What is Flexible Sigmoidoscopy?

Flexible sigmoidoscopy is a minimally invasive procedure used to examine the lower part of your colon, specifically the rectum and sigmoid colon. This is achieved using a flexible sigmoidoscope, a thin, flexible tube equipped with a light and a tiny camera. The sigmoidoscope is gently inserted into the rectum, allowing the doctor to visualize the lining of the colon on a monitor.

Think of it as a focused inspection of the lower colon, allowing doctors to identify potential problems like inflammation, ulcers, or polyps (abnormal growths). While it doesn't examine the entire colon like a colonoscopy, it's a valuable tool for screening and diagnosing certain conditions, especially those affecting the rectum and sigmoid colon.

Key Facts:

• Examines the rectum and sigmoid colon (lower colon).
• Uses a flexible tube with a camera.
• Helps detect early signs of colon cancer and other conditions.
• Generally takes 15-30 minutes.
• Usually performed by a gastroenterologist.

Why is Flexible Sigmoidoscopy Performed?

Flexible sigmoidoscopy is performed for various reasons, including both screening and diagnostic purposes. Your doctor may recommend it for the following:

Main Conditions/Indications:

• Screening for Colon Cancer: Particularly for individuals over 50 or those with increased risk factors for colon cancer.
• Rectal Bleeding: To identify the source of the bleeding.
• Changes in Bowel Habits: Such as persistent diarrhea, constipation, or changes in stool consistency.
• Abdominal or Pelvic Pain: To investigate potential causes in the lower colon.
• Unexplained Weight Loss: As a part of a comprehensive diagnostic workup.
• Detecting and Removing Polyps: Identifying and removing potentially precancerous polyps.
• Diagnosing Conditions: Such as colitis (inflammation of the colon), proctitis (inflammation of the rectum), diverticulitis (inflammation of pouches in the colon), strictures (narrowing of the colon), and ulcers.

When Doctors Recommend It:

Doctors typically recommend flexible sigmoidoscopy when you experience persistent symptoms related to your lower digestive tract or when you are due for routine colon cancer screening, based on age and risk factors. It's a less invasive alternative to colonoscopy for examining the lower colon, but a colonoscopy may be recommended if abnormalities are found or if a more complete examination is needed.

Preparation for Flexible Sigmoidoscopy

Proper preparation is crucial for a successful and accurate flexible sigmoidoscopy. The aim is to ensure your colon is clear of stool, allowing for a clear view of the lining.

Essential Preparation Steps:

• Bowel Preparation: This is the most important step. You will likely need to:
  • Follow a liquid diet: For 1-2 days before the test. Clear liquids include water, clear broth, clear juice (apple, white grape), and black tea or coffee (no milk or cream). Avoid red or purple-colored liquids.
  • Take laxatives: Your doctor will prescribe a laxative, either in pill or liquid form, to be taken the night before the procedure. Follow the instructions carefully.
  • Use enemas: You'll likely need to administer one or two enemas a few hours before the procedure. Instructions will be provided.
• Dietary Restrictions: Stick to the liquid diet and avoid solid foods as instructed.
• Medications:
  • Inform your doctor: About all medications you are taking, including over-the-counter drugs, vitamins, and herbal supplements.
  • Blood thinners, aspirin, and iron supplements: These may need to be adjusted or temporarily stopped before the procedure. Your doctor will provide specific instructions. Iron supplements should generally be stopped 1-2 weeks prior.
  • Diabetes medication: If you have diabetes, your medication dosage may need to be adjusted. Discuss this with your doctor.
• Fasting: You may need to avoid eating or drinking anything after midnight before the procedure. Clarify the specific fasting instructions with your doctor.

India-Specific Tips:

• Fasting: Be mindful of the fasting period, especially if you have diabetes or other medical conditions. Discuss any concerns with your doctor.
• Documents: Carry your Aadhaar card and any relevant medical records, including previous test results and medication lists.
• Hospital Choice: If you have the option, choose a hospital with experienced gastroenterologists and a good reputation for endoscopic procedures.
• Insurance: Check with your insurance provider to understand the extent of coverage for flexible sigmoidoscopy.
• Communicate Clearly: Don't hesitate to ask your doctor any questions you have about the preparation or the procedure itself.

