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First time having Flexible Sigmoidoscopy.. advice?

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Posted 1/6/2016 3:49 PM (GMT 0)
Hey there,

I'm very nervous as after over four years of symptoms including constipation, frequent bowel movements, abdo pain, rectal pain, and constant gas (as well as one bm which seemed to just be blood but not 100% sure whether related), I finally got referred to a gastro.

The hospital I was at seemed nerve wracking as the appt was running 50 mins late and there was so many people I was on edge but the nurse seemed nice enough. She's decided that after four years of symptoms of 'suspected IBS', she recommends that I have a flexible sigmoidoscopy, if only at the very least because my brother has UC. Although I definitely haven't had any symptoms to the level of severity he had, I have had previous GP's mention that 'perhaps' I had borderline colitis or something so who knows.

Anyway, my main concern going in was bowel cancer, which they didn't completely poo-poo, but she said at 30 it's unlikely (plus she said symptoms can be pretty variable and generally more extreme after 4 years - or I'd not be around anymore, which I imagine to be the case if I was indeed suffering from the big C).

Anyone have any advice for me? She's allowed me to have the sigmoidoscopy instead of a colonoscopy as atm I live in shared accommodation and can't really use the bathroom constantly with other people in the house at all times. So she's suggested I take an enema when I get to the hospital before the procedure, of which I am welcome to be sedated for, but she said a lot of people don't have sedation or anything??? I don't really know what to expect - both my mother and bro have had the full colonoscopy, and my mother said she didn't even feel it happening at the time, where as the nurse has said i may feel very uncomfortable and it might hurt.

I've also finally just had blood tests checking my blood markers for inflammation?? So hopefully that'll come back with news one way or another - is it generally a good way of determining UC?

What are other obvious symptoms that I could be missing? I've always thought I was more likely to have IBS just simply for the fact the doctor's for four years have told me so!! What can I expect after the procedure also?

Thanks, and sorry for all the questions! I do tend to worry too much cry
Posted 1/6/2016 4:22 PM (GMT 0)
Hi LuSmith. IBS is probably most of the symptoms you are describing minus the blood as it is no disease involved I don't think, Irritable Bowel Syndrome. I've had a couple of sigmoidoscopes and way more colonoscopies which you are sedated for. At my gastroenterologist office I've had sigmoidoscopes without sedation. I've actually watched it being done as you are awake. It is not really that painful, it is crampy due to the air from the scope inside your colon. Causes gas. I've always had to clean out with way more than an enema for both though. But under your circumstances I can understand as it can get smelly. I live with UC and have had it for 29 years, since 1986, never have I had the issues with constipation with mine, especially when I have flareups. I haven't really had a flareup in years, thought I was in a mild one now and may be but was diagnosed with something else so I'm not sure now. I've always had the urgency issues, barely able to get to the bathroom, wasn't many times, when mine was the worst, was a combination of brown, watery, bloody looking and runny, sorry to be so graphic, you may also notice a whitish mucous substance. Frequent bm's, abdominal pain, rectal pain can be signs of UC also. Good they are going to do a scope, they will take some biopsies probably also, I have to have a colonoscopy every two years, and the gastro doctor can see things immediately, as to inflammation, by viewing your colon, wondering where exactly your abdominal pain is, mine is confined to the lower left area, sigmoid colon and the rectum. The colonoscopy you are totally asleep for with sedation and are awake right after the procedure. The worst is always the prep. As for the bloodwork being a good way to determine UC, I'm not sure, I have bloodwork done there but not every time I go, I probably will tomorrow because of my problem now. Hope this answered some of your questions.
Posted 1/6/2016 4:36 PM (GMT 0)
Generally, you are given two fleet enemas as preparation for the procedure. Fleet has salt water in it. I take one two hours before the procedure and another an hour before. It's a laxative and makes you clean out.

