Sigmoidoscopy Test – Procedure Indications, Purpose, Side Effects & Cost

Indications of Sigmoidoscopy

In general, primary care physicians or gastroenterologist recommend sigmoidoscopy to screen for colon and rectal cancers or the presence of tumours. It is also used to examine or diagnose certain conditions like:

• Diverticula (pouches on the colon wall)
• Haemorrhoids or piles
• Inflammatory bowel diseases like Ulcerative colitis and Crohn’s disease.
• Polyps
• Strictures (narrowing of the lower colon)
• Ulcers (sores)

It can also be used to investigate the following:

• Anaemia due to low iron and blood count
• Annal irritation
• Changes in your bowel habits
• Haematochezia (blood in stool) 
• Lower abdominal pain
  

The gastroenterologist might insert or suggest the patient to insert two enemas 90 minutes prior to the test to clean or empty the colon, or the physician might suggest a laxative (pill or liquid form) two days prior to or the night before the procedure as a part of bowel preparation. If there is any residue in the patient’s colon, the technician might not get a clear picture of the patient’s rectum and colon.

Directions to insert enemas (two):

• The patient should lie on his left side.
• Second, the cap should be removed from the tip of the enema bottle (first enema).
• The third step is to insert the enema bottle's tip gently into the patient’s rectum. 
• The entire contents of the bottle need to be gently squeezed into the patient’s rectum.
• If at all possible, the patient should hold the fluid inside for 15 minutes.
• Sit on the toilet and let it all out.
• Repeat the same process with the second enema.

The physician might suggest the following:

• Don't eat or drink anything solid for 8 hours before the procedure. Only clear liquids such as apple juice, white cranberry, or white grape juice, carbonated or non-carbonated soft drinks, coffee, or tea without milk should be consumed. Non-clear liquids (any liquid which cannot be seen through) such as milk, alcohol, juice with pulp, chicken, vegetable broth and hard candy should be avoided.
• The patient will be advised to stop taking clear liquids 2 hours before the test.
• If a patient was prescribed centrally acting anti-obesity products (weight reducing agents) and iron tablets, the doctor might advise the patient to discontinue their use for 7 days prior to the test. If the patient is on blood thinners, the patient should inform his concerning doctor about the test (sigmoidoscopy), who might suggest the patient specific directions for using blood-thinning medications or stop them till the date of the procedure.
• On the day of the test, if the patient is diabetic, the patient is allowed to take regular morning medicines with water up to 4 hours before the procedure, apart from oral diabetic pills or insulin (as the patient needs to stay for a long time without food). The patient needs to consider his diabetologist prior to the day of the test for advice on diet and diabetic medication.
• It's important for women taking the oral contraceptive pill to know that bowel preparations can inhibit the pill's absorption. The patient needs an extra precaution until her next period starts. 
• The patient will be advised not to bring jewellery and personal items with them to the procedure and not to wear contact lenses.
• The entire procedure and risk (if any) of the sigmoidoscopy will be explained clearly to the patient, and the patient will be provided with a consent form to sign, which gives permission to do the procedure.
  

Before starting the procedure, to have the proper position to insert a sigmoidoscope, the patient will be instructed to lie on his left side on the exam table with his knees drawn up to his chest. The gastroenterologist will check for signs of blood, mucus, or stool by undergoing a rectal exam and then doctor will dilate the patient’s anus gently with a gloved finger (lubricated) and insert a thin lubricated tube (sigmoidoscope) slowly into the patient’s anus and advance into the rectum and lower colon. Most people will be fine without sedatives or pain relievers. 

The sigmoidoscope is equipped with both a light and a tube, allowing the doctor to inject air into the patient's colon in order to see its lining more clearly. The use of a suction device is an option used for cleaning up liquid faeces.

The gastroenterologist can combine a sigmoidoscopy with either an anoscopy (to examine the patient’s anus) or a proctoscopy (to examine the patient’s colon). Additionally, the tip of the sigmoidoscope is equipped with a mini video lens (camera). This transmits images to an external monitor, which helps the physician to view the inside of the patient’s colon. Tissue samples (using a special brush, forceps or a swab) can be taken by inserting instruments through the sigmoidoscope as well.

The sigmoidoscopy typically takes 15 to 30 minutes, but additional time may be needed if biopsies are performed. If a polyp is discovered in the lower part of the large intestine, a full colonoscopy will be recommended to check for any additional polyps that may be further up the colon.

Slight discomfort is to be expected during a sigmoidoscopy. After the tube is inserted, the patient may feel a sudden urge to have a bowel movement. In addition, the patient might experience brief muscle spasms or stomach pain while taking the examination (if the patient was not sedated). Deep breathing during tube insertion may help to alleviate the discomfort.



After inserting the sigmoidoscope as far as it is necessary, the doctor will slowly remove it while paying close attention to the colon's and rectum's curved surfaces.