Flexible sigmoidoscopy

What is a flexible sigmoidoscopy?

A flexible sigmoidoscopy is a minimally invasive procedure used to examine the inner lining of your rectum and the lower part of your large intestine (your colon). It’s usually done to investigate symptoms that you may have been experiencing, or to monitor conditions that affect these parts of your body. It involves inserting a thin tube with a light and camera on the end (sigmoidoscope) into your body rectally, so it can pass into the colon. It then feeds back real-time images to a screen in the room.

It’s very common, usually painless and can be performed without the need for sedation or anaesthesia.

What conditions can a flexible sigmoidoscopy detect?

A flexible sigmoidoscopy can be used to detect and help diagnose a range of different conditions, including:

• Polyps: abnormal growths of tissue that project outwards from the lining of any mucous membrane in your body, including those found in the rectum and colon.
• Ulcerative colitis: a form of chronic, inflammatory bowel disease that can cause inflammation and open sores to develop in the lining of the colon and rectum.
• Crohn’s disease: another type of chronic bowel disease, but that is characterised by inflammation in any part of the digestive tract.
• Diverticular disease: a digestive condition where small pouches of tissue push outwards through weak spots in the colon, sometimes causing complications including pain.
• Haemorrhoids: swollen veins found in the lower rectum and anus that are sometimes visible outside the body.
• Fissures: small cracks that develop in the lining of your anal canal, causing pain, bleeding and other issues

Flexible sigmoidoscopies are also routinely used to investigate unexplained rectal bleeding.

Can a flexible sigmoidoscopy detect cancer?

Yes, a flexible sigmoidoscopy can help to detect cancer in your rectum or colon as it enables your specialist to visualise any potentially cancerous abnormalities. However, it’s important to understand that it forms part of the diagnostic process and alone isn’t conclusive evidence of cancer.

Can polyps be removed during a flexible sigmoidoscopy?

Yes, if your specialist discovers any abnormal growths during your flexible sigmoidoscopy, they may be able to remove them there and then. In other cases, it may be recommended to take a small tissue sample, called a biopsy first. This is then looked at under the microscope to determine what the growth is before further treatment takes place.

What are the alternatives to a flexible sigmoidoscopy?

There are primarily two alternatives to a flexible sigmoidoscopy.

Flexible sigmoidoscopy vs rigid sigmoidoscopy

As you may guess from its name, a rigid sigmoidoscopy is different because it uses a small, rigid telescope to visualise inside your body instead. Since it’s made from inflexible material, it can’t travel as far up into the rectum and colon, meaning it’s better suited to examinations of the rectum and lower portion of your colon.

Flexible sigmoidoscopy vs colonoscopy

Some people confuse a flexible sigmoidoscopy with a colonoscopy. A colonoscopy is designed to investigate the full length of the colon, not just the lower portion. As a result, they need greater preparation (including bowel evacuation) as well as sedation.

Who is suitable for a flexible sigmoidoscopy?

If you’ve been experiencing unexplained digestive or bowel issues, or you have already been diagnosed with an ongoing condition such as an inflammatory bowel disease, you may be recommended to have a flexible sigmoidoscopy.

Some of the symptoms that may lead to this procedure could include:

• Unexplained rectal bleeding
• Persistent abdominal pain
• Sudden bowel changes
• Chronic diarrhoea or constipation.

If you have any concerns about any of these symptoms, always seek an appointment with your GP as soon as possible.

Do I need a GP referral for a flexible sigmoidoscopy at Nuffield Health?

Yes, you will need a referral letter from a GP before you can have a flexible sigmoidoscopy. This is to ensure that you see the most appropriate specialist based on the initial recommendations of your doctor.

Who may not be suitable for a flexible sigmoidoscopy?

A flexible sigmoidoscopy may not be appropriate for you if you:

• Are taking certain medications, including blood thinners
• Have already been diagnosed with a severe bowel condition
• Have severe breathing or kidney problems
• Are pregnant
• Have a cardiac or other implanted device.

Your consultant (doctor) will do a comprehensive review of your medical history and current medications before deciding whether this investigative treatment is suitable for you.

How can I prepare for a flexible sigmoidoscopy?

There are several stages of preparing for a flexible sigmoidoscopy.