The sigmoidoscopies I've had numerous of, all unsedated. It's a 10 minute procedure (much longer for you as sedation is involved). There is no pain, unless you're badly inflammed (as typical of a severe ulcerative colitis flare). The scope puffs air in your bowel. A large intestine is collapsed when empty, much like a clean sock. The air puffs enables them to see better. You can feel the air during and after the procedure. Afterwards, there might be some minor discomfort until you fart that air out. I always sit on the toilet afterwards and try to pass as much as I can before heading home. Due to the sedation, your memory is bound to be a bit hazy/fuzzy. So, it's helpful to have someone else able to listen to the doctor's immediate follow-up after the procedure. Due to the sedation, you'll need to have someone else drive you home.
Posted 1/6/2016 5:30 PM (GMT 0)
I had my first flex sig about 7 months ago. Without sedation or gas and air which I was offered. I got the impression from the nurse that people did opt for sedation but I would have had to get picked up, stay for hours after etc and quite frankly after having 2 kids fairly recently not much bothers me now lol!!
I had a prep to drink 2 days before and one the night before. They were ummm... Effective!! However, actually given the awful symptoms I was having it was a bit of a relief as it was just pure water in the end. No mucus, no blood!
The nurses were lovely. The whole thing took 15 mins max maybe. It was uncomfortable at times but only as the air they pump in makes you want to go and naturally we try stop that from happening but once they said I was totally empty, let it go.... It was fine. Bit uncomfortable when they switched the sig to the other side. Took loads of biopsies which I could see but never felt a thing which is odd as you can see them tugging at the tissue!
I was diagnosed then and there whilst still on the table, wheeled to a recovery room, encouraged to go to toilet and let air pass. Free to go when I wanted. Drove home no issues. Doc rang that afternoon did me a prescription and I had relief within a week.
So overall, do the prep they ask. Don't hold back, let the air out, you will be empty! Not the most glamorous 15mins of your life but very bare able!! Good luck
Posted 1/6/2016 6:05 PM (GMT 0)
to make it easier
I would avoid eating things like nuts, seeds, corn and whole grains for a few days before the scope
this will make sure you are cleaner for the procedure
Posted 1/6/2016 10:02 PM (GMT 0)

at wit's end said...
Hi LuSmith. IBS is probably most of the symptoms you are describing minus the blood as it is no disease involved I don't think, Irritable Bowel Syndrome. I've had a couple of sigmoidoscopes and way more colonoscopies which you are sedated for. At my gastroenterologist office I've had sigmoidoscopes without sedation. I've actually watched it being done as you are awake. It is not really that painful, it is crampy due to the air from the scope inside your colon. Causes gas. I've always had to clean out with way more than an enema for both though. But under your circumstances I can understand as it can get smelly. I live with UC and have had it for 29 years, since 1986, never have I had the issues with constipation with mine, especially when I have flareups. I haven't really had a flareup in years, thought I was in a mild one now and may be but was diagnosed with something else so I'm not sure now. I've always had the urgency issues, barely able to get to the bathroom, wasn't many times, when mine was the worst, was a combination of brown, watery, bloody looking and runny, sorry to be so graphic, you may also notice a whitish mucous substance. Frequent bm's, abdominal pain, rectal pain can be signs of UC also. Good they are going to do a scope, they will take some biopsies probably also, I have to have a colonoscopy every two years, and the gastro doctor can see things immediately, as to inflammation, by viewing your colon, wondering where exactly your abdominal pain is, mine is confined to the lower left area, sigmoid colon and the rectum. The colonoscopy you are totally asleep for with sedation and are awake right after the procedure. The worst is always the prep. As for the bloodwork being a good way to determine UC, I'm not sure, I have bloodwork done there but not every time I go, I probably will tomorrow because of my problem now. Hope this answered some of your questions.

