Sigmoidoscopy Introduction Sigmoidoscopy is a procedure in which a doctor looks in your large intestine.

A length of flexible tube connected to a fiberoptic camera is used. A light is transmitted through the scope to the tip by a bundle of light fibers. The doctor uses this light to look at your intestine through an eyepiece or video screen. Sigmoidoscopy is the best way to diagnose colon cancer. This procedure may also be used to help investigate problems such as bleeding, abdominal pain, or diarrhea. Several leading medical groups recommend routine screening of men and women aged 50 years and older for colon cancer and benign (harmless) polyps every 3-5 years. Younger people may require this procedure if they have close relatives with colon cancer. A similar screening procedure is known as a colonoscopy. The basic difference is that the tube goes farther up the colon with a colonoscopy Risks The risks of the procedure include damage to the colon by the tube, bleeding, abdominal pain, and infection Sigmoidoscopy Preparation Sigmoidoscopy is well tolerated by the vast majority of people. This procedure is usually done in a doctor's office without the need for any anesthesia or sedation. Your doctor may require you to use a strong laxative (called a bowel cleanser) to clear your bowel of fecal contents before sigmoidoscopy. Several medications are available for bowel cleansing, including polyethylene glycol 3350 (GoLYTELY, NuLYTELY), magnesium citrate, (Citroma), and senna (X-Prep). These medications produce diarrhea, which can be uncomfortable, but unless the bowel is empty of stool, the test can be limited and may need to be repeated at a later date. Your doctor may also require a special diet, such as a clear liquid diet, starting 1-2 days before your scheduled sigmoidoscopy. Some people also need to use an enema (liquid is forced into the colon through the anus) before bedtime. The next day, you may take your normal medications. About 1 hour before the procedure is to begin, you will need to have an enema. The clear diet and enema help clear the intestine so your doctor can see well. During the Procedure The doctor will have you lie down on your left side with your knees bent and pulled up slightly toward your head. The doctor will examine your rectum first with a finger lubricated with special jelly. The tip of the scope is then lubricated with the same jelly and slowly inserted into your rectum. The doctor will slowly advance the tube through your lower intestine. In order to help the doctor see, a small amount of air and water may be placed in the intestine through the end of the scope. If the doctor encounters a suspicious area of intestine, he or she may remove a small piece of the tissue for analysis. This is done with the same scope and is known as a biopsy. After the Procedure After the procedure, you may experience mild abdominal cramping and gas as a result of the air that was placed in your intestine. Some people may have slight rectal bleeding due to minor irritation and trauma from the insertion of the sigmoidoscope

Colonoscopy is an internal examination of the colon (large intestine) and rectum, using an instrument called a colonoscope. How the Test is Performed The colonoscope has a small camera attached to a flexible tube. Unlike sigmoidoscopy, which can only reach the lower third of the colon, colonoscopy examines the entire length of the colon. You will lie on your left side with your knees drawn up toward your chest. After you have received a sedative and pain reliever, the colonoscope is inserted through the anus. It is gently moved into the beginning of the large bowel and sometimes into the lowest part of the small intestine. Air will be inserted through the scope to provide a better view. Suction may be used to remove fluid or stool. Because the health care provider gets a better view as the colonoscope is pulled back out, a more careful examination is done while the scope is being pulled out. Tissue samples may be taken with tiny biopsy forceps inserted through the scope. Polyps may be removed with electrocautery snares, and photographs may be taken. Specialized procedures, such as laser therapy, may also be done. How to Prepare for the Test You will need to completely cleanse your intestines. Your health care provider will give you instructions for doing this. This may include a combination of enemas, not eating solid foods for 2 or 3 days before the test, and taking laxatives. You will usually be told to stop taking aspirin, ibuprofen, naproxen, or other blood-thinning medications for several days before the test. You will be asked to drink plenty of clear liquids for 1 - 3 days before the test. Examples of clear liquids are: y Clean coffee or tea y Sports drinks y Fat-free bouillon or broth y Strained fruit juices y Gelatin y Water Unless otherwise instructed, continue taking any regularly prescribed medication. Stop taking iron medications a few weeks before the test, unless your health care provider tells you otherwise. Iron can produce a dark black stool, which makes the view inside the bowel less clear.

Outpatients must plan to have someone take them home after the test, because they will be woozy and unable to drive. Infants and children: The preparation you can provide for this test depends on your child's age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics: How the Test Will Feel The sedative and pain medication will relax you and make you feel drowsy. Many patients do not remember having the colonoscopy. A rectal examination usually is done before the test to make sure there are no major blockages. You may have the urge to have a bowel movement when the rectal exam is performed or as the colonoscope is inserted. You may feel pressure as the scope moves inside. You may feel brief cramping and gas pains as air is inserted or the scope advances. Passing gas is necessary and should be expected. You can reduce discomfort by taking slow, deep breaths. This will also help relax your abdominal muscles. You may have mild abdominal cramping and pass a lot of gas after the exam. Sedation should wear off in a few hours. Because of the sedation, you may not feel any discomfort and may have no memory of the test. Why the Test is Performed Colonoscopy may be used for the following reasons: y Abdominal pain, changes in bowel movements, or weight loss y Abnormal changes (such as polyps) found on sigmoidoscopy or x-ray tests (CT scan or barium enema) y Anemia due to low iron (usually when no other cause has been found) y Blood in the stool, or black, tarry stools y Follow-up of a past finding, such as polyps or colon cancer y Inflammatory bowel disease (ulcerative colitis and Crohn's disease) y Screening for colorectal cancer Normal Results Normal findings are healthy intestinal tissues. What Abnormal Results Mean y Diverticulosis (abnormal pouches on the lining of the intestines, which increase with age) y Inflammatory bowel disease y Lower gastrointestinal (GI) bleeding y Polyps (which can be removed through the colonoscope during the exam) y Tumor Additional conditions under which the test may be performed: y Cytomegalovirus, gastroenteritis, or colitis y Colon cancer screening y Colorectal polyps y Ischemic colitis y Pseudomembranous colitis Risks y Heavy or persistent bleeding from biopsy or polyp-removal sites y Hole or tear in the wall of the colon (bowel perforation) that requires a repair operation y Fluid imbalances in the body due to enemas and laxatives given before the procedure y Infection needing antibiotic therapy (very rare) y Nausea, vomiting, bloating, or rectal irritation caused by medicines taken by mouth to cleanse the bowel y Reaction to sedative medication, causing breathing problems or low blood pressure