Introduction
You have been advised by your GP or hospital doctor to have an investigation known as a flexible sigmoidoscopy to help find the cause of your symptoms. We will need to have your formal consent before we can carry out this examination. This leaflet explains how the examinations are carried out and what the risks are. This will help you to make an informed decision when agreeing to the examination. This leaflet may not answer all your questions so if you have any worries please don’t hesitate to ask.
What is a Flexi-Sigmoidoscopy?
This is an examination of the left side (lower part) of the large bowel using a flexible colonoscope. The examination takes about 10-15 minutes.
You will have seen your GP or a Consultant with concerns about your bowels, for example bleeding or a change in bowel habit that does not seem to be returning back to normal. The GP or Consultant would have then referred you for this examination to find the cause of your symptoms.
If the Endoscopist thinks the bowel lining does not look normal they will use this opportunity to take tiny samples of tissue called biopsies. Sometimes small benign growths, called polyps, are found at Sigmoidoscopy. Polyps are generally removed there and then. Some polyps, if left for years, have the potential to change into cancers.
The benefits of a Flexible Sigmoidoscopy are that it is quick and that it examines the part of the bowel where most bowel problems occur.
Why do I need to have a Flexible Sigmoidoscopy?
You have been advised to have this investigation to try and find the cause of your symptoms, help with treatment and if necessary, to decide on further investigations.
There are many reasons for this investigation including:
- Rectal Bleeding
- Altered Bowel Habit
- Abnormal Findings on previous scans
- Assessment of Inflammatory Bowel Disease (IBD)
- Polyp Surveillance
- Banding of Haemorrhoids
Alternatives to sigmoidoscopy
There are x-ray examinations which can be done instead, these can tell us if the bowel looks normal or not, but they cannot tell us what the problem is. We need to be able to take biopsies and this is not possible with x-ray. If you would like to discuss this further please speak to a member of staff.
Before your examination
Pre Assessment Appointment
Once you have a booking date you will be pre-assessed over the phone. Please ensure you have contact details of your next of kin , escort and a list of your medicines to hand. The nurse will go into detail about the procedure, check your medical history and answer any questions you may have.
Medication
Seven days before the procedure: stop taking any iron preparations.
Please stop taking Aspirin when you start taking your bowel preparation.
Your procedure
Specialist doctors or nurses perform the majority of these procedures, however Bedford Hospital has commitments to train both doctors and nurses in all aspects of endoscopy and care and your test may involve Doctors or nurses training in the performance of sigmoidoscopy. Their training is provided through specialist courses and supervised by experienced consultants. If you have any queries about this please do speak to a member of the team.
The preparation
To allow a clear view, the colon must be completely empty of waste material. If it is not, certain areas may be obscured and the test may have to be cancelled or repeated. It is important to follow the detailed instructions of the laxatives about clearing the colon. Please try to follow the diet sheet provided for 2 days before you commence your bowel preparation.
It is important to take the entire laxative prescribed and also considerably increase your intake of clear fluids on the day before examination, which will help clean the bowel. You will need to be close to a toilet facility during this period, you may find a barrier cream useful, such as Sudocream or Vaseline if you become tender or sore.
If you have any issues with the bowel preparation, please contact the Endoscopy unit.
Occasionally an enema may need to be given in the department before the procedure. Sometimes your referring Doctor may decide that an enema alone is enough in which case you don’t need to take any bowel preparation.
Take all your tablets as normal.
PLEASE FOLLOW A LOW RESIDUE DIET FOR 3 DAYS BEFORE TAKING YOUR BOWEL PREP
What is a low fibre (residue) diet?
Dietary fibre (also known as roughage) is the part of plants that cannot be easily digested. Some of it passes through the body without being absorbed.
A low fibre (low residue) diet will help you to reduce the volume and frequency of your stools. It also lengthens the time food passes through your gut.
Eating a variety of different foods will help you get the nourishment you need to stay healthy. This leaflet gives ideas on what food to eat and also which foods to avoid while you are on a low residue diet.
WHAT FRUIT AND VEGETABLES CAN I EAT?