Hey there! My abdominal pain generally changes but I find it's mostly confined to my lower abdomen, just above and below the bellybutton. I usually find myself very gassy a lot of the time, and if I do pass the gas it doesn't go away. I've not really had any noticeable bleeding episodes other than that one time, but I do wonder if the browny red mucus mixed with my stool is blood or not (looks more brown than red but sometimes I do believe I think the worst!). I also have constant lower back pain and rectal discomfort/pain.

I find a lot of the time the abdo pain is at a bearable enough level, it gets worse if I eat certain things or if I'm constipated. I don't find myself having any watery diarrhea or anything, though I did have it initially 4 and a half years ago. My stools are generally soft, sausage like motions (sometimes broken up pieces) that I find really hard to pass but I think this is because of pelvic floor dysfunction personally as I also suffer with bladder problems.

I think I will be too nervous to have the flexible sigmoidoscopy without sedation, so knowing me I will opt for it, but I imagine I'll be very spaced out after! I obviously at this point don't know if it's UC or IBS or the worst case scenario, which I sincerely hope not, but it will be good to be able to get some answers finally!
Posted 1/6/2016 10:08 PM (GMT 0)

iPoop said...
Generally, you are given two fleet enemas as preparation for the procedure. Fleet has salt water in it. I take one two hours before the procedure and another an hour before. It's a laxative and makes you clean out.

The sigmoidoscopies I've had numerous of, all unsedated. It's a 10 minute procedure (much longer for you as sedation is involved). There is no pain, unless you're badly inflammed (as typical of a severe ulcerative colitis flare). The scope puffs air in your bowel. A large intestine is collapsed when empty, much like a clean sock. The air puffs enables them to see better. You can feel the air during and after the procedure. Afterwards, there might be some minor discomfort until you fart that air out. I always sit on the toilet afterwards and try to pass as much as I can before heading home. Due to the sedation, your memory is bound to be a bit hazy/fuzzy. So, it's helpful to have someone else able to listen to the doctor's immediate follow-up after the procedure. Due to the sedation, you'll need to have someone else drive you home.

Does the clearing out take a while? How long are you expected to be at the hospital for as mine is meant to be a day case procedure.

I've heard many people say that they didn't feel much during the procedure, or just discomfort, but I'm paranoid since I literally always find procedures I have done super painful (I even find the smear test painful!!)

I will definitely make sure to have someone with me on the day. So there's no bleeding afterward or anything?
Posted 1/6/2016 10:19 PM (GMT 0)

Feekerry said...
I had my first flex sig about 7 months ago. Without sedation or gas and air which I was offered. I got the impression from the nurse that people did opt for sedation but I would have had to get picked up, stay for hours after etc and quite frankly after having 2 kids fairly recently not much bothers me now lol!!
I had a prep to drink 2 days before and one the night before. They were ummm... Effective!! However, actually given the awful symptoms I was having it was a bit of a relief as it was just pure water in the end. No mucus, no blood!
The nurses were lovely. The whole thing took 15 mins max maybe. It was uncomfortable at times but only as the air they pump in makes you want to go and naturally we try stop that from happening but once they said I was totally empty, let it go.... It was fine. Bit uncomfortable when they switched the sig to the other side. Took loads of biopsies which I could see but never felt a thing which is odd as you can see them tugging at the tissue!
I was diagnosed then and there whilst still on the table, wheeled to a recovery room, encouraged to go to toilet and let air pass. Free to go when I wanted. Drove home no issues. Doc rang that afternoon did me a prescription and I had relief within a week.
So overall, do the prep they ask. Don't hold back, let the air out, you will be empty! Not the most glamorous 15mins of your life but very bare able!! Good luck

Yeah I was told people generally have gas and air but I know that would probably not do much for me, as I have a very low pain threshold lol! Ah they gave you a prep? On mine I was told I could just have the enemas when I get there so I have no idea.. I think it's just because I can't really take prep living in shared accommodation right now. Was you diagnosed with UC there and then? I guess its a relief to find out whats going on immediately!

I'm told they will take biopsies, that's a relief to know they don't hurt! I would have thought you could feel them doing it haha.

