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Flexible Sigmoidoscopy
Patient Education for Flexible Sigmoidoscopy
Preparation for Flex Sigmoid Exam
- Clear liquids the day before the exam.
- Magnesium Citrate 8 oz. at 2:00 p.m. the day before.
- Fleets enema at 7:00 a.m. the morning of the exam (buy Magnesium Citrate and enema at the drug store).
- Do not eat the day of your exam.
Clear liquids you may have are:
- unsweetened colas, unsweetened tea
- broth or bouillon
- apple juice or grape juice
- Jell-O (no red kind)
- popsicles (no red kind)
- black coffee or water
If you are also scheduled for a barium enema, please follow the instructions provided in the kit
provided to you only. If you cannot keep your appointment, please call at least 24 hours in advance.
This information is to help you become informed about a procedure called flexible sigmoidoscopy. If you have
any questions after reading this information, please feel free to discuss them with your physician.
Purpose
To identify and diagnose lesions of the bowel at an early age to prevent cancer.
To find cancer that may already be developed in earlier stages so that it might be more beneficially treated.
Suspicious Symptoms
- Persistent abdominal pain
- A change in bowel habits (constipation or diarrhea that persists)
- Rectal bleeding of any sort
- A stool specimen that tests positive for blood (positive guaiac or hemoccult)
- Unexplained weight loss or fevers
- Anemia
- Follow-up of previous polyps or cancers
- Any person 50 years of age and older, regardless of symptoms
- A high risk history before age 50 (previous cancer, history of ulcerative colitis
or Crohn's disease, history of female genital cancer, family history of cancer, history of multiple polyps).
The Benefits of Screening
Colon cancer is the second most common cause of cancer death in the United States, surpassed only by lung
cancer. Every year, 35,000 lives could be saved by early diagnosis. It has now been fairly well documented that
the majority of colon cancers begin in small polyps or growths that are totally benign. It takes 5 to 10 years
for these benign polyps to become cancerous. If these polyps can be detected early and removed, cancer
may be prevented. Polyps found in the lower part of the bowel may be associated with polyps higher up
in the bowel or with other cancers. Therefore, a screening procedure may identify those patients who
need a more extensive procedure called colonoscopy. If all polyps are removed and a vigorous screening program
is initiated, the chance of colon cancer is decreased to only 15% of what is predicted for an unscreened population.
The Procedure
Flexible sigmoidoscopy is easily carried out in a physician's office. It takes between 15 and 30 minutes. The
patient lies on a flat table on his or her left side. The physician performs a rectal examination, trying to feel for
any growths, and then inserts the flexible sigmoidoscope instrument. This is a small tube approximately 1/2 inch
in diameter. It is about 24 inches (60 cm) long and is actually quite movable, like a small piece of tubing.
The physician can control the movement with some dials at one end, and can make the scope go up and down and
to the right or left. The end of the tubing has a small opening for illumination, another for suctioning
any fluid that might be left in the bowel, and another one for inserting air. By gently manipulating this tubing,
the physician can insert it into the rectum and look at the lower part of the bowel (called the sigmoid colon)
and left descending colon.
Pain
The discomfort is usually minimal. It feels similar to the pain associated with gas cramps, because the physician
inflates the colon with air to see inside. Most people compare the pain to a slightly uncomfortable bowel movement.
Occasionally, if the bowel really has a lot of loops, pain will be greater, but this is rare. Usually, medication
is not prescribed before or after the procedure unless the patient feels particularly anxious and requests it.
The patient may take four ibuprofen 200 mg tablets 2 hours before the procedure. One is generally able to come
straight from work and return to work after the procedure.
Reasons for Not Having the Procedure
In some instances, if you are having abdominal pain that is severe enough that you are admitted to the hospital,
you should not have the procedure done. Your physician will need to be the guide for this. Likewise, if you are
pregnant, have had a recent heart attack, or have some other significant medical disease, you should let
your physician evaluate this before going on with the procedure. If you have an artificial heart valve or an
artificial joint, you should received antibiotics before the procedure. Some heart murmurs also require
antibiotics. Please discuss these issues with your physician.
Possible Complications
Flexible sigmoidoscopy is relatively safe. Approximately one time out of 10,000 procedures, a tear may be made
in the bowel wall. This may require further surgery. Very rarely, there may be some bleeding. Generally, there is
little discomfort. Some people who get lightheaded when they see blood or when they are under stress may faint.
(If you are one of these, inform your physician who can prescribe medicine to prevent this).
Costs
If the flexible sigmoidoscopy is done totally for the purpose of screening, it is unlikely that your insurance
company will cover the charge. However, if you have any symptoms at all, insurance companies generally will
provide coverage.
Additional questions and/or concerns should be discussed with your physician.
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