FRUIT
Foods allowed (limit to 1 portion per day):
- Fruit juice (no bits)
- Bananas
- Mango, papaya
- Pineapple (without the core)
- Melon, watermelon
- Fruit with the skins removed e.g. peeled apples, pears, peaches, plums, nectarines, apricots
- Pureed, stewed or cooked fruit (without skins, pips or stones)
- Tinned fruit
- Fruit sauces and coulis with pips removed e.g. sieved raspberry coulis, apple sauce
Foods to avoid:
- Fruit juice with bits
- Smoothies
- Fruits with skins on e.g. grapes, cherries, blueberries
- Citrus fruit
- Coconut
- Pineapple core
- Rhubarb
- Berries and fruits with seeds e.g. strawberries, raspberries, blackberries, kiwi,
- All dried fruit e.g. raisins, cranberry
VEGETABLES
Foods allowed (limit to 1 portion per day):
- Well-cooked root vegetables e.g. carrots, parsnips, swede, turnips
- Butternut or gem squash
- Pumpkin
- Peeled marrow, courgette, squash
- Well-cooked cabbage, broccoli and cauliflower (no tough stalks)
- Peeled and de-seeded tomato, cucumber, peppers
- Avocado
- Smooth vegetable soups
- Well cooked, softened onions and garlic (as a paste)
Foods to avoid:
- All skins, pips and seeds
- Tough stalks of vegetables e.g. cauliflower, broccoli
- Raw vegetables
- Asparagus
- Aubergine
- Brussel sprouts
- Leeks, spring onions
- Raw or undercooked onions and garlic
- Pickled onions, gherkins
- Sweetcorn
- Peas, sugar snaps, mangetout
- Green, French and runner beans, broad beans
- Mushrooms
- Spring greens
- Beetroot
- Celery
- Radish
- Lettuce, rocket, watercress and spinach
- Whole tomatoes
- Bean sprouts
- Pak choi
- Soup with whole vegetables e.g. minestrone
- Chicory, fennel
- Olives
WHAT STARCHY FOODS CAN I EAT?
BREADS AND CEREALS
Foods allowed:
- Rice Krispies®, Cornflakes, Coco pops®, Frosties®, Cheerios®
- White flour, cornflour, rice flour, potato flour
- White bread, rolls, baguettes
- Seedless rye bread
- White pitta bread
- White tortilla wraps
- Crumpets, plain or cheese scones, scotch pancakes
- Croissants, brioche
- Melba toast, crackers and crispbreads (without seeds and grains)
- Rice cakes
- Plain white bagels
- Plain white
Foods to avoid:
- Wholemeal, wholegrain and bran cereals e.g. All Bran®, Branflakes®, Weetabix®
- Cereals containing dried fruit, seeds or nuts e.g. Sultana Bran®, Fruit n Fibre®, Muesli, Crunchy Nut Cornflakes®
- Special K® (all types)
- Oats, porridge, Ready Brek®
- Granola
- Wholemeal flour, wholegrain or granary flour
- Chickpea flour, cornmeal
- Wholemeal, 50/50, granary, malted, seeded or multigrain bread and bread products
- Bran
- Barley, pearl barley, spelt
- Wholegrain or seeded crackers or crispbreads
- Oat cakes
- Cereal bars containing nuts,
- Seeds and fruit
POTATO, RICE AND PASTA
Foods allowed:
- Peeled white or sweet potatoes (boiled, mashed, fried or roasted)
- Plain hash browns
- White rice
- White pasta
- Yorkshire pudding
- Pastry
- Waffles
- Rice pudding
- Couscous, bulgar wheat,
- Quinoa, gnocchi, tapioca, sago
Foods to avoid:
- Skins of jacket potatoes
- Brown and wild rice
- Wholemeal pasta
- Hash browns made with onion
WHAT PROTEIN FOODS CAN I EAT?
MEAT, FISH, POULTRY, EGGS AND MEAT SUBSTITUTES
Foods allowed:
- Most types of fish, meat and meat Products i.e. fresh, frozen, tinned
- Smooth paté and liver sausage
- Eggs
- Tofu
- Quorn
- Soya mince
- Corned beef
Foods to avoid:
- Skin and bones of fish
- Convenience items which contain whole grains and vegetables e.g. onions, peppers
- Coarse paté made with onions
- Avoid Bacon, Sausages, Black/White Pudding
PULSES, NUTS AND SEEDS
Foods allowed:
- It is best to avoid all varieties of pulses, nuts and seeds. If you are vegetarian have a very small portion since these foods are a very good source of protein.