Thanks for the advice though, I hope this can give me some closure or answers at the very least. Am worried about both the procedure and the possible result! Mainly because it's been YEARS and I worry that because of that I have waited too long :/
Posted 1/6/2016 11:03 PM (GMT 0)
Another quick question - my iron store levels were apparently considered low to some doctors but only a little low to others - last time I had blood taken in Oct they were 12 (whatever that is)

Is this indicative of anything? I was told by one doctor a diet high in iron would be acceptable enough and that I didn't really need iron pills but I've been told today by gastro nurse that I should really have taken iron pills. Anyone got any experience with this?!
Posted 1/7/2016 2:42 AM (GMT 0)
There's no point trying to guess hate you have. Only way to know for sure is get the scope and wait for biopsy results.

Flex sig is very quick. I've always been sedated for mine, my GE says it's optional for flex sig, im a wuss and prefer to be zonked out. When sedated I don't feel anything- including the embarrassment of having my butt on display-petty? Sure, but it works for me and leads to no anxiety before any of my scopes because I know I will be out for the whole thing. Your pprep sounds a bit iffy though, I'm told to take a could laxative pills the night before and two fleet enemas the morning of the procedure, before I leave home. This causes me to poop-a lot! I'm not done pooping an hour after taking the fleet...not sure how that's going to work for you at the hospital.
Posted 1/7/2016 6:08 AM (GMT 0)
Ye I was diagnosed with uc whilst he the consultant was still doing the sig. He talked me through the areas of inflammation as he saw them and pointed out the little ulcers. They were very clear. I left mine about 3 years without seeing someone which is silly as I had almost total relief within a week.
I was told if the prep wasn't enough I could do an enema there but prep was definitely enough in my case as and Ye you would need constant access to bathroom with it!
Posted 1/7/2016 7:07 AM (GMT 0)
I've had a few. The night before I think they tell me not to eat or drink anything after midnight. The following morning I do the two enemas. Usually spaced out by like two hours.

I've never been sedated. You don't need to be. It's a little uncomfortable but just take deep breathes and you will be alright. As said before, the air just makes you feel like you have to go. Even though I know nothing will probably come out if I let go, I still always just try to hold in that feeling.

I've always been able to feel the biopsies too. Just a little pinch inside, doesn't hurt. It's interesting watching the video in front of you then seeing them tug at your colon and snip.
Posted 1/7/2016 3:49 PM (GMT 0)

toomuchpoopin said...
There's no point trying to guess hate you have. Only way to know for sure is get the scope and wait for biopsy results.

Flex sig is very quick. I've always been sedated for mine, my GE says it's optional for flex sig, im a wuss and prefer to be zonked out. When sedated I don't feel anything- including the embarrassment of having my butt on display-petty? Sure, but it works for me and leads to no anxiety before any of my scopes because I know I will be out for the whole thing. Your pprep sounds a bit iffy though, I'm told to take a could laxative pills the night before and two fleet enemas the morning of the procedure, before I leave home. This causes me to poop-a lot! I'm not done pooping an hour after taking the fleet...not sure how that's going to work for you at the hospital.

Yeah, it is a little weird, wasn't even aware that just taking enemas before the thing were an option, but they definitely said it's fine :/ I'm definitely gonna go for the sedative - have had bad reactions to general before but hoping this is somewhat a little different.

Hopefully I will have the whole thing explained - not sure how it's gonna work as of yet but will see.
Posted 1/7/2016 3:53 PM (GMT 0)

miestomaga said...
I've had a few. The night before I think they tell me not to eat or drink anything after midnight. The following morning I do the two enemas. Usually spaced out by like two hours.

I've never been sedated. You don't need to be. It's a little uncomfortable but just take deep breathes and you will be alright. As said before, the air just makes you feel like you have to go. Even though I know nothing will probably come out if I let go, I still always just try to hold in that feeling.