What to Expect:

The preparation process can be uncomfortable due to the liquid diet, laxatives, and enemas. However, it's essential for a successful procedure. Plan to stay home during the bowel preparation process, as you will need frequent access to a toilet.

The Flexible Sigmoidoscopy Procedure

Here's a step-by-step guide to what happens during the flexible sigmoidoscopy procedure:

Step-by-Step:

1. Arrival and Preparation: You'll arrive at the hospital or clinic and be asked to change into a gown.
2. Positioning: You will lie on your left side on the examination table, with your knees drawn up towards your chest.
3. Insertion of the Sigmoidoscope: The doctor will gently insert the flexible sigmoidoscope into your rectum.
4. Advancement and Inflation: The scope is advanced through the rectum into the sigmoid colon. Air is gently pumped through the scope to inflate the colon, providing a better view of the lining.
5. Examination: The doctor examines the lining of the rectum and sigmoid colon on a monitor connected to the camera on the sigmoidoscope.
6. Biopsy or Polyp Removal (if necessary): If any abnormalities, such as polyps or areas of inflammation, are found, the doctor can pass instruments through the scope to take tissue samples (biopsies) or remove polyps.
7. Withdrawal of the Sigmoidoscope: Once the examination is complete, the sigmoidoscope is slowly withdrawn.

Duration and Comfort Level:

The procedure typically takes 15-30 minutes. You may experience some cramping, bloating, or the urge to pass gas during the procedure, especially when air is introduced into the colon. It's important to relax and breathe deeply to minimize discomfort. While some individuals find it slightly uncomfortable, it is generally not painful. Sedation is usually not required but can be offered in some cases to reduce anxiety.

What Happens During the Test:

During the test, the doctor is carefully inspecting the lining of your lower colon for any signs of abnormalities. They are looking for:

• Polyps: Abnormal growths that can potentially become cancerous.
• Inflammation: Indicating conditions like colitis or proctitis.
• Ulcers: Sores in the lining of the colon.
• Diverticulitis: Inflammation or infection of pouches (diverticula) in the colon wall.
• Strictures: Narrowing of the colon.
• Bleeding: Active bleeding or signs of previous bleeding.

If any abnormalities are found, the doctor will take biopsies or remove polyps for further examination in the laboratory.

Understanding Results

After the flexible sigmoidoscopy, the doctor will usually discuss the initial findings with you.

Normal vs. Abnormal:

• Normal: A normal result means that the lining of your rectum and sigmoid colon appeared healthy, with no signs of polyps, inflammation, ulcers, or other abnormalities.
• Abnormal: An abnormal result indicates the presence of one or more of the conditions mentioned above.

What Results Mean:

• Polyps: If polyps are found, they will be sent to a laboratory for analysis to determine if they are precancerous or cancerous. Depending on the size, type, and number of polyps, your doctor may recommend a colonoscopy to examine the entire colon.
• Inflammation: Inflammation may indicate colitis or proctitis. Biopsy samples will help determine the cause of the inflammation, such as infection, inflammatory bowel disease (IBD), or other conditions.
• Ulcers: Ulcers can be caused by various factors, including infection, IBD, or certain medications. Biopsy samples will help determine the underlying cause.
• Diverticulitis: If diverticulitis is found, your doctor will recommend treatment options, such as antibiotics or dietary changes.

Next Steps:

• Colonoscopy: If polyps are found during the sigmoidoscopy, your doctor may recommend a colonoscopy to examine the entire colon. This is because polyps can occur in other parts of the colon as well.
• Biopsy Results: Biopsy results usually take a week to 10 days to come back. Your doctor will discuss the results with you and recommend any necessary treatment or follow-up.
• Treatment: Depending on the findings, your doctor may recommend medication, dietary changes, lifestyle modifications, or further procedures.
• Follow-up: Regular follow-up appointments may be necessary to monitor your condition and ensure that treatment is effective.

