A flexible sigmoidoscopy is a standard medical procedure used to examine the rectum and part of the large intestine (colon). During the procedure, a healthcare professional inserts a flexible tube with a camera into the anus, guiding it through the rectum, sigmoid colon, and part of the descending colon. This allows them to visualize irregular tissues, such as cancer or polyps. Sigmoidoscopy is also used to screen for colon cancer or polyps that can lead to cancer. The Preventive Services Task Force recommends a first screening at age 45, with screenings every five years until age 75. People with a higher risk of colon cancer may have a first test at age 40.
Before undergoing a flexible sigmoidoscopy, it's essential to properly prepare your colon to ensure a clear view for the healthcare professional. This preparation involves dietary restrictions and bowel cleansing, which are crucial for an accurate examination. A good prep means your bowel is empty and clear. Without a good prep, your gastroenterologist will not be able to see your colon clearly.
Dietary Guidelines Before Your Flexible Sigmoidoscopy
To ensure the success of your flexible sigmoidoscopy, it's crucial to adhere to specific dietary guidelines in the days leading up to the procedure. These restrictions help clear your colon and allow for a better view during the examination.
One Week Before Your Procedure
- Ask about your medications: Talk with your healthcare provider about which medications are safe for you to stop taking.
- Discontinue Certain Foods: Stop eating corn, popcorn, frozen corn, seeds, or nuts of any type, as these foods are difficult to clean from your colon.
- Stop Iron Supplements: Refrain from taking any iron supplements, as they may discolor your colon.
Three Days Before Your Procedure
- Avoid Certain Supplements: Stop taking Vitamin E, fish oil, mineral oil, or flaxseed oil, as these can cause bleeding.
- Purchase Enemas: Buy two bottles of Fleet enemas at a pharmacy or grocery store.
The Day Before Your Procedure
- Clear Liquid Diet: Starting the day before your procedure, follow a clear liquid diet. This includes only liquids you can see through, such as water, coffee, tea, broth, sodas, apple juice, Gatorade, Kool-aid, Jell-O, popsicles, and hard candy. Do not drink liquids that are not clear, such as milk, or liquids that are red or purple in color.
- Hydration: It is important to drink extra clear liquids before your prep to maintain adequate hydration.
- Medication Adjustments: If you take oral medications for diabetes, do NOT take your diabetes pills on the day prior to your procedure (prep day) or on the day of your procedure (until your procedure is complete and you resume a normal diet). If you take non-insulin injectable medications (Byetta, Bydureon, Victoza, Trulicity, Tanzeum, Symlin), do not take the medication if your injection day is the day prior to your procedure (prep day). You can resume it after the procedure is complete. If you take insulin, reduce your dose by 50% (half) of your normal dose on the day prior to your procedure and the day of your procedure. You can resume your normal dose after the procedure when you resume normal diet. If you use an insulin pump, contact your diabetes doctor for instruction.
- Carbohydrate Intake: You should aim for 45-60 grams of carbs with each meal. Although you may ordinarily avoid sugars, they are ok to take when you are prepping for your colonoscopy as these will be the main source of calories when you are on a clear liquid diet. For snacks, try to include other fluids that contain electrolytes such as broth. Note, if you experience low blood sugar (<60) during the 2 hours before your procedure, you can take 3 teaspoons of soda or clear juice to raise your sugar.
- Evening Prep: The day before your procedure you may have your usual food until 6:00 pm. At 7:00 pm drink 1/2 of the prep that was sent to your pharmacy. Clear liquids only from 6:00 pm until midnight if your appointment is in the morning. For afternoon appointments, you may have clear liquids until 8:30 am the day of your procedure.
- Nothing to eat: Do not eat anything after the time specified by your doctor.
The Day of Your Procedure
- Enemas: Administer the two enemas at least ONE HOUR before you leave home to come here. If you will drive over an hour to get here, you may wait until you are here to do the enemas.
- Clear Liquids: Drink clear liquids while you prep up until 3 hours before your procedure.
- Medications: Take any morning medications you need (but not any of the supplements listed above).
- Diabetes Management: Take special care while only drinking clear liquids! Monitor your blood sugar every 4 hours during your prep time before your colonoscopy. If you have an insulin pump: Maintain pump as usual and bring all pump equipment and supplies as well as continuous glucose monitor on the day of the procedure. Oral diabetic medications: Please hold all oral diabetic agents the morning of the procedure. Metformin: Hold the night before and the day of the procedure. GSLT2i: (Canagliflozin,Dapagliflozin,Empagliflozin): hold 3 days prior to the procedure. GLP1R: agonists (Ozempic, Wegovy): Hold oral dose the morning of surgery. Hold weekly injections 1 week(7 days) prior to the procedure. Insulin: Hold all short acting insulin when on the liquid diet (1- or 2-day colon prep). Decrease the long-acting Insulin 50% the days you are doing the prep/liquid diet. Take 50% of the normal long-acting dose of insulin on the day of the procedure IF YOU TAKE A MORNING DOSE. Do Not Take short acting insulin on the days of prepping/liquid diet or day of the procedure. Taking any of the following GLP-1 medications for Diabetes, weight loss, or any other reason? If taking once daily, stop taking 2 days before procedure. If taking once weekly, stop at least 7 days before procedure: Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide, Tirzepatide. Unless otherwise instructed by your physician
- Arrival Time: Please arrive 60 minutes before your appointment time.
