First flex sig, have some questions

Hi guys,

I recently switched GI's, and the new doc is having me come in for a flexible sigmoidoscopy on Monday. I've have 3 colonscopies but this will be my first flex sig. My instructions are to use two fleet enemas 15 minutes apart the morning of the procedure. I'll be doing the enemas at 6am and leaving for the procedure a little before 8am. Some questions I have...

-Does that give me enough time to be emptied out so that I'm not going to be hit with the urge to go while I'm on my way to the procedure? I've done retention enemas and c-scope prep but never fleet enemas.

-Is it normal for there to be no dietary restrictions the day before? I see some places have you go on a liquid diet while others say you can eat as normal the day before. My doctor is not requiring me do a liquid diet day.

-Is the gas buildup for a flex sig the same as for a c-scope? It would be really nice if it was less, but I suppose I shouldn't get my hopes up. I have major self-consciousness/embarrassment issues so I'm not comfortable with my boyfriend being there for the release of gas afterward. Some nurses react weird when I tell them that. I know when you have UC you pretty much have to throw your dignity out the window and that there's nothing to be ashamed of. Unfortunately, knowing that doesn't help when you have social anxiety.

-I need some input on sedation. I will be opting for sedation because my tolerance for pain and discomfort is incredibly low. I sort of experience all discomfort as pain. I know, it's only a 15 minute procedure. Believe me, if I didn't have to be sedated I wouldn't because I cannot stand not having control over what I say and do. But trust me when I say I couldn't handle it without. Last time I had a colonoscopy, supposedly I woke up during it, so they pumped up the anesthesia. Well, that ended up being the most out of it I've ever been. I could not stay awake at all for quite a while and don't even remember the doctor coming in, let alone what he might have said. It was awful. I'm on an antidepressant that always makes me tired, so I'm wondering if that also contributed. My question is, is there any sort of balance I can ask for between making sure I don't wake up during the procedure and major, long-lasting disorientation? If so that would be awesome and would make feel a lot better about this.

Thank you in advance for sharing your knowledge/experiences.

Casey_LB said...
My experience:

Flexsig is not exactly painful but it can be EXTREMELY uncomfortable. Kind of like water-boarding isn't exactly painful. Especially if they take a dozen biopsies. Go for sedation. Sometimes they do "twilight " sedation, but I still feel out of it for a few hours.

It's normal to have no dietary restrictions.

For me, starting at 6am isn't close to enough time to leave the house at 8am. I would allow 3-4 hours from start to departure time. I guess everyone is different, but it took a long time for the effects of Fleet to wear off enough for me to feel ready to leave this house. I was late for my first flexsig.

Good luck.

That's helpful info, thank you. So it sounds like I need to start the enemas at more like 4 or 5am. Hope there's no particular reason why they want me to do 6am. I definitely do not need to be crapping my pants in my boyfriend's truck. What's the difference between regular sedation and twilight? I feel like I've never been sure which one I was under at any given time (wisdom tooth extraction, my last 3 scopes, etc).

1.) When you take a fleet, holding it for more than 30-seconds would be a world-record. A fleet enema is 7.8-ounces (or 237ml) of liquid, whereas a mesalamine enema is 60ml of liquid. There is so much fluid, that holding it for long is physically impossible. It comes out very FAST. When I take a fleet I expel some in less than a minute, and there is more episodes of going within the next 10-minutes or so. So, I'd say about 10-minutes from start to finish, pad that to 15-minutes of just sitting on the toilet a while long "just to be safe." As far as preps go, it is a pretty immediate and fast process compared to a colonoscopy prep that takes A LOT longer.

Just note this is salt water (a fleet) and if you have a lot of inflammation, then the expression "hurts like putting salt on a wound applies." You can screw the cap off, empty the salt water out and refill with regular water if concerned about pain from salt water on your inflammation. I've used plain tap water, but you can first boil the water to sterilize it, and let it cool down to room temp before administering.

2.) Is it normal for there to be no dietary restrictions the day before? Yes, normal. Enjoy and eat whatever you want! Fleet cleans out just the rectum, sigmoid colon and left-side enough that they can see the intestinal walls clearly. The fleet will purge any stool that's in there and cleanse the walls. You prep just before the procedure, so the left-side will remain empty for that procedure.

3.) Depends on the equipment used. I had a flex-sig earlier this year, no air was injected at all (they had a screen that I could watch). My old doctor had an old flex-sig that injected air, and there was no screen (just a lens he could look through, old school equip). I did not miss the abdominal discomfort and 10-minute farting spree-post procedure this time!

4.) I've had a dozen or more flex sigs over the year, none of which had sedation. Maybe I am crazy. I have a high-tolerance for pain. My best indicator for the pain you experience, is the fleet enema which is a salt water suspension. If I take that fleet enema and it burns and hurts then I know there is going to be pain during the procedure. Sigs during a remission do not hurt, just a little mild discomfort from the insertion and pressure from the scope, easy-peasy. During a severe flare, the pain was intense (never again). When mildly inflamed the pain was tolerable, but I was watching the seconds tick by and glad it was 5-minutes or less.

If you have any worries at all then ask for sedation, they do the same sedation options for a flex-sig as for a colonoscopy. From the twilight-sedation to the stronger stuff. Ask for whatever you feel would work the best for you. Just know that getting sedation turns a 15-minute procedure into an hour or more, mostly all related to the recovery from the sedation.

Twilight sedation is the normal sedation they give for colonoscopies. You won't remember a single thing. You get twilight sedation for wisdom teeth extraction, too.

Casey_LB said...
My gastroenterologist has used the the term "twilight " sedation to mean you're not completely unconscious (full sedation), but sedated enough that you don't much care what happens and only vaguely aware of what's going on. I don't know if it is a commonly used term.

Oh okay, that makes sense. I feel like they've told me I get twilight but I end up very much asleep. Which is fine, haha.

Sara14 said...
GET THE SEDATION. I had one once without sedation and it was extraordinarily painful.

Can you just not let your boyfriend into the recovery room with you afterwards? Just have him in the waiting room instead and tell the medical staff and him that that is what you want? You don't have to have anyone come into the recovery room with you. That would give you time to release gas. One time i ripped ass really loud after a scope with my boyfriend at the time and nurse in the room and it was embarrassing. My boyfriend found it hilarious though. Lol.

Good luck.

Oh yes. I would never attempt to have it unsedated. Wish I could, but not a chance.

Thank you SO much for understanding about the boyfriend thing and sharing your story. None of the nurses seem to get it, I guess because they're unfazed by it. I do ask them to have him wait until I have a chance to wake up a little more. So the last two times, no one was in the recovery room right away (besides the nurse obviously) and I have no problem with that.