A Flexible Sigmoidoscopy (sometimes referred to as a flex sig) is different from a colonoscopy in that it only examines the sigmoid colon (lower portion of the bowel).
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This outpatient procedure is done to evaluate the lower portion of the intestine either as a screening tool or when symptoms appear (abdominal pain, rectal bleeding, change in bowel habits, diarrhea) to determine the cause. It can detect inflamed tissue, abnormal growths and ulcers.
A Flexible Sigmoidoscopy is a diagnostic procedure in which your physician examines the lining of your lower intestine by inserting a thin, flexible lighted tube with a tiny camera into your anus and slowly moving it through the rectum and colon. The images are shown on a nearby computer, providing a visual diagnosis of possible abnormalities.
Unless you request otherwise, patients are given a light to moderate sedative to help you relax and minimize awareness of any slight discomfort. You may feel pressure, bloating or cramping. You will lie on your side or back, while the physician slowly advances the scope through your intestine to examine the lining for any abnormalities. The scope will inflate the colon with air for better examination. You may be asked to move periodically so the scope can be adjusted for improved viewing. He or she will again examine it as the tube is removed.
If your physician notices something for further evaluation, he or she will insert an instrument into the colon to obtain a sample so a biopsy can be performed. The tissue will be analyzed under a microscope. This is done even if cancer isn’t suspected. Polyps can also be removed during the procedure. If your flex sig is being performed to identify a source of bleeding, your doctor may inject medications to control the bleeding or seal off the blood vessels using heat treatment (known as coagulation) or by placing clips at the bleeding site. These procedures typically don’t cause pain.
After the procedure, your physician will provide you with an overview of the examination, although any biopsy results won’t be available for about one week.
You may feel cramping, bloating or abdominal pressure, but passing gas will relieve this. Although you will probably be able to eat after the procedure, your doctor may place some restrictions on diet and exercise, especially if you’ve had a polypectomy.
As mentioned above, if polyps are identified they can be removed during the examination of your colon. Polyps are abnormal growths in the lining of the colon that are usually benign (noncancerous). However, since cancer starts in polyps, removing them is a form of cancer prevention. Polyps range from a tiny dot to several inches. Upon removal, the physician will analyze them under a microscope.
Smaller polyps are removed using biopsy instruments, burning (also called fulguration) or with wire loops called snares. Larger polyps are removed using a technique known as a snare polypectomy. A wire loop is passed through the colonoscope and then removes the polyp using an electrical current. You shouldn’t feel any pain during this procedure.
In order for the Flexible Sigmoidoscopy to be accurate, the colon and rectum must be completely empty. A laxative (medicine that loosens your stools and increases bowel movements) or an enema (liquid solution that washes out the intestines) may be required the night before or a few hours before the procedure. Your doctor will also perform one or more enemas about two hours before the procedure to remove all solids from the sigmoid colon. In some cases, the entire gastrointestinal (GI) tract must be emptied. Your physician will provide you with details prior to the flex sig procedure. You can also download a copy here as a point of reference, but always follow your physician’s instructions. You may be given one of the following preparations:
- Liquid Diet
You should tell your physician about any medications you take, including prescriptions, over-the-counter pills and herbal supplements. He or she will let you know if you should continue to take them or modify the dosage. It is especially important to mention any blood thinners (anticoagulants), aspirin, arthritis or iron products, diabetic medications or any drugs prescribed because you have a cardiac stent or have had a stroke. Please mention speak up any allergies you have to medications or medical conditions such as heart or lung disease.
The actual Sigmoidoscopy takes about 20 minutes and you will be in the recovery room for approximately 30 minutes more. However, you should allow two to three hours for the entire process of check-in, procedure, follow-up and discharge. Because of the sedation, you must have someone drive you home after the procedure. Even if you feel alert, your reflexes may be impaired for the rest of the day. If you choose not to use sedation, you will be able to drive yourself home.
Complications from Flex Sig and Polypectomy are rare when the procedures are performed by an experienced physician. However, with any procedure there are always potential risks. A rare, but possible, complication is bowel perforation (tear in the colon wall) that could require surgery. Some patients may experience bleeding at the site the biopsy or polypectomy, but it’s typically minor – it may stop on its own or be controlled through the scope. Follow-up treatment is rare. Other patients may have a reaction to the sedatives or complications related to heart or lung disease.
Although rare, if you do notice symptoms that could indicate a complication, call our office. Contact us if you have severe abdominal pain, fever and chills, or excessive rectal bleeding. Bleeding can occur several days after a polypectomy (polyp removal).