Bowel Preparation Instructions
In addition to dietary restrictions, bowel preparation is crucial for a successful flexible sigmoidoscopy. This involves using enemas to clear the colon of any remaining stool.
Using Fleet Enemas
- Preparation: Take the protective cap off the enema bottle. Apply Vaseline petroleum jelly to the area around your anus.
- Administration: Lie on your left side. Gently insert the enema tip into your rectum with a slight side-to-side movement, pointing the tip toward your navel. Insertion may be easier if you bear down as if having a bowel movement.
- Application: Squeeze the bottle until nearly all the liquid is gone.
- Retention: Keep lying on your left side and hold the liquid in your rectum until you feel the urge to move your bowels.
- Repeat if Necessary: If you see any stool (poop) in the toilet, fill the enema bottle with room temperature tap water and repeat the steps above. Repeat the enema until you don’t see any stool.
Medications and Medical Conditions
It's essential to inform your healthcare provider about any medications you're taking, as some may need to be adjusted or temporarily discontinued before the procedure.
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Blood Thinners
If you take blood thinners (Plavix®, warfarin, Eliquis®, Xarelto®, etc.) and haven’t been given directions to stop them by our office or your prescribing physician’s office, please call to clarify. The Anticoagulant Clinic should call you if you take a blood thinner such as Warfarin/Coumadin, Eliquis/Apixaban, Xarelto/Rivaroxaban or Pradaxa/Dabigatran. If they haven’t by fourteen days prior to the procedure, call 720-723-6756. If you are on Plavix/Clopidogrel, Brilinta/Ticagrelor, Pletal/Cilostazol, Aggrenox/Aspirin with Dipyridamole or Prasugrel/Effient, you should receive a call from the GI Department at least fourteen days prior to the procedure. If you don’t, please call 720-723-6166. If you are on a medication to thin your blood (an anticoagulant or antiplatelet), do not stop your blood thinning medications until you hear from our office. We will contact your physician who prescribes this medication for instructions and notify you.
Diabetes
If you have diabetes or take any weight loss/diet medication, take special care while only drinking clear liquids! Monitor your blood sugar every 4 hours during your prep time before your colonoscopy. If you have an insulin pump: Maintain pump as usual and bring all pump equipment and supplies as well as continuous glucose monitor on the day of the procedure. Oral diabetic medications: Please hold all oral diabetic agents the morning of the procedure. Metformin: Hold the night before and the day of the procedure. GSLT2i: (Canagliflozin,Dapagliflozin,Empagliflozin): hold 3 days prior to the procedure. GLP1R: agonists (Ozempic, Wegovy): Hold oral dose the morning of surgery. Hold weekly injections 1 week(7 days) prior to the procedure. Insulin: Hold all short acting insulin when on the liquid diet (1- or 2-day colon prep). Decrease the long-acting Insulin 50% the days you are doing the prep/liquid diet. Take 50% of the normal long-acting dose of insulin on the day of the procedure IF YOU TAKE A MORNING DOSE. Do Not Take short acting insulin on the days of prepping/liquid diet or day of the procedure.
Other Medications
Using a small amount of water, take your prescription medications as you usually do unless you have been instructed to hold the medication prior to the procedure. It is very important that you take your blood pressure or heart medication as usual.
What to Expect During and After the Procedure
During the Exam
Anesthesia and pain medicines usually aren't necessary. During a sigmoidoscopy, the examiner inserts the tube into the anus and guides it through the rectum, sigmoid colon and most of the descending colon on the left side of the body. The sigmoidoscope tube allows the healthcare professional to place air with carbon dioxide into your colon. This expands the colon to provide a better view of the colon lining. The sigmoidoscope also contains a tiny video camera at its tip. The camera sends live images of the colon to a screen like a computer monitor. A flexible sigmoidoscopy typically takes about 15 to 20 minutes.
After the Exam
After the exam, you may have mild discomfort around your belly. You may feel bloated or pass gas for a few hours. You should be able to return to your usual diet and activities right away.
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Results
Some results of a sigmoidoscopy can be shared right after the test. Some results may require lab studies. If polyps or biopsies were taken, they will be sent to a lab to be examined by a specialist. Specimens: During your procedure, specimens (biopsies, Clo tests, or stool samples) may be taken. These specimens are sent to an outside pathologist, hospital, or lab for processing. If your procedure requires specimens, you will be billed for these services from the respective pathologist, hospital, or lab. Please let us know if your insurance company requires you to use a certain pathology doctor, hospital, or lab. We will ask you for this information.
Important Reminders
- Transportation: You will be sedated and you will have to have someone available to listen to the doctor’s advice upon discharge and drive you home after the test. A responsible adult will need to drive you home. Taxis, Ubers, buses, medical ride services, or walking are not options unless a responsible adult accompanies you. You will not be able to drive for the rest of the day.
- Arrival: Please plan to arrive 60 minutes before your appointment time.
- Procedure Duration: Plan on being at our facility for about 1 1⁄2 hours from arrival to departure (although this may vary depending on the day/procedure/location - ex. approx.
- Rescheduling: If you are unable to keep your appointment, please call at least 3 business days prior to your procedure to reschedule.
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