Flexible Sigmoidoscopy

INTRODUCTION

Sigmoidoscopy is the visual examination of the inside of the rectum and sigmoid colon using a lighted, flexible fiberoptic or video endoscope. The colon, or large intestine, is 5 to 6 feet long. During a sigmoidoscopy, only the last 1 to 2 feet of the colon is examined. This last part of the colon, just above the rectum, is called the sigmoid colon.



REASONS FOR THE PROCEDURE

Sigmoidoscopy is performed to diagnose causes of symptoms or as a preventative measure to detect problems at an early stage before they are even apparent to the patient.

Bleeding-Rectal bleeding is very common. It often is caused by hemorrhoids or a small tear at the anus, called a fissure. However, more serious problems can cause bleeding. Benign polyps can bleed. It is important to identify and remove polyps at an early stage before they become malignant. Rectal and colon cancers bleed and require immediate diagnosis and treatment. Finally, various forms of colitis and inflammation can cause bleeding.

Diarrhea - Persistent diarrhea should always be evaluated by Sigmoidoscopy There are many causes of diarrhea and the exam is of great help in tracking down the specific cause.

Pain - Hemorrhoids and fissures are some causes of pain around the anus or in the rectum. Discomfort in the lower abdomen can be caused by tumors as well as diverticuli. This condition is called diverticulosis. Small pockets or sacks project from the bowel in this condition.

X-ray Findings - A barium enema x-ray exam may show abnormalities that need to be confirmed or treated by Sigmoidoscopy

Detection - Colon cancer is the most common cancer in this country. it is highly curable if it is found early. This cancer may begin in the colon as a polyp that remains benign for many years. Therefore, it is generally advisable to have a surveillance exam after age 40. If there is a history of
colon polyps or cancer in parents or siblings, it is even more critical to have this exam because there is a definite hereditary aspect of colon cancer.

PREPARATION

To obtain the full benefits of the exam and allow thorough inspection, the rectum and sigmoid colon must be clean. Preparation usually involves drinking clear liquids the day before along with taking enemas and/or laxatives. Specific instructions for preparation are always given by the physicians office.

THE PROCEDURE

Flexible sigmoidoscopy is performed on an outpatient basis, usually in the doctor's office. It performed with the patient lying on the left side with the legs drawn up. A sheet is placed over the lower body. A finger or digital exam of the anus and rectum is performed. Then the sigmoidoscope is gently inserted into the rectum. Air is inflated into the bowel to distend it and allow for careful examination. The patient usually feels this distention of the rectum. The scope is then advanced under direct vision and moved around the various bends in the lower bowel.

The scope is advanced as far as possible without causing undue discomfort. When possible, the exam is continued to 25 inches (60 cm). Certain conditions, such as diverticulosis, irritable bowel syndrome or prior pelvic surgery, may produce discomfort when the sigmoid colon is entered by the scope. The exam is stopped if this occurs. The entire exam usually takes only 5 to 10 minutes. Sedation is not normally required.

BENEFITS

The benefits of Sigmoidoscopy are considerable. A specific diagnosis can often be made. A condition, such as colitis, can be monitored following treatment. Polyps and tumors can be discovered at an early stage.

ALTERNATIVE TESTING

Alternative testing includes barium enema X-ray exams. Additionally, the stools can be examined in a variety of ways to uncover or study certain bowel conditions. However, direct visualization of the lower rectum and lower bowel is by far the best method of examining this area.

RISKS

Bloating and bowel distention are common due to the air inflated into the bowel. This usually lasts only 30 to 60 minutes. If biopsies are done or if a polyp is removed, there may be some spotting of blood. This is rarely ever serious. Other very uncommon risks include a diagnostic error or oversight, or a tear (perforation) of the wall of the colon which might require surgery.