Foods to avoid:
- All varieties of pulses e.g. lentils, chickpeas
- All varieties of beans e.g. borlotti, cannellini, kidney, soya, baked beans and broad beans
- All nuts
- All seeds e.g. sunflower, pumpkin, sesame, poppy
- Peanut butter
- Houmous
WHAT DAIRY FOODS CAN I EAT?
Foods allowed:
- All types of milk e.g. cow’s, goat’s, sheep’s, soya, rice, oat
- Cream, crème fraiche
- Buttermilk
- All types of cheese (without dried fruit and nuts)
- Butter, margarine, spread
- Smooth yoghurt
- Ice cream and sorbet
- Custard
Foods to avoid:
- Cheese containing dried fruit or nuts
- Yoghurt containing whole fruit, nuts or seeds or pips
- Ice cream and sorbet containing nuts, seeds and whole fruits
WHAT SWEET TREATS CAN I EAT?
Foods allowed:
- Cakes made with white flour (without dried fruit or nuts)
- Plain biscuits e.g. Rich tea, shortbread
- Pancakes
- Jelly (without fruit)
- Boiled sweets
- Chocolate (without dried fruit and nuts)
- Toffee
- Jelly sweets
- Marshmallows
- Smooth nougat
Foods to avoid:
- Cakes made with wholemeal or wholegrain flour
- Cakes made with dried fruit and nuts
- Wholemeal and wholegrain biscuits e.g. Digestives, Hobnobs®
- Biscuits containing dried fruit e.g. fig rolls, Garibaldi®
- Hot cross buns, tea cakes, fruit scones
- Cereal bars containing dried fruit and nuts
- Flapjacks
- Jelly made with fresh berries
- Chocolate with nuts and dried fruit
- Nougat made with nuts and dried fruit
WHAT SAVOURY TREATS CAN I EAT?
Foods allowed:
- Crisps
- Plain bread sticks
- Cheese straws
- Mini cheddars or TUC® sandwich biscuits
- Smooth dips e.g. taramasalata, smooth guacamole
Foods to avoid:
- Nuts
- Popcorn
- Bombay Mix
- Dips that contain whole tomatoes, cucumbers, onions e.g. salsa, tzatziki
WHAT CONDIMENTS CAN I EAT?
Foods allowed:
- Tomato ketchup
- Smooth mustard
- Brown sauce
- Worcester sauce
- Soya sauce
- Mayonnaise, salad cream
- Salt and pepper
- Dried herbs
- Powdered spices
- Gravy
- Seedless jam or marmalade
- Lemon curd
- Honey
- Golden syrup, maple syrup
- Marmite®, Vegemite®, Bovril®
Foods to avoid:
- Pickles and relishes
- Chutneys
- Wholegrain mustard
- Stalks and leaves of fresh herbs
- Jam with seeds
- Marmalade with peel
- Salad dressing with wholegrain
- Mustard
On the day of the procedure
You may have as much clear fluids as you like up to 2 hours before your examination. Clear fluid is water, smooth fruit juice (not containing bits), fruit squash, fizzy drinks, tea or coffee without milk.
What happens when I arrive?
When you arrive at Reception you will be asked to take a seat to wait to be called by the admissions nurse. Once in admissions they will explain the procedure and go through your pre assessment to make sure there have been no changes in your health. You will then be asked to get changed and prepared to see the Endoscopist. The Endoscopist will go through a consent form with you and ask you to sign it. The consent may also be obtained by a trained nurse. This is to ensure you understand the procedure and its implications and risks. If you have any worries or questions don’t be afraid to ask. The staff want you to be as relaxed as possible for the procedure and will not mind answering your queries.
A small cannula will be inserted into a vein in your arm which allows access for the doctor to give you the sedative and any other medications that may be required. Some people decline to have this procedure with sedation preferring to use other methods of pain relief such as Entonox (Gas and Air). You may still require a cannula for fluids or anti spasmodic drugs.
You will be given the choice whether to have sedation prior to the test.
During the test
A flexible sigmoidoscopy usually takes 10-15 minutes, although it may take longer if it’s being used to treat a condition.
You will be taken into the examination room, where the endoscopist and the nurses will introduce themselves and you will have the opportunity to ask any final questions.
You will be asked safety questions about you and your health prior to the procedure.
In the examination room you will be made comfortable on a couch, resting on your left side, with your knees slightly bent. A nurse will stay with you throughout the test. A small device will be attached to your finger or thumb in order to record your pulse rate and monitor your general condition during the examination and they will insert a tiny sponge into a nostril to administer oxygen, if required.
