Flexible sigmoidoscopy

Flexible sigmoidoscopy is a procedure for examining the last part of the colon (the sigmoid colon and rectum) with an endoscope or colonoscope. Flexible sigmoidoscopy is similar to colonoscopy but only allows examination of the left side of the colon. Colonoscopy, on the other hand, allows examination of both the left and right side of the colon and often the last part of the small bowel (ileum).

Flexible sigmoidoscopy is performed when a full examination of the colon is not required. It is a less invasive and quicker procedure and usually does not require an oral bowel preparation.

Are there any risks?
Flexible sigmoidoscopy is a simple and safe procedure. It is usually very well tolerated with a minimum of discomfort. Although very safe complications including pain, bleeding, tearing (perforation) of the bowel and reaction to the sedative (if used) can rarely occur. Because flexible sigmoidoscopy only examines the left side of the bowel, any problems further up the bowel will be missed.

How do I prepare?
Usually patients will be given an enema shortly before the procedure to empty out the last part of the colon. A small tube will be inserted into the passage and some liquid will be inserted into the rectum. You will be asked to hold the liquid in the bowel while lying on your side for 5 or 10 minutes and then use the toilet to empty the lower part of the bowel. If you wish to have sedation for the procedure you will need to be fasted (nothing to eat or drink) for at least 4 hours before the procedure.

Can I take my usual medications?
Most medications can be continued for flexible sigmoidoscopy. Medications that increase the risk of bleeding (such as Aspirin, Clopidogrel and Warfarin) may be stopped up to a week before the procedure if it is anticipated that biopsies need to be taken or polyps removed. This will be discussed when the procedure is booked.

If you have diabetes then a plan for you diabetic medications and insulin should be agreed when the procedure is booked. Some blood pressure medications may need to be ceased before the procedure.

What will happen during the procedure?
Flexible sigmoidoscopy can be performed under sedation but is usually well tolerated with the patient fully awake. For this reason the procedure is quicker, the recovery is quicker and the risks of a complication are smaller.

What happens after the procedure?
If you have not had any sedation then you should feel back to normal soon after the procedure. Some gas will be inserted into the bowel during the procedure and you may have some bloating and cramping and pass some residual gas after the procedure.

If you do have sedation then you will need to stay until you have recovered sufficiently from the sedatives (usually an hour or so). You must not drive, return to work, drink alcohol, operate machinery, sign legal documents or use public transport unaccompanied until the following day. You should be escorted home by an adult and have someone with you at home until the following day.

The findings will be discussed in person with the patient, along with a written report and a full report sent to your GP. A follow up with either your Gastroenterologist or your GP will be advised. If biopsies are taken your Gastroenterologist may give you a call when the results are available.

If you have unanswered questions about the procedure please phone Northern Gastroenterology on 9439 7575.  Further information is available from the Gastroenterological Society of Australia on their ‘consumer information’ page at www.gesa.org.au.