Costs in India

The cost of flexible sigmoidoscopy in India can vary depending on several factors.

Price Range in ₹:

• The cost can range from approximately ₹2,200 to ₹15,000.
• In Tier-1 cities like Mumbai, Delhi, and Bangalore, the cost might be on the higher end of this range (₹8,000 to ₹15,000).
• In Tier-2 cities, the cost may be slightly lower. For example, in Hyderabad, it may range from ₹2,500 to ₹10,000.
• The average cost is often quoted around ₹11,500.

Government vs. Private:

• Government Hospitals: Flexible sigmoidoscopy may be more affordable in government hospitals, but there may be longer waiting times.
• Private Hospitals and Clinics: Private hospitals and clinics generally charge more, but offer quicker access and potentially more specialized care.

Factors Affecting Cost:

• Hospital or Clinic Charges: Different hospitals and clinics have different pricing structures.
• Doctor's Fee: The doctor's experience and reputation can influence the fee.
• Anesthesia or Sedation Fees: If sedation is used, there will be an additional fee.
• Equipment and Test Charges: The cost of the sigmoidoscope and other equipment, as well as any related tests, will be factored into the total cost.
• Biopsy and Lab Analysis: If biopsies are taken, the cost of lab analysis will be added.
• Follow-up Consultations: The cost of follow-up consultations with the doctor.
• Patient's Overall Health: Pre-existing conditions can affect the complexity and cost of the procedure.
• Room Type: If admission is required, the type of room (e.g., general ward vs. private room) will impact the cost.

Insurance Tips:

• Check Coverage: Before undergoing the procedure, check with your health insurance provider to understand the extent of your coverage for flexible sigmoidoscopy.
• Pre-Authorization: Some insurance companies require pre-authorization for certain procedures. Make sure to obtain pre-authorization if required.
• Cashless Facility: If possible, opt for a hospital that offers a cashless facility with your insurance provider.
• Reimbursement: If cashless facility is not available, you may need to pay upfront and then claim reimbursement from your insurance company.

How Ayu Helps

Ayu helps you manage your health records securely.

• Store Results Digitally: You can securely store your flexible sigmoidoscopy results, including reports and images, within the Ayu app.
• Track Over Time: Track your results over time to monitor your health and detect any changes.
• Share via QR Code: Easily share your records with your doctor or other healthcare providers using a secure QR code.

FAQ

Q: Is flexible sigmoidoscopy painful?

A: Most people experience some discomfort, such as cramping or bloating, but it is generally not painful. Sedation is usually not required but can be offered in some cases.

Q: How long does the procedure take?

A: The procedure typically takes 15-30 minutes.

Q: What are the risks of flexible sigmoidoscopy?

A: Flexible sigmoidoscopy is generally a low-risk procedure. Possible risks include bleeding, perforation (tear in the colon wall), infection, and abdominal discomfort. However, these complications are rare.

Q: How do I prepare for the procedure?

A: You will need to follow a liquid diet for 1-2 days before the test, take laxatives the night before, and administer enemas a few hours before the procedure. Your doctor will provide detailed instructions.

Q: What if polyps are found?

A: If polyps are found, they will be sent to a laboratory for analysis. Your doctor may recommend a colonoscopy to examine the entire colon.

Q: How soon will I get the results?

A: The doctor will usually discuss the initial findings with you immediately after the procedure. Biopsy results usually take a week to 10 days to come back.

Q: Is flexible sigmoidoscopy covered by insurance in India?

A: Coverage varies depending on your insurance policy. Check with your insurance provider to understand the extent of your coverage.

Q: When should I contact my doctor after the procedure?

A: Contact your doctor if you experience severe abdominal pain, fever or chills, heavy rectal bleeding, or weakness or dizziness.