About Your Flexible Sigmoidoscopy

This information will help you get ready for your flexible sigmoidoscopy (sig-MOY-DOS-koh-pee).

A flexible sigmoidoscopy is an exam of your rectum and lower colon. During your flexible sigmoidoscopy, your doctor will use a flexible tube called a scope to see the inside of your rectum and lower colon on a video screen. Your doctor can take a small sample of tissue (do a biopsy) or remove a polyp (growth of tissue) during your procedure.

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1 Week Before Your Procedure

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop taking. We have included some common examples below.

Anticoagulants (blood thinners)

If you take a blood thinner, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it. See below for examples of common blood thinners.

Common Anticoagulants
  • apixaban (Eliquis®)
  • cilostazol (Pletal®)
  • clopidogrel (Plavix®)
  • dalteparin (Fragmin®)
  • enoxaparin (Lovenox®)
  • fondaparinux (Arixtra®)
  • heparin
  • rivaroxaban (Xarelto®)
  • tinzaparin (Innohep®)
  • warfarin (Coumadin®)

There are others, so check with your doctor if you’re not sure.

Medications for diabetes

If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the day before and the morning of your procedure. Tell your doctor you will be drinking a sugar-free clear liquid diet the day before your procedure.

If you take metformin (such as Glucophage® or Glumetza®) or a medication that contains metformin (such as Janumet®), don’t take it the day before or the day of your procedure.

If you take any other oral medications (medications that you swallow) for your diabetes, don’t take them the day before or the day of your procedure.

Tell your doctor if you have an AICD

Tell your Memorial Sloan Kettering (MSK) doctor if you have an automatic implantable cardioverter-defibrillator (AICD). If you have this device, you will need to have your procedure done at Memorial Hospital (MSK’s main hospital).

Get a letter from your doctor, if needed

  • If you have an AICD, you will need to get a clearance letter from your cardiologist (heart doctor) before your procedure.
  • If you’ve had chest pain, trouble breathing that’s new or worse, or have fainted in the last 6 weeks, you will need to get a clearance letter from your doctor before your procedure.

Your MSK doctor’s office must receive your clearance letter at least 1 day before your procedure.

Buy supplies

  • 1 (10-ounce) bottle of Citrate of Magnesia (magnesium citrate)
  • 1 saline enema (such as Fleet® enema)
  • Clear liquids
  • Petroleum jelly (Vaseline®) or A & D® ointment

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely and report concerns to your healthcare providers, if needed. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s usually a charge for this service, and you’ll need to provide transportation. It’s okay to use a taxi or car service, but you must still have a responsible care partner with you.

Agencies in New York                                     Agencies in New Jersey
Partners in Care: 888-735-8913                                     Caring People: 877-227-4649
Caring People: 877-227-4649                                      


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5 Days Before Your Procedure

Stop taking iron supplements

If you take an iron supplement, you’ll need to stop taking it 5 days before your procedure. Iron supplements can cause color changes in your stool, which can make it harder for your doctor to see your colon clearly.

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3 Days Before Your Procedure

An endoscopy nurse will call you between 8:00 am and 6:00 pm 3 days before your procedure. They will review the instructions in this guide with you and ask you questions about your medical history. The nurse will also review your medications and tell you which medications to take the morning of your procedure.

Use the space below to write them down.

‌  ___________________________________________

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The Day Before Your Procedure

Starting the day before your procedure, do not eat anything. Follow a clear liquid diet.

Follow a clear liquid diet

A clear liquid diet includes only liquids you can see through. Examples are listed in the “Clear Liquid Diet” table. While you’re on this diet:

  • Don’t eat any solid foods.
  • Try to drink at least 1 (8-ounce) glass of clear liquid every hour you’re awake. Drink plenty of liquids other than water, coffee, and tea.
  • Don’t drink anything red, purple, or orange.

If you have diabetes, only drink sugar-free clear liquids and check your blood sugar level often. If you have any questions, talk with your healthcare provider.

