Flexible Sigmoidoscopy (West Mid site)

What is a flexible sigmoidoscopy?

A Flexible Sigmoidoscopy is a test where a long, flexible telescope called an endoscope is passed into the anus (back passage), allowing the endoscopist to directly view the lining of the last part of the large bowel.

Sometimes a biopsy—a tissue sample—is taken for laboratory analysis. This tissue is removed through the endoscope using tiny forceps and is not painful. The whole procedure usually lasts between 10–15 minutes.

What are the risks and benefits?

The benefit of this procedure is that it helps to investigate your symptoms and may assist in your treatment.

Flexible Sigmoidoscopy carries an extremely small risk of bleeding or a tear in the lining of the bowel (perforation occurs in approximately 1 in 2,500 cases), which may require urgent treatment, a blood transfusion, or surgery.

What should I do before my test?

Please stop taking iron tablets and bulking agents (such as Regulan or Fybogel) one week before the test. If you are taking any of the following medications, please inform the preassessment nurse or a member of the endoscopy team for further instructions:

• Warfarin, rivaroxaban, apixaban, dabigatran, edoxaban
• Clopidogrel, prasugrel, ticagrelor
• Aspirin
• Any other medication used to thin the blood (anti-coagulant)

Unless advised otherwise, you should take all other usual medications normally with a few sips of water. If you are diabetic, please let us know in advance.

You may eat and drink normally before the procedure.

You will need to take an enema approximately 1–2 hours before attending for your procedure, which you will need to administer it at home.

The enema, a Phosphate Enema, is available over the counter at a chemist and usually costs about £2. Alternatively, you can collect the enema from the Endoscopy Unit in advance of your appointment. Please call us in advance if you would like to collect your enema from our unit.

Enemas are safe and easy to use. They clean the lower half of your large bowel (sigmoid colon) to ensure a clear view during your flexible sigmoidoscopy. Most people find it convenient to use the enema at home.

If do not think you can do this yourself, please ring the Endoscopy Unit on 020 8321 5191/5752 and we will arrange for you to come in earlier on the day of your test to have it here.

Please speak to a member of staff if the following applies to you:

• If you have been diagnosed with an inflammatory or ulcerative bowel condition like Crohn’s or Colitis.
• Your doctor has asked you to limit your sodium (salt) intake.

You will need the following:

• Phosphate Enema
• Jug or bowl of warm tap water
• Towel
• Bed or sofa to lie on

How do I get ready to use the enema?

• Do not eat for at least 30 minutes before using the enema.
• Make sure you can get to a toilet easily.
• Find a comfortable place to lie down.
• Have a towel to lie on.
• Warm the enema in a bowl or sink of warm water.
• Read the instructions on the packet/tube carefully.
• Use the enema even if you have diarrhoea or have recently passed a bowel motion.

When do I use the enema?

• Use it at least one to two hours before leaving home for your test.
• It will work after a few minutes but stay near a toilet for the next hour because you may need to open your bowels more than once.
• The effects of the enema will wear off after one hour at most.

How do I use the enema?

1. Once you have warmed the enema in a bowl or sink of warm water, pull the lid off the nozzle. Hold the bottle upright so the contents do not spill.
2. The nozzle is already lubricated, but you can put on more lubricating jelly if you like.
3. Lie on your left hand side, on the towel, with your knees bent up toward your chest as far as comfortable.
4. Gently push the nozzle about 7cm (3in) into your back passage (anus). This should not be painful, if you feel any resistance or pain please do not continue
5. Slowly squeeze the bottle until all the contents are in. Remove the nozzle once you have finished and stay lying down.
6. Try to hold the liquid in your bottom for as long as you can – ten minutes, if possible.
7. Go to the toilet when you can no longer hold it and you really feel like emptying your bowels.
8. Stay near the toilet for the next hour, you might need to open your bowels more than once.
9. Some people have stomach cramps for a short time after using the enema.
10. Occasionally, you can feel faint or dizzy. If this happens, lie down until you feel better.
11. If you have no response to the enema – do not worry. Come into hospital normal and we can always give another enema if necessary.

Note: If you feel that you cannot give the enema yourself then please inform the Endoscopy unit.

What will happen when I come in?

On arrival to the endoscopy unit please report to reception where the receptionist will check your personal details. You will be asked to take a seat in the waiting area until you are collected by a nurse, and taken through to one of our admission rooms.  You do not need to bring anyone with you to your appointment, unless they are acting on your behalf e.g. interpreting for you.  Please leave any valuables at home, as we cannot be responsible for any valuables lost whilst you are in the unit.

On admission a nurse will review your pre-assessment form (Medical history and current medications) that you should have completed online or over the telephone.  We will take your blood pressure, pulse and ask you to get changed into a gown and dignity shorts. Dignity shorts are specially designed to maintain patient modesty before, during and after a procedure.

Prior to the test you will be seen by the Endoscopist doing the test for you. This is an opportunity to discuss the test before you sign a consent form. Please ask any questions you may have. It is important that you understand what is going to happen.

What can I expect during my test?

In the procedure room you will lie on a trolley (narrow bed), on your left side. Two nurses and the endoscopist will stay with you throughout the test. The test should not cause you pain, but may be uncomfortable.

The Endoscopist will perform the flexible sigmoidoscopy by passing the endoscope into your bottom. During the test air is passed through the endoscope into your bowel to expand it, so the doctor has a clear view of the lining of your bowel. This may give you some wind like pain and may also make you need to pass wind. Although this may be embarrassing, it is normal and the air is sucked out at the end of the test. You may also get the sensation of wanting to go to the toilet, but as the bowel is empty, there is no danger of this happening. This sensation is normally due to the air we have pumped in. 

The test can cause some discomfort and cramping as air is placed into your bowel, however most people tolerate the procedure without any problems.

How long will I be in the endoscopy unit?

The whole procedure usually takes 10-15 minutes; however please expect to be in the department for 1-2 hours – having pre-procedure checks, the procedure and for recovery after the procedure. 

Please note your appointment time in Endoscopy is approximate because some procedures may take longer than expected and emergency procedures need to take priority.

Will I get the results of my test on the same day?

Before you go home you will be given the results of the test. It will also say whether you need an appointment with a consultant or with your GP. Your GP will receive a copy of the report of the examination from the hospital. If biopsies were taken these results take longer and will be sent to your consultant and GP.

What happens to my medications?

We will talk to you before you go home about any changes/additions to your medications.

After you go home

You may experience bloating and stomach discomfort for a few hours after the test. This is because of the air that is used to expand and inflate your bowel during the test. These symptoms are often relieved by passing the wind.

If you have had a polyp removed or a biopsy, you may experience a little bleeding from your back passage.

Some patients have told us that they experience discharge from their back passage or an urgent need to open their bowels after the procedure. You may therefore like to bring a change of underwear to your appointment.

If the pain continues or are passing large amount of blood, or you have concerns or questions, please contact the Endoscopy Unit from 8am–6pm on 020 8321 2585/5191 - after 6pm call 020 8560 2121 and ask for the on call gastroenterologist.

This leaflet has been written by the staff working in the Endoscopy Unit at West Middlesex University Hospital. We hope you find it useful. If, after you have read it, you have any questions or concerns; please contact us on 020 8321 2585/5191. 

If you would like to change your appointment time or date please contact the endoscopy booking team on 020 8321 5752 or email us chelwest.endoscopy.westmid@nhs.net

How to find us

The Endoscopy Unit is located on the ground floor of the Main Hospital Building in the East Wing.