I've always been able to feel the biopsies too. Just a little pinch inside, doesn't hurt. It's interesting watching the video in front of you then seeing them tug at your colon and snip.

Ah, so you can just do the enemas in the morning before the actual procedure?

I definitely would prefer to not have to be sedated but I know I'm definitely a wimp! I guess I could start without and maybe ask them to sedate me if it gets too painful? I don't know if they allow that. Yeah, I've had rectal digital examinations and I definitely can imagine it feels like you need to go.

Not looking forward to it as they've fast-tracked me for next Friday! Really worried re results though.
Posted 1/7/2016 4:24 PM (GMT 0)
I've had numerous colonoscopies and flex sigs. The former required food abstinence the day before and preps in advance. The flex sigs I've only had following emergency admissions. In each case I had not abstained from food the day before (didn't know I was going to hospital!) and did a single enema in the morning and had the flex sig at mid day.

Sedation has always been light for both and with one exception it has been pain free ... I watched on the screen and discussed with them at the time. But last two times (prob due to severity of inflammation) I was also given a drug that removed short term memory. I recall going in, was awake throughout... And I recall going out. But remember nothing of the procedure. The doc had told my partner everything he told me as he said I wouldn't recall the conversation ... And I didn't! Quite a bizarre experience given I pride myself on my good memory.

Another option is gas and air ... Which you can control yourself.

Basically the options are varied. I'd check with them in advance what they can offer you. If they know in advance they are more likely to be able to accommodate your wishes.

Good Luck
Posted 1/7/2016 9:44 PM (GMT 0)

LuSmith said...

miestomaga said...
I've had a few. The night before I think they tell me not to eat or drink anything after midnight. The following morning I do the two enemas. Usually spaced out by like two hours.

I've never been sedated. You don't need to be. It's a little uncomfortable but just take deep breathes and you will be alright. As said before, the air just makes you feel like you have to go. Even though I know nothing will probably come out if I let go, I still always just try to hold in that feeling.

I've always been able to feel the biopsies too. Just a little pinch inside, doesn't hurt. It's interesting watching the video in front of you then seeing them tug at your colon and snip.

Ah, so you can just do the enemas in the morning before the actual procedure?

I definitely would prefer to not have to be sedated but I know I'm definitely a wimp! I guess I could start without and maybe ask them to sedate me if it gets too painful? I don't know if they allow that. Yeah, I've had rectal digital examinations and I definitely can imagine it feels like you need to go.

Not looking forward to it as they've fast-tracked me for next Friday! Really worried re results though.

yea, enemas the morning of procedure because you don't have to clear out the entire colon, just that lower portion. I've had bad inflammation during flex sigs and still didn't find them painful. It only takes a couple of minutes so asking for a sedation once they have the scope in you would be kind of pointless and probably irritate your doc. You don't need sedation, just buck up.

Although, I'm not sure why they aren't giving you a colonoscopy. Flex sigs are usually used to see if inflammation is still there in patients that have been diagnosed with colitis, at least that is the reasoning for all of the ones I've had, I didn't know they were used for diagnosis as if there is colitis in the rectum(where everyones starts) then the flex sig won't be able to tell you the extent of it(sigmoid, left sided, pancolitis). So if they see colitis with the flex sig then they will probably have to do a follow up colonoscopy to see how far it reaches. Seems like your doc is kind of working backwards here. Also, if it isn't colitis and they don't see anything(inflammation) in your rectum or sigmoid and you are still dealing with problems then there is probably an issue higher up in the colon that a flex sig won't be able to see, only a colonoscopy will.

I'd just try to get a full colonoscopy. Do you really want to have a flex sig, them not find anything then order a colonoscopy? Sure the colonoscopy prep sucks and I saw you say you have shared living. Maybe rent a hotel room for the night? Colonoscopy you will have sedation for, you will get knocked out, won't feel a thing, wake up with no recollection of the procedure and feel relatively fine, like nothing even happened.
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