Sigmoidoscopy (Flexible)

What is a sigmoidoscopy?

The doctor looks at the lining of the lower part of our large bowel to see if there are any growths or disease.

This is done by putting an instrument called a sigmoidoscope into your back passage (anus).
A sigmoidoscope is short flexible tube with a bright light and tiny camera attached. Pictures of the inside of our bowel can be seen on a video camera.

You will lie on your side or back while the doctor will slowly passes the sigmoidoscope along your large bowel to look at the inside lining. Some pressure, cramping or bloating might be felt during the procedure. Your doctor will examine the lining again as the sigmoidoscope is taken out.

The procedure itself usually takes anywhere from 5 to 10 minutes.

You should plan on two to three hours for waiting, preparation and recovery. This time also depends on whether you have had any sedation.

This procedure may or may not require a sedation anaesthetic.

Will there be any discomfort? Is any anaesthetic needed?

The procedure is a bit uncomfortable due to the air used to expand your bowel.
Rarely, a sedative injection may be given to make the procedure less unpleasant.

What is sedation?

Sedation is the use of drugs that give you a ‘sleep-like’ feeling. It makes you feel very relaxed during a procedure that may be otherwise unpleasant or painful.
You may remember some or little about what has occurred during the procedure.
Anaesthesia is generally very safe but every anaesthetic has a risk of side-effects and complications. Whilst these are usually temporary, some of them may cause long-term problems.

The risk to you will depend on:

• personal factors, such as whether you smoke or are overweight.
• whether you have any other illness such as asthma, diabetes, heart disease, kidney disease, high blood pressure or other serious medical conditions.

What are the risks of this specific procedure?

There are risks and complications with this procedure.
They include but are not limited to the following.

Common risks and complications include:

• Mild pain and discomfort in the abdomen for one or 2 days after the procedure. This usually settles with walking and moving around to get rid of the trapped air.

Uncommon risks and complications include:

• About 1 person in 500 will accidentally get a hole (perforation) to the bowel causing leakage of bowel contents into the abdomen. Surgery may be needed to repair the hole.
• Missed polyps, growths or bowel disease.
• Bleeding. The risk of bleeding when taking a biopsy sample is about 1 person in every 1000. If a polyp is removed this increases to about 1 person in every 100.

Rare risks and complications include:

• Bacteraemia (infection in the blood). This will need antibiotics.
• Death as a result of complications to this procedure is rare.

If sedation has been given extra risks include:

• Nausea and vomiting.
• Faintness or dizziness, especially when you start to move around.
• Headache
• Pain, redness or bruising at the sedation injection site (either in the hand or arm).
• Muscle aches and pains.
• Allergy to medications – mild to severe.
• “Dead arm” type feeling in any nerve, due to positioning with the procedure – usually temporary.
• An existing medical condition that may have getting worse.
• Anaphylaxis (severe allergy) to mediation given at the time of procedure.
• Heart and lung problems such as heart attack or vomit in the lungs causing pneumonia.
• Emergency treatment may be necessary.
• Stroke resulting in brain damage.

What are you responsibilities before having this procedure?

You are less at risk of problems if you do the following:

• Bring all your prescribed drugs, those drugs you buy over the counter, herbal remedies and supplements and show your doctor what you are taking. Tell your doctor about any allergies or side effects that you may have.
• Do not drink any alcohol and stop recreational drugs 24 hours before the procedure. If you have a drug habit, please tell your doctor.
  If you take Warfarin, Persantin, Clopidogrel (Plavix or Iscover), Asasantin or any other drug that is used to thin your blood ask your doctor if you should stop taking it before the procedure as it may affect your blood clotting.
• Do not stop taking them without asking your doctor

Tell your doctor if you have:

• had heart valve replacement surgery.
• received previous advice about taking antibiotics before a dental treatment or a surgical procedure.
  If so, you may also need antibiotics before a sigmoidoscopy.

Preparation for the procedure

Iron tablets need to be stopped at least one week before your procedure.
Before your sigmoidoscopy, your doctor/nurse will tell you what you can and cannot eat or drink.
They will also tell you what bowel cleansing routine (if any) you will use.

What if the doctor finds something wrong?

Your doctor may take a biopsy (a very small piece of the bowel lining) to be examined at Pathology.
Biopsies are used to identify many conditions even if cancer is not thought to be the problem.
If your sigmoidoscopy is being done to find sites of bleeding, your doctor may stop the bleeding
through the sigmoidoscope by

• Injecting drugs or
• Sealing off bleeding vessels with heat treatment

What if I don’t have the procedure?

Your symptoms may become worse and the doctor will not be able to give you the correct treatment without knowing the cause of your problems.

What can I expect after the procedure?

• If you were not sedated, you can get dressed and go home. If you were sedated, you will need to stay in the recovery area for up to an hour to rest.
  Your doctor will tell you when you can eat and drink.
• Most times this is straight after the procedure.
• You may have some cramping or bloating because of the air entering the bowel during the procedure. This should go away when you pass wind. Moving around helps this.
• You will be told what was found during the examination or you may need to come back to discuss the results, and to find out the results of any biopsies that may have been taken.

What are polyps and why are they removed?

Polyps are fleshy growths in the bowel lining and they can be as small as a tiny dot or up to several centimeters in size.
They are not usually cancer but can potentially grow into cancer over time. Taking polyps out is an important way of preventing bower cancer.
The doctor usually removes a polyp with a sigmoidoscope, using a wire loop to remove the polyp
From the bowel wall. An electric current is sometimes also used. This is not painful.

What are the safety issues?

If you were sedated, this will affect your judgement for about 24 hours.
For your own safety and in some cases legally;

• Do NOT drive any type of car, bike or other vehicle. You must be taken home by a responsible adult person.
• Do NOT operate machinery including cooking implements.
• Do NOT make important decisions or sign a legal document.
• Do NOT drink alcohol, take other mind-altering substances, or smoke. They may react with the sedation drugs.

Notify the hospital Emergency Department straight away if you have;

• severe ongoing abdominal pain.
• Black tarry motions or bleeding from the back passage (more than ½ cup of blood).
• a fever.
• sharp chest or throat pain.
• have redness, tenderness or swelling for more than 48hours where you had the injection for sedation (either in the hand or arm).