The Endoscopist will examine your bottom first with a finger, this is to feel the first few centimetres of the bowel.
When the tube has been gently inserted through the anus into the large bowel, air will be passed through it to give a clearer view of the lining. This may give you some wind-like pains but they will not last long. You may get the sensation of wanting to go to the toilet, but as the bowel is empty, there is no danger of this happening. You may pass some wind but, although this is embarrassing, remember the staff do understand what is causing it. If you are finding you have discomfort you will be offered Entonox (Gas & Air) to help relieve the pain. It usually takes up to thirty minutes for the colon to be examined, but the test sometimes lasts longer. When the examination is finished, the tube is removed safely.
Sometimes the doctor takes a biopsy – a sample of the lining for examination in the laboratory. A small piece of tissue is removed painlessly through the colonoscope, using tiny forceps. It is also possible to remove polyps during the sigmoidoscopy. Polyps are abnormal projections of tissue, which the doctor will want to examine in detail.
After the test, how soon will I recover?
After the test, you will be transferred to the recovery area where you will be continually monitored until safe for discharge, if you had sedation. If you were not given a sedative, you can normally get up straight away. You may feel a little bloated with wind pains but these usually settle quite quickly. Once you have recovered from the procedure, the cannula will be removed (if applicable) and you will be able to get dressed. The nurse will also go through your report and the results of your procedure.
A nurse will take you to the Endoscopy discharge lounge and you will be given refreshments while you wait for your transport home. Once your escort has arrived to collect you from discharge lounge , if you have sedation, your escort will need to sign the discharge form , being the responsible adult who will look after you in the next 12-24 hours.
If you had the procedure without sedation you must still not drive for 45 minutes following your last inhalation of any Entonox.
The effects of the test and injection should have worn off by the next day, however the effects of the sedation can last for 24 hours, so for this time you must not:
- Drive a car
- Operate machinery
- Drink alcohol
- Sign any legal documents
- Be responsible for small children or other dependants
Results
As soon as the examination has finished you will be told the result and what happens next. If biopsies were taken then the results will be sent to your referring Consultant or GP.
Risks
There are some risks associated with this procedure, however serious complications during sigmoidoscopy are very rare. There is a small risk that during the examination a small tear can be made through the bowel wall (perforation). If this occurs you may begin to feel unwell, become nauseous and your tummy may feel hard, swollen and painful. This may lead to a hospital admission and sometimes an operation.
Another risk is bleeding. Care is taken to ensure there is no bleeding after the removal of polyps but as the bowel contracts when the bowels are opened this sometimes causes the area to bleed. You may experience spotting on the toilet paper, this usually subsides. If it continues and bleeding increases contact your GP immediately.
The risk of either of the above is about 1: 10000.
Points to Remember:
- If you are unable to keep your appointment please notify the Endoscopy unit as soon as possible
- It is our aim for you to be seen and investigated as soon as possible after your arrival. However the department is busy and your investigation may be delayed. If emergencies occur, these patients will obviously be given priority over less urgent cases.
- The hospital cannot accept any responsibility for the loss or damage of personal property during your time on these premises.
Concerns
If you have any queries regarding the procedure please contact the endoscopy unit between 8am and 6pm Monday to Sunday and the nursing staff will be happy to give you information or advice.
FOLLOWING THIS PROCEDURE YOU MUST NOT DONATE BLOOD FOR 4-6 MONTHS
The reason for this is that your ability to donate blood in the future is dependent upon your diagnosis and the possibility that you might need to undergo further investigations or complete treatments. (British Society of Gastroenterology, 2019)
Lifestyle changes
If you smoke, stopping smoking will improve your long-term health. Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. Regular exercise should improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.
Summary
A flexible sigmoidoscopy is usually a safe and effective way of finding out if there is a problem with your large bowel. However, complications can happen. You need to know about them to help you make an informed decision about the procedure. Knowing about them will also help to detect and treat any problems early.
Some information, such as risk and complication statistics, is taken from global studies and/or databases. Please ask your doctor for more information about the risks that are specific to you. This document is intended for information purposes only and should not replace advice that your relevant healthcare team would give you.
You are advised against foreign/remote travel in the 2 week period (if you have had a polyp removed) after this procedure; please discuss any concerns with the nursing team.