examination.

When do I get to find out the result of my examination?

As soon as it is finished. You will be told what has been found, if any biopsies/polyps have been taken and what happens next. Sometimes further tests are needed or follow up with your specialist will be arranged.

Sometimes if the examination is normal, no other investigations are needed and you may be discharged.

If you have any questions about what was found or future treatment, please do not hesitate to ask.

If biopsies and /or polyps are taken for analysis, the results of these will take up to 4 weeks to come back. These results are usually discussed with you at your next clinic visit.

Does flexible sigmoidoscopy have any risks I should know about?

Yes, there are. Risk is meant here as the potential for complications to occur. It is important to say that serious complications during sigmoidoscopy are rare.

Complications can be described as minor (mild) or major (serious):

Minor complications:

These complications are common, expected, do not last for long and do not cause serious harm.

They include feeling bloated after the examination because of trapped wind, feeling faint and dizzy, cold sweats and occasionally feeling sick.

A close eye is kept on you in recovery and in the majority of patients these subside very quickly (15-20 minutes) or over the next 24 hours. After this time bloated ness is common and comes and goes. As long as you are passing wind and going to toilet, this will settle down.

There is a small risk of bleeding from the bottom after sigmoidoscopy. The entrance to your bottom, the anus, does have a very good blood supply and this is where piles are often found. The insertion of the camera can cause a little bleeding. This should only be ‘spotting’ on the toilet paper or drops in the toilet bowl. It may take a few days for this to subside.

Major complications:

These are complications, which can be serious, may lead to admission to hospital and sometimes an operation. On rare occasions these can be life threatening, especially in people with serious and/or unstable cardiovascular or lung problems.

It is important to stress major and serious complications are rare!

Complications, which can become serious and life threatening include:

Perforation of the bowel : a small tear may be made through the bowel wall. This can especially occur in thin, diseased bowel or when polyps are been removed. If it occurs you may begin to feel unwell, feel nauseous or vomit, your tummy may become hard, swollen and painful. You may feel hot and shivery. These symptoms can occur within minutes of the perforation or may slowly develop over days.

If you have any of these symptoms YOU MUST CONTACT the hospital, as soon as possible.

Bleeding: this can occur especially after the removal of polyps. Although great care is taken to ensure there is no sign of bleeding after a polyp is removed, the contraction of the bowel after sigmoidoscopy when getting rid of wind or when the bowels are next opened can cause the area where the polyp was to bleed.

You should expect a little bleeding, such as ‘spotting’ on the toilet paper or small drops in the toilet bowl. This usually subsides as already described. If bleeding begins to increase where large clots of blood are seen and / or you begin to feel unwell or faint, please contact your doctor immediately for advice and help.

Recent evidence puts the risk of bleeding and perforation between 1 in 1000 to 1 in 3000. This can be more common with the removal of large or difficult polyps.

Will I need this examination again?

For some, despite following instructions to the letter and taking the enema to empty the bowel, the view with the camera is poor. The endoscopist cannot be certain that the large bowel has been adequately seen. In these circumstances, a repeat enema is needed, and is usually done within the endoscopy unit at this visit. Sometimes larger amounts of bowel preparation are prescribed.

Sometimes it is the anatomy of the large bowel, which defeats the endoscopist. Sometimes people’s bowels have very difficult twists and turns that become too difficult for the endoscopist to get the camera through. Sometimes, it is too painful for the patient and he/she asks the endoscopist to stop. In these cases a barium enema x-ray may be needed to examine the large bowel. If you do need a repeat sigmoidoscopy do not worry. It is not because something serious has been found but usually for the reasons described above.

What do these words mean?

 

Biopsy-A sample of tissue is taken for analysis

Colon-This is the part of the large bowel above the rectum

Consent-This is the agreement between you and the endoscopist. You are agreeing to have investigations or treatment and that you understand the purpose , benefits, alternatives and risks. You and the endoscopists during this process usually sign a consent form.

Sigmoidoscopy-The examination of the inside of part of the large bowel using a long, flexible camera.

Perforation-A rare, but possible risk in which a hole or tear is made through the large bowel.

Polyp-A common, benign (not cancer) growth arising from the lining of the large bowel. They take some years to develop. Some polyps, depending on their size and type, have the potential to turn cancerous.

Polypectomy-The removal of a polyp usually performed at the same time as the sigmoidoscopy

Colonoscopy - This is an examination of the large bowel using a long, flexible tube called a colonoscope. The tube allows the colon to be viewed directly and for pictures of the lining and samples of the tissues to be taken.