Flexible sigmoidoscopy

Flexible sigmoidoscopy is a very useful exam to have available for the outpatient clinic. It allows examination of the rectum and lower colon in patients with rectal bleeding, diarrhea, or an existing diagnosis of polyps and cancer. The keys to an informative examination include a preparation with two fleet enemas, and a focus on patient comfort. This examination is intended to be performed without sedation and so once it becomes painful for the patient it has to stop. The pain is usually from trying to pass around a tight loop at the rectosigmoid or higher up the sigmoid, or from inserting too much air. The extent of the examination depends on how high the enemas reached and how tortuous is the bowel.

Techniques for flexible sigmoidoscopy are very similar to those described in the section on colonoscopy. It is possible to perform polypectomy during the flexible sigmoidoscopy but extensive polypectomy either in size or number of the polyps should be done in an endoscopy suite where sedation can be given and where there is the capacity to deal with hemorrhage.