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Flexible sigmoidoscopy

Your doctor has recommended that you have a flexible sigmoidoscopy. This page tells you what to expect. Please ask staff any other questions you have.

What is flexible sigmoidoscopy?

Flexible sigmoidoscopy is a test that allows the doctor to examine your bowel from the anus to the descending colon with a small, flexible telescope.

Why am I having the procedure?

Your doctor may have referred you for a sigmoidoscopy in order to investigate some symptoms you have been having, such as a change in bowel habit, rectal bleeding; or to review a problem they may have found before, for example polyps or colitis. This will benefit you by providing a clear diagnosis. If you prefer not to be investigated, we advise you to discuss the implications with your doctor.

A flexible sigmoidoscopy is one of the simplest and safest methods to examine the lower part of the colon. Therefore, it is often the first test that the doctor requests. It may however be necessary to undertake further tests, such as a colonoscopy, barium enema, or a CT scan. If you wish, please discuss with your doctor which is the best test for you.

What preparation will I need?

You can eat and drink normally on the day of the test unless you choose to be sedated, in which case you should not eat or drink for 4 hours before the test. Shortly before your procedure, one of the nurses in the endoscopy unit will give you an enema. This is a liquid medicine that is given through your back passage. It works as a laxative that cleans the end of your bowel.

What should I bring on the day?

Please bring all your medication and a dressing gown.

What about my medications?

If you are taking iron tablets, please stop them 7 days before your test.
If you are taking anti-inflammatory tablets (such as neurofen, brufen or voltarol) please stop taking them 5 days before your test.
Do not stop taking aspirin, clopidogrel or warfarin but please make sure that you have discussed this with your referring doctor before the test. There is a significant risk that a coronary stent will block if these medicines are stopped within one month of stent placement; and a slightly increased risk within the first six months. If the referring doctor thinks it is in your best interests to stop taking them, they should be stopped 10 days before the procedure.
If you are a diabetic, continue your medication and eat normally.

What will happen to me on the day of the test?

Please book in with the endoscopy reception staff when you arrive. They check your personal details, such as your name and address. We try to ensure that all patients are seen and have their tests within a short period of time of arriving in the unit, but occasionally emergencies take precedence and you may need to wait. The reception staff will keep you informed in the event that this happens.
Next, the doctor (endoscopist) who will be doing the procedure talks you through the consent form and the potential complications. It is important for you to think about these in advance so when you sign the form you are comfortable that it is a test you really want. Remember, you can change your mind about having the test at any time. Please tell the doctor if you have heart valve disease or if you are normally given antibiotics when you visit the dentist.
One of the endoscopy nurses then sees you, asks you some further questions, checks you have taken your preparation correctly and answers any questions you may have. Then the nurse asks you to get changed into a gown and shows you into the endoscopy room.
Patients do not usually need to be sedated for this test. However, if a patient chooses to be sedated, the doctor or nurse puts a small needle into the back of their hand in order to give the sedative. This is not a general anaesthetic. Alternatively, short term pain-relief can be provided using an inhalation of Entonox™ (“laughing gas”), which is a mixture of nitrous oxide and oxygen (effects last for no more than 10 minutes).
The doctor inserts a thin flexible tube with a light on the end of it into your back passage. It is thinner than an index finger. Air is inserted into your bowel which may make you feel a little bloated. The tube is slowly moved up the left side of your colon whilst the doctor looks at the wall of the bowel. The test usually takes between 5 – 15 minutes.
During the test the doctor may take biopsies (tissue samples), photographs or video of your bowel, even if it all looks normal. There may be periods of discomfort as the tube goes around bends in the bowel. Usually these will ease once the bend has been passed. If you are finding the procedure more uncomfortable than you would like, please let the nurse know. In order to make the procedure easier you may be asked to change position (for example, to roll onto your back).
There will be a nurse with you throughout the procedure explaining what is happening, monitoring your vital signs, level of comfort and assisting the doctor.

What are the complications of flexible sigmoidoscopy?

Complications are extremely rare, but it is important that you know all the risks before you decide to go ahead with the test.

Minor complications

Some patients can experience abdominal discomfort or pain.

Major complications

There is a very small risk of making a hole in the bowel wall (a perforation) or causing bleeding. This occurs in approximately 1 in 15,000 examinations. A perforation usually requires an operation to repair it.
Using sedation can cause breathing complications in up to 1 in 200 procedures, which usually are not serious. To reduce this risk, we monitor your pulse and oxygen levels at all times throughout the test.
If you have severe pain, black tarry stools or persistent bleeding, you should contact your nearest A&E Department for further advice and also inform us.

What happens after the test?

You will be moved into the recovery area where a nurse will review you. If you have received no sedation, you may go home immediately after the procedure. You may feel a little discomfort due to the air inserted during the procedure – this is normal.

You must arrange for someone to escort you home if you have been given a sedative. Be aware that parking at the hospital is very limited. If no escort is available, please carry enough money to pay for a taxi. No escort is required if you are using hospital transport.
We strongly advise that you do not drink alcohol, operate machinery, drive or make important decisions for 24 hours after your procedure if you were sedated as sedatives can impair your judgement.
The endoscopist will be able to tell you the results after the procedure. If you had sedation, it is a good idea to have someone with you when this occurs because the sedation can make you forget what is discussed. If biopsies were taken or polyps removed, you will be told the final diagnosis by the team who requested the flexible sigmoidoscopy (in the clinic or by letter to you or your GP). These results may take one week to come through. Copies of your flexible-sigmoidoscopy report will be sent to your GP.

Any other questions?

Feel free to use the space below to write down any other questions you may have. No question is ever too minor or too silly to ask, so please ask any member of the team caring for you if there is anything you wish to know.
If you have any problem understanding or reading any of this information, please contact me on Dr.Harbord@hcahealthcare.co.uk or MarcusHarbord@btinternet.com