Clear Liquid Diet
  Drink Do Not Drink
  • Clear broth, bouillon, or consommé
  • Any products with pieces of dried food or seasoning
  • Gelatin (such as Jell-O®)
  • Flavored ices
  • Hard candies (such as Life Savers®)
  • All others
  • Clear fruit juices (such as lemonade, apple, cranberry, and grape juices)
  • Soda (such as ginger ale, 7-Up®, Sprite®, and seltzer)
  • Sports drinks (such as Gatorade®)
  • Black coffee
  • Tea
  • Water
  • Juices with pulp
  • Nectars
  • Milk or cream
  • Alcoholic drinks

Note the time of your appointment

A staff member will call you after 11:00 am the day before your procedure. The staff member will tell you what time you should arrive for your procedure. If you’re scheduled for your procedure on a Monday, you will be called on the Friday before. If you don’t receive a call, call your doctor’s office.

If you need to cancel your procedure, call the doctor who scheduled it for you.

Take your bowel preparation

Between 4:00 pm and 6:00 pm, drink the 10-ounce bottle of Citrate of Magnesia. It will cause multiple bowel movements and diarrhea. It often works within 30 minutes, but may take as long as 3 hours.

After your bowel preparation, you can keep drinking clear liquids until 4 hours before your scheduled arrival time.

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The Day of Your Procedure

  Starting 4 hours before your scheduled arrival time, do not eat or drink anything. This includes water, hard candy, and gum.

Give yourself an enema

Start the enema 4 hours before your scheduled arrival time. This may be early in the morning. Follow the steps below.

  1. Apply Vaseline or A & D ointment to the area around your anus. This prevents irritation.
  2. Lie on your left side with your right knee bent in toward your chest.
  3. Take the protective cap off the enema bottle. Insert the tip into your rectum.
  4. Squeeze the bottle until it’s empty.
  5. Remove the tip from your rectum. Keep lying on your left side. Hold the liquid in your rectum until you feel the urge to move your bowels. This usually takes about 5 to 10 minutes.
  6. Go to the bathroom to let the liquid out of your rectum, into the toilet.

If you see any stool (solid waste) in the toilet, fill the enema bottle with room temperature tap water and repeat the steps above. Repeat the enema until you don’t see any stool. It’s okay if the liquid from the enema doesn’t change color.

Things to remember

  • Take only the medications your doctor told you to take the morning of your procedure. Take them with a few sips of water.
  • Don’t put on any lotion, cream, powder, makeup, perfume, or cologne.
  • Remove any jewelry, including body piercings.
  • Leave valuable objects (such as credit cards and jewelry) at home.
  • If you wear contact lenses, wear your glasses instead.

What to bring

  • A list of the medications you take at home, including patches and creams.
  • Your rescue inhaler (such as albuterol for asthma), if you have one.
  • A case for your glasses.
  • Your Health Care Proxy form, if you have completed one.

Where to go

Your procedure will take place at one of these locations:

  • Endoscopy Suite at Memorial Hospital (MSK’s main hospital)
    1275 York Avenue (between East 67th and East 68th Streets)
    New York, NY 10065
    Take the M elevator to the 2nd Floor. Enter the Endoscopy Suite through the glass doors.
  • MSK Monmouth
    480 Red Hill Road
    Middletown, NJ 07748

What to expect

Once you arrive

Once you arrive, you will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having procedures on the same day.

After changing into a hospital gown, you will meet your nurse. They will place an intravenous (IV) catheter into one of your veins, usually in your hand or arm. The IV will be used to give you anesthesia (medication to make you sleep) during your procedure. You may also get fluids through the IV before your procedure.

You will talk with your doctor before your procedure. They will explain the procedure and answer your questions.

During your procedure

When it’s time for your procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through a thin tube that rests below your nose.

You will get anesthesia through your IV, which will make you fall asleep. Once you’re asleep, your doctor will examine your rectum, then use a flexible scope to see the inside of your rectum and the end of your colon. Your doctor will take biopsies if needed.

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After Your Procedure

Your nurse will continue to monitor your heart, breathing, and blood pressure. Once you’re fully awake, your nurse will remove your IV. If you have someone waiting with you, your nurse will explain your discharge instructions to both of you before you go home.

At home

  • Don’t drink alcoholic beverages for 24 hours after your procedure.
  • You might have a little bleeding during your bowel movements. This may last for up to 24 hours after your procedure.
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Call your doctor or nurse if you have:

  • A fever of 101 °F (38.3 °C) or higher
  • Chest pain or shortness of breath (difficulty breathing)
  • Severe pain, hardness, or swelling in your abdomen (belly)
  • Bleeding from your rectum that lasts more than 24 hours
  • Weakness, faintness, or both
  • Any other questions or concerns
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