About Your Flexible Sigmoidoscopy

This information will help you prepare for your flexible sigmoidoscopy at Memorial Sloan Kettering (MSK). A flexible sigmoidoscopy is an exam of the rectum and lower colon performed with a flexible scope. During the procedure, your doctor can remove a small sample of tissue (biopsy), remove a polyp (growth of tissue), and take photos.

A Week Before Your Procedure

Ask about your medications

You may need to stop taking some of your medication before your procedure. We have included some common examples below.

  • If you take medication to thin your blood, 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. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), and cilostazol (Pletal®).
  • 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 or a medication that contains metformin, do not take it the day before or the day of your procedure.

Get a letter from your doctor, if necessary

  • If you have an automatic implantable cardioverter-defibrillator (AICD), you need to get a clearance letter from your cardiologist (heart doctor) before your procedure.
  • If you’ve had chest pain, trouble breathing that is 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.

Arrange for someone to take you home

You must have someone 18 years or older take you home after your procedure. If you don’t have anyone, call one of the agencies below. They will provide someone to accompany you home, however there is a charge for this service and you will also need to provide transportation.

In New York:
     Partners in Care 888-735-8913
     Prime Care 212-944-0244

In New York or New Jersey:
     Caring People 877-227-4649

Purchase supplies

  • 1 (10-ounce) bottle of Citrate of Magnesia
  • 1 saline enema such as Fleet®
  • Clear liquids
  • Petroleum jelly (Vaseline®) or A & D® ointment
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3 Days Before Your Procedure

A few days before your procedure, you will receive a telephone call from an endoscopy nurse. He or she 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 to take the morning of your procedure. Use the space below to write them down.

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The Day Before Your Procedure

Follow a clear liquid diet

You’ll need to follow a clear liquid diet the day before your procedure.

  • Make sure to drink plenty of liquids other than water, coffee, and tea.
  • If you have diabetes, you should drink only sugar-free clear liquids and check your blood sugar level often. If you have any questions, talk with your healthcare provider.
  • Do not drink anything red, purple, or orange the day before your procedure.
  Drink Do Not Drink
Soups
  • Clear broth or bouillon
  • Clear consommé
  • Clear packaged vegetable, chicken, or beef broth-mix
  • Any products with any particles of dried food or seasoning
Sweets
  • Gelatin (such as Jello®)
  • Flavored ices
  • Anything red, purple, or orange
Beverages
  • Clear fruit juices, such as white cranberry, white grape, apple
  • Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, Gatorade®
  • Black coffee (no cream)
  • Tea
  • Water
  • Juice with pulp
  • Nectars
  • Milk
  • Alcoholic beverages

Time of your procedure

A clerk from the Admitting Office will call you after 11:00 am the day before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If you are scheduled for your procedure on a Monday, you will be called on the Friday before. If you do not receive a call, please call 212-639-7882.

 

Take your bowel preparation

Between 2:00 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. It is important for you to be near a restroom after starting your bowel prep.

Instructions for eating and drinking before your procedure

12 ounces of water

  • Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.
  • Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
  • Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
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The Day of Your Procedure

Perform a tap water enema

  1. Empty the contents from the saline enema bottle. Fill the bottle with room temperature tap water.
  2. Apply Vaseline® or A & D® ointment to the area around your anus. This prevents irritation.
  3. Lie on your left side with your right knee bent in toward your chest.
  4. Remove the protective cap on the enema bottle. Insert the tip into your rectum.
  5. Squeeze the bottle until it is empty.
  6. Remove the tip from your rectum. Hold the water until you feel the urge to move your bowels. Remaining in the left-sided position helps the enema to work.
  7. Expel the water in the toilet. If solid waste is present in the toilet, repeat the enema until the water is clear.

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.Do not put on any lotion, cream, powder, make-up, or perfume.
  • Remove any jewelry, including body piercings.
  • Leave all valuables such as credit cards and jewelry at home.
  • If you wear contacts wear your glasses instead.

What to bring with you

  • A list of the medications you take at home
  • 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 flexible sigmoidoscopy will take place at one of these locations:

  • Memorial Hospital
    1275 York Avenue (between East 67th and East 68th Streets)
    New York, NY 10065
  • MSK Monmouth
    480 Red Hill Road
    Middletown, NJ 07748

What to expect

Once you arrive at the hospital, doctors, nurses, and other staff members will ask you 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. He or she will place an intravenous (IV) catheter into a vein, usually in your hand or arm. At first you will receive fluids through the IV, but it will be used later to give you anesthesia (medication to make you sleepy). Your doctor will explain the procedure, and answer any questions you have.

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 your nose. You will lay on your left side with your knees bent.

You will receive anesthesia through your IV, which will make you fall asleep. Once you are 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 necessary.

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After Your Procedure

In the recovery room

You will wake up in the recovery room. Your nurse will continue to monitor your heart, breathing, and blood pressure. Once you are 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

  • Do not drink alcoholic beverages for 24 hours after your procedure.
  • You might have a little bleeding during your bowel movement up to 24 hours after your procedure.
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Call your doctor or nurse if you have:

  • A temperature of 101° F (38.3° C) or higher
  • Severe stomach pain or hardness
  • Bleeding from your rectum that lasts more than 24 hours
  • Any other questions or concerns
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