Sigmoidoscopy

What is Sigmoidoscopy?

Sigmoidoscopy, also known as flexible sigmoidoscopy, is a procedure that allows doctors to examine the sigmoid colon and rectum. A flexible 60 cm long tube called sigmoidoscope connected to a fiberoptic camera is used to check the inside of your sigmoid colon or rectum.

Why do I need a Sigmoidoscopy?

Your doctor or medical practitioner can recommend a sigmoidoscopy exam due to the following reasons:

– Rectal bleeding.
– Change in bowel habits.
– Persistent abdominal pain.
– Chronic diarrhea.
– Sudden or unexplained weight loss.
– Screening for colon or rectal cancer.
– Family history of colon or rectal cancer.
– To investigate for inflammatory bowel disease.
– Screening for polyps.

Sigmoidoscopy is often preferred by doctors over colonoscopy because of the simplicity of the procedure. Sigmoidoscopy takes less time than a colonoscopy and often is done without any anesthetics. There is also a lower risk of side effects in the procedure.

How many people are diagnosed with colorectal cancer in India?

Globally speaking, colorectal cancer is the 3rd most commonly reported cancer in men. In women, this is the 2nd most common type of cancer. Every year 1.4 million cases of colorectal cancer are reported worldwide. In India, however, the prevalence of this cancer is lower compared to breast and lung cancer. It has been estimated that colorectal cancer is prevalent in 7.2/100,000 males and 5.1/100,000 females in India.

How should one prepare for this examination?

First of all, you need to inform your doctor if you have the following conditions:

– You are pregnant.
– Allergic to any particular medication.
– Lung or heart condition.
– You are taking any particular medication like blood thinners, anti-inflammatory drugs, or diabetic medications.
– If you are taking any vitamins or iron supplements.

Before a sigmoidoscopy, your endoscopist or doctor will ask you to completely clean or empty your colon as any residue of stool might obstruct the procedure.

– Your doctor will give you bowel prep instructions which will clear out all liquids and stool from your intestine. This helps your endoscopist to get a better view of the linings of your intestine.

– To empty your colon, your doctor will ask you to follow these particular instructions:

You will be asked to follow a clear liquid diet before the day of the exam. You may drink a light broth, carbonated beverages, tea or coffee without milk and sugar, strained fruit juice, flavored gelatin, and plain water. You may be asked not to eat or drink anything after midnight before the day of the exam.

Your health provider will give you laxatives to take at home or at the hospital. The laxative can be in the form of liquid, powder, or pill.An over-the-counter enema kit can also be given to you. You need to take your enema a few hours before the exam.You are advised not to eat or drink anything a few hours before the test.

Do I continue taking my normal medications during sigmoidoscopy?

Yes, you can continue taking your normal medications but you need to inform your doctor about all your prescribed medications, allergies if any and other non-prescription drugs. Your doctor may ask you to discontinue certain drugs like blood thinners and aspirin a few days before the exam. Patients who have certain medical conditions like an artificial valve, aortic stenosis, or knee prosthesis must inform that to their doctor.

How is Sigmoidoscopy exam done?

– As you arrive in the hospital, your nurse or medical attendant will take your blood pressure, temperature, and heart rate. After that, your endoscopist will explain you the procedure and you will be required to sign in the written consent. Your nurse will help you to change to a hospital gown or paper shorts.

– During the test, you will be asked to lie down on your left side on the examination table. Your endoscopist will insert the sigmoidoscope gently through your back passage. A gel is used to soothe out the discomfort. The procedure is generally painless and does not require any anesthesia.

– A small amount of water and air will be passed through the tube to open up the bowel so that the doctor can have a clear vision. You will feel bloated, but this is quite normal.

– The endoscopist will take photographs of your bowel lining to rule out any polyps or abnormalities. They can also take a tissue sample if any abnormality is found. If there are any polyps, a wire loop will be used to remove them from your bowel lining. The samples are sent to the laboratory for further examination.

– Your endoscopist will inform you if any polyps or abnormalities are found during the procedure.

What happens if I am feeling discomfort during the Sigmoidoscopy procedure?

If at any point during the examination, there is discomfort you can tell your endoscopist and he will immediately stop the examination.

What happens after the examination?

How long does it take to undergo a Sigmoidoscopy?

A sigmoidoscopy generally takes 15 to 20 minutes. It might be slightly longer for children or infants.

What is the cost of Sigmoidoscopy in India?

The cost of sigmoidoscopy in India can be anywhere between Rs. 1500 to INR 33,000.

What are the risks of Sigmoidoscopy?

Sigmoidoscopy is a fairly safe procedure and does not involve any risk. However, in very rare situations if the procedure is not performed properly there can be certain complications. Patients who have undergone sigmoidoscopy are advised to contact the doctor immediately if they have the following symptoms:

– Acute abdominal pain.
– Profuse rectal bleeding.
– Fever or chills.
– Passing of blood clots.
– Blackish tools generally due to the presence of blood in the stool.
– Nausea or vomiting.

In certain cases, patients may experience a tear in the rectal wall or perforation. In such cases, you should contact your endoscopist and physician immediately. Your doctor will examine the area and you may have to undergo a small surgery to repair the tear.

Can I get an infection because of Sigmoidoscopy?

Infection after sigmoidoscopy is very rare and usually follows with high temperature and chills. You will be needed to contact your physician immediately.

When will I get my Sigmoidoscopy results?

You will get your sigmoidoscopy results after two weeks of the procedure. After you get the test results, you have to make a follow-up appointment with your general practitioner, who will explain your test results. In case your biopsy results show some abnormalities, you will be prescribed medications or asked to do further tests.

What do the results of Sigmoidoscopy mean?

A normal test result will indicate normal color, texture, rectal mucosa and lining of the sigmoid colon and rectum. In case a tissue sample was taken and shows a positive sigmoidoscopy, then you will be asked to do further tests and preferably a colonoscopy.

What do abnormal Sigmoidoscopy test results indicate?

A positive sigmoidoscopy usually indicates cancerous cells or polyps or can indicate any of the following:

– Anal polyps or fissures.
– Hirschsprung disease or blockage in the passage of the large intestine.
– Anorectal abscess.
– IBD or inflammatory bowel disease.
– Proctitis or inflammation or infection around the rectum and anus.
– Cancer
– Diverticulosis

Is Sigmoidoscopy safe during pregnancy?

Flexible sigmoidoscopy is generally considered to be safe during pregnancy. However, the endoscopist should be aware of the risks involved like potential harm to the fetus, placental rupture, bleeding, risk of sedation and other complications.The pregnant woman should be fully aware of the risks involved in the procedure. A sigmoidoscopy is only performed when it is absolutely necessary and that too not before the second trimester.

Can Sigmoidoscopy be performed on children?

Yes, flexible sigmoidoscopy is completely safe and can be performed on children. Your child will be mildly sedated or anesthetized during the procedure.

What are the prep instructions for a child undergoing Sigmoidoscopy?

– Depending upon the age, your child needs to follow certain prep instructions before undergoing a sigmoidoscopy examination.

– All children upon arrival to the hospital will receive saline. Children below 2 years of age will receive a pediatric enema.

– Infants below 12 months can have breast milk three hours before the procedure. Infants above 12 months are not allowed to take any formula, milk, or solid food after 11 p.m. the night before the test.

– There are no restrictions on diet or liquid intake for a child who will not receive any sedation or anesthesia.

– Children who will be sedated or anesthetized will not take any food or liquid after 11 p.m. the night before the test.