What is a flexible sigmoidoscopy?

• A flexible sigmoidoscopy examines the inside of your lower bowel with a flexible sigmoidoscope (a flexible tube with a small camera at the end)
• The endoscope is a tube approximately the width of your finger.
• The instrument is passed carefully through your back passage (anus).
• Some air is inflated into the bowel enabling the person performing the procedure (the endoscopist) to look directly at its lining.
• The examination is carried out when you are fully awake.
• It will help discover the cause of your symptoms.
• Banding of haemorrhoids may be offered if appropriate.

Alternative Tests:

• Although there are alternatives your doctor has decided that this is the best test for you.
• One alternative is a barium enema x-ray examination. It is not as informative as a colonoscopy and has the added disadvantage that tissue samples cannot be taken.
• If you want further information, please discuss this with your GP or the doctor who has referred you for this test.

What are the risks of having a flexible sigmoidoscopy?

A flexible sigmoidoscopy carries a small risk of complications but the main risks are:

• Perforation or tear of the lining of the bowel wall (1in every 15,000). An operation is nearly always required to repair the hole. The risk of perforation is higher with polyp removal.
• Bleeding may occur at the biopsy site or polyp removal (1in every 100-200). This may stop on its own but may require further treatment and an operation may be required.
• An abnormality may be missed due to poor bowel preparation or for technical reasons; however this is rare and tends to be with small polyps.

What happens if I decide not to have a flexible sigmoidoscopy?

• The symptoms may persist, and it may be hard to reach a diagnosis.

Preparing for the flexible sigmoidoscopy

• If you have had a heart valve replacement, endocarditis or require antibiotics for dental treatment, please contact the Endoscopy Unit prior to your appointment.
• If you are a Diabetic or taking Warfarin, Aspirin or Clopidogrel tablets please contact the Endoscopy Unit prior to your appointment.
• If you are taking iron preparations you should stop taking them one week before the examination.
• You will need to have an enema to give the endoscopist a clear view. You will need to give this yourself at home 2 hours before your appointment. See instructions below for more information.

• Please take your usual medication, except iron, as normal up to and including the day of your examination.

How to Give Yourself an Enema At Home

Introduction

If this is the first time using an enema, don’t worry. Enemas are safe, gentle and surprisingly easy to use.

Most people find it convenient and comfortable to use the enema at home. By using the enema 1-2 hours before your appointment will ensure your bowel is empty before your test.

Instructions – How to use the enema

• Spread a towel on the bed where your bottom will be.
• Keeping the bottle upright, remove the cap and screw on the administration tub securely.
• Smear the lubricating jelly on the enema nozzle.
• Lie on your side with your knees drawn up.
• Pinch the tubing near to the bottle to stop the liquid leaking out.
• Gently insert nozzle (3 inches up to the disc) into your bottom.
• You will need to gently squirt the contents into your bottom.
• Remove the nozzle and remain lying down.
• Squeeze your bottom muscles as if to stop yourself going to the toilet for as long as possible
• Go to the toilet, but do not worry if you do not pass a motion.
• Stay near the toilet for the next hour.
• Some people may experience mild stomach cramps for a short while.
• Some people may feel faint or dizzy. If you feel faint please lie down until you feel better.
• The enema will have worked within the first hour or so you will have no problems travelling to the Biddlestone Health Centre.

The day of the flexible sigmoidoscopy:

• You may eat and drink as normal.
• Please do not bring valuables with you.

Please report to:

Biddlestone Road Health Centre, Biddlestone Road, Heaton, Newcastle upon Tyne.

Before the procedure you will be seen by a qualified nurse and the Endoscopist and you will have the opportunity to discuss any problems or worries.

You will be asked to sign a consent form indicating that you understand the nature and risks of the procedure. The consent form is a legal document, therefore please read it carefully.

What will happen during the flexible sigmoidoscopy?

• Your test will be performed by a qualified endoscopist or a trainee endoscopist under direct supervision.
• If necessary, a clip will be lightly attached to your finger to record your pulse rate and level of oxygen.
• You will be asked to lie on a trolley on your left side.
• When the sigmoidoscope is inserted into your bottom, air is gently passed into the bowel. This opens up the bowel so the endoscopist can see where they are going. At first you may feel that you want to go to the toilet. You may feel a little embarrassed that you will pass a motion. Do not worry! It is the air that causes this feeling. You will not soil yourself.
• Throughout the test, the endoscopist will put air into your bowel to provide a clear view. This may result in some mild discomfort.
• During the procedure a sample of tissue (biopsy) may be taken for analysis, this will be painless. These will be retained.
• If a polyp, a small growth on the wall of the bowel is found, then it may be removed. A polyp is a protrusion from the lining of the bowel. Polyps when found are generally removed or sampled by the Endoscopist as they may grow and later cause problems.
• If a large polyp is found, or any small polyp which needs to be removed following analysis, the Endoscopist will request that you have a colonoscopy (a complete examination of the colon) to remove the polyp.
• A video recording and /or photographs may be taken for your records and will only be seen by those involved in your care.
• The flexible sigmoidoscopy will take 5 - 20 minutes.

What will happen after the flexible sigmoidoscopy?

• You may feel bloated but this will soon pass.
• You will be able to go home soon after the examination.
• You can eat and drink normally after the examination.
• You may experience some slight soreness where the flexible tube has been however this will wear off in a day or so.
• If you have had any biopsies or a polyp removed, you may notice a small amount of bleeding from your back passage over the next few days. If the bleeding increases or you experience severe abdominal pain contact your GP or NHS Direct.

When will I know the result of my flexible sigmoidoscopy?

• The endoscopist performing the test will often be able to give you some preliminary results.
• If you have had biopsies taken you will receive the results at your out patient appointment or by letter.
• A full report will be sent to your doctor.
• Before you are discharged you should be given clear details concerning follow-up arrangements.

When to contact your GP or NHS Direct

• Severe abdominal pain or severe vomiting
• Temperature greater than 38°C/101°F
• Passing large amount of fresh red blood or clots

If you have any further questions you should contact:

Freeman Hospital:

• Endoscopy Unit (9.00 am - 4.30 pm) 0191 2231208

If you have any queries or require any further information out of these hours, please contact your GP or NHS Direct (0845 46 47).