Flexible Sigmoidoscopy (Direct Access) – a guide for patients and their carers
Your GP has referred you to hospital to have an examination of the lower part of the bowel. “Flexible sigmoidoscopy” is used as a precautionary measure to detect bowel problems at an early stage.
You will be telephoned by the hospital to arrange an appointment. If you are unable to attend, please let us know immediately so we can give your appointment to another patient, and we can arrange an alternative time for you.
Please read this leaflet together with the Enema at Home leaflet.
What is a flexible sigmoidoscopy?
It is an examination which allows an endoscopist (health professional) to look directly at the lining of the lower part of your bowel. This is done using a sigmoidoscope (a flexible tube about the thickness of the index finger).
Why do I need a flexible sigmoidoscopy?
You may have noticed things happening with your bowel that are not usual for you. They may include:
· Pain in the back passage
· A lump in the back passage
· Bleeding from the back passage
· A change in the consistency or frequency of your bowel motions
What are the benefits of a flexible sigmoidoscopy?
This procedure will help to check the health of the lower bowel and to find the cause of problems such as bleeding or pain. Biopsies (small tissue samples) may be taken to be checked in the laboratory. It is also a means of checking for polyps (fleshy lumps, rather like warts, which are usually benign), which may need further investigation. Advice and/or treatment will be offered for haemorrhoids (piles) or other minor conditions.
What are the risks of having a flexible sigmoidoscopy?
There are risks associated with most procedures but problems with flexible sigmoidoscopy are very rare.
· Bleeding if a biopsy is taken. If this does not stop within 24 hours or is excessive, please contact the Endoscopy Unit (see telephone number on page 5) or your GP.
· Perforation, which is a little tear in the wall of the bowel. This would require a short stay in hospital and treatment with antibiotics, or very occasionally may require surgical repair.
· Very occasionally a condition can be missed, especially if bowel preparation is inadequate. Therefore, if your symptoms continue, please consult your GP again immediately.
Are there any alternatives to Flexible Sigmoidoscopy?
Sometimes a colonoscopy may be needed to look at the whole colon. This is similar to flexible sigmoidoscopy but takes longer and requires more bowel preparation and sedation.
Is there anything I need to do before the flexible sigmoidoscopy?
To get a clear view of your lower bowel, it needs to be completely clean. In order to do this, you will need to have an enema before you arrive at the hospital. An enema is a natural and safe method for cleaning the bowel thoroughly. It introduces liquids into the rectum via the anus. Your GP will have given you a prescription for an enema.
Your GP will have discussed with you whether you are able to use the enema yourself, or if you require a District Nurse to visit you to do this.
When the hospital calls to arrange your appointment, they will advise you when you need to administer the enema if you are doing it yourself. If you are able to do this yourself, please refer to the Enema at Home leaflet included in your patient pack. If you are not able to use the enema yourself, the hospital will arrange for the District Nurse to come to your home. It is important you have collected your enema from the pharmacy as you will need to give this to the District Nurse when he/she arrives at your home.
If you have any questions, please contact the Endoscopy Unit (see telephone number on the final page of this leaflet).
Preparation for the examination
You do not have to fast before you come to the hospital for your appointment.
If you are diabetic, please continue to take your medication as normal.
If you are taking warfarin or other blood thinning medications, please inform the Endoscopy Unit (contact number on final page of this leaflet) for advice as soon as you receive your hospital appointment.
You may continue to take medicines or pills as normal except iron tablets or stool bulking agents (such as Fybogel) which must be stopped one week prior to your examination.
Do I need to bring anything?
Please leave any valuables, including jewellery and large amounts of money at home, as the hospital cannot accept responsibility for the safety of personal belongings.
Please bring a list of any medications you are currently taking. It is especially important to remember to bring any angina sprays or asthma inhalers with you.
What happens when I arrive at the hospital?
1. Please report to the reception of the Endoscopy Unit where your details will be checked.
Location of the Endoscopy Unit;
Croydon University Hospital – Red Zone of the Woodcroft Wing (opposite the x-ray department)
A map is included in this pack.
2. The endoscopist performing the examination will explain the procedure.
3. A nurse will check your details, blood pressure and pulse. If you are allergic to anything (medication, plasters etc), please tell the nurse.
4. Please leave any valuables, including jewellery and large amounts of money at home, as the hospital cannot accept responsibility for the safety of personal belongings.
5. You will be asked to change into a hospital gown and disposable shorts. You will also be asked to remove any jewellery and false teeth before the examination. All your belongings will stay with you during your visit to the Endoscopy Unit.
Please do not hesitate to ask any questions you may have.
Consent
A consent form is included in the pack given to you by your GP. Please sign the form and bring it with you to your hospital appointment. Signing the form will confirm that you understand the examination and agree to go ahead with it. Any queries about the consent form can be answered before your procedure.
What happens to me during the flexible sigmoidoscopy?
A small device for recording your pulse and breathing will be attached to your finger. While you are lying comfortably on your left side, the endoscopist will gently insert the flexible sigmoidoscope into your back passage and pass it around the lower part of the bowel.
Air will be passed into the bowel to expand it so the bowel lining can be seen more clearly. This may give you some discomfort, but this will not last long.
Air that has been passed up into the bowel will obviously have to come out again as wind. Please do not worry about this, it is quite normal.
You may feel as if you want to go to the toilet, but as the lower part of the bowel is empty, you do not need to worry about it actually happening. Any remaining fluid in the bowel will be removed by the sigmoidoscope.
A biopsy may be taken during the examination. You cannot feel this. The sample will be sent to the laboratory to be examined.
A nurse will stay with you throughout the examination. The examination itself will take 10-20 minutes.
Sedation
You will not normally need sedation, but occasionally it is used. If you do have sedation, a small needle will be inserted into a vein and a sedative given before starting the examination. This will make you feel more relaxed and sleepy.
If you have had sedation, you will need to rest for at least 45 minutes, and once recovered you may eat and drink as normal.
Going home If you had a sedative injection:
· You must have a friend or relative to take you home and stay with you for at least 12 hours
· You must not drive, drink alcohol, operate machinery (including the kettle), or sign important documents for at least 24 hours following the sedative.
· If you have not had sedation, you can go home when the nurses think you are well enough. Please make your own arrangements for returning home.
What happens afterwards?
You will be taken to the recovery area where you can rest and a nurse will monitor you.
You may feel a little bloated with wind pains, but these will usually ease within a few hours.
When will I know the results?
Before you leave the hospital, the endoscopist will explain the results of the examination to you and any treatment that is necessary. You will be given a copy of the report for your information and a copy of this report will also be sent to your GP.
After the Flexible Sigmoidoscopy, if you develop severe abdominal pain, please phone:
· Endoscopy Unit
Croydon University Hospital – 020 8401 3073
(Monday-Friday – 8am-8pm)
· Your GP
· The A&E department (24 hours)
Croydon University Hospital – 020 8401 3103
This leaflet can be translated for patients whose first language is not English. A large print copy of this leaflet is available.
For further details please contact:
Chris Losty
South West London Cancer Network 020 8407 3931
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