• Changing your diet: You will normally be asked to reduce the number of foods you eat containing skins, nuts, seeds and whole grains in the days before your procedure. This is because they can be harder to digest, and your bowel must be empty before your sigmoidoscopy.
• Emptying your bowel: Unfortunately, just going for a poo before your procedure isn’t enough. You will need to prepare your bowel fully, and this may mean taking laxatives for several days, as well as completing some at-home enemas before you come into hospital.
• Fasting: You’ll be told not to eat any solid food for at least 6 hours before your appointment, although you may be able to drink clear liquids for up to two hours before.
• Clothing: We recommend that you wear comfortable, loose-fitting clothes for travelling to and from your appointment, although you will be asked to change into a hospital gown for the actual procedure. Avoid bringing jewellery or valuables too.
• Going home: Whether or not you have any sedation during your flexible sigmoidoscopy, we’d also recommend that you have someone drive you home after. If you have sedation, you’ll also have some additional advice to follow.

What happens during a flexible sigmoidoscopy?

During a flexible sigmoidoscopy, you’ll be asked to lie on your side with your knees pulled up to your chest. Sedation or anaesthesia is not usually needed, though your doctor may offer you Entonox (a pain-relieving gas), which has no after-effects. After a quick rectal exam by your doctor, the lubricated scope will be gently guided up through your rectum into your colon.

A very small amount of air will be pumped into the colon to expand it, and this will provide better visibility inside the organ for your doctor.

Depending on what they find, they may remove any polyps or take samples of any other abnormalities. The scope is then gently removed, and the investigation is over.

How long does a flexible sigmoidoscopy take?

The actual sigmoidoscopy usually takes around 10 to 20 minutes, but you should allow several hours for the complete appointment.

Does a flexible sigmoidoscopy hurt?

You may feel some cramping and an urge to pass wind during the procedure, but rarely any pain.

What happens after a flexible sigmoidoscopy?

You’ll be kept in a recovery area within the hospital for a short while after your procedure, which will allow us to monitor you and, if you’ve had any sedation, provide time for this to wear off. Most people can go home less than an hour after their sigmoidoscopy.

Can I drive home after a flexible sigmoidoscopy?

Not if you’ve had sedation. It’s recommended that you wait at least 24 hours to drive after any type of sedative. You are more likely to cause an accident if you do, and your insurance will be invalidated.

When can I return to normal activities after a flexible sigmoidoscopy?

It really depends on whether you’ve had any sedation and how you are feeling. If you’ve not had sedation and you generally feel ok, you may be able to get back to most of your usual activities straight away. With sedation, it’s recommended to rest for at least 24 hours while the sedative medication makes its way out of your body.

Always follow the recommendations given to you by your consultant.

What can I eat and drink after a flexible sigmoidoscopy?

It’s recommended that you stick to light meals for the first 24 hours after your procedure, just to give your colon time to stabilise after your flexible sigmoidoscopy. After this, you should be able to go back to eating and drinking as normal.

When will I get my results after a flexible sigmoidoscopy?

Usually, any immediate discoveries will be discussed with you before you leave your appointment, and you will be given a copy of your endoscopy report and a discharge advice sheet.

If you’ve had a biopsy, you will need to wait for the laboratory to process your sample. Your consultant will be able to advise you how long this will take and when you can expect to be invited back for a follow-up appointment.

What are the risks and possible complications of a flexible sigmoidoscopy?

As with any procedure, there are some side effects and risks of possible complications associated with a flexible sigmoidoscopy to be aware of. These include, but aren’t limited to:

• Discomfort, cramping or bloating
• Slight bleeding from the rectum
• Infection
• Perforation of the bowel wall, which is serious and may require surgery (very rare)
• Incomplete examination, meaning that something is missed during the investigation
• Problems related to sedation, such as breathing difficulties, changes in blood pressure, etc.

Your doctor will explain all side effects and risks to you in detail before your procedure.

How safe is a flexible sigmoidoscopy?

As a routine investigative test, a flexible sigmoidoscopy is extremely safe, with low risk of complications and a fast recovery time.

How much does a flexible sigmoidoscopy cost at Nuffield Health?

For pricing information, please contact your local hospital.