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How do I have a flexible sigmoidoscopy?

To make sure the endoscopist has a clear view of your bowel during the procedure, your bowel must first be prepared.

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This section outlines the steps of having a flexible sigmoidoscopy:

  • Pre-procedure preparation

  • Arrival to the unit

  • During the procedure

  • After the procedure

During the procedure

Pre-procedure preparation

In order to see the lining of the bowel clearing during the procedure, the back passage needs to be empty. You will need to give yourself an enema 1-2 hours before leaving home to attend your appointment.

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You may have a light breakfast/lunch on the day of your test, but do not eat anything after using the enema; you may have water to drink.

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Preparing the enema (see guidelines)

The modern enema is small, simple and very easy to use.

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You should not use an enema if you are having treatment for kidney disease, colitis or have diarrhoea.

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  • Wash hands

  • Pull off orange tip from the nozzle, keeping the enema upright so it does not spill.

  • Lay on left side with a towel placed underneath you, and bend knees.

  • Insert whole nozzle into the back passage and squeeze the bottle until it feels empty.

  • Stay lying down and hold the liquid in the bottom for about 5 minutes if possible.

  • Go to the toilet, but do not worry if you only pass the enema

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Some people experience mild stomach cramps for a short while after using the enema.

Occasionally people feel faint or dizzy; if you do, either lie down safely or place your head between your knees.

You are advised to stay near a toilet for about an hour.

The enema will have worked within the first hour so it will not hinder your journey into the hospital.

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If you do not feel you can manage to prepare the enema, please phone the Endoscopy Unit and you will be asked to come into the Unit earlier than your appointment so that a nurse can give you the enema.

Arrival to the unit

When you arrive to the Endoscopy Unit you will first be booked in by the receptionist. After this you will be reviewed by a member of the specialist nursing team who will ask you a few questions about your medical condition as well as your arrangements for getting home after the procedure.
 
The nurse will also record your heart rate, blood pressure and oxygen levels. If you are a diabetic they will also measure your blood glucose level. This information is used to confirm that you are fit enough to undergo the procedure.

Finally, the nurse will ask you to remove some of your clothing and change into a hospital gown. You may also like to bring your dressing gown and slippers. 

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You may now have to wait some time before your procedure starts. Before you go into the endoscopy room, the endoscopist will come and discuss with you the aspects of the procedure, You will then be asked to sign the consent form which will explain why you are having the procedure as well as the associated risks and benefits. You can withdraw your consent for the procedure at point. Should you have any further questions or need to raise any concerns, the endoscopist will gladly discuss them with you.

During the procedure

Once you are ready for your procedure, you will be taken into the examination room where the team of nurses and the endoscopist will introduce themselves.
 
The team will do checks to confirm your details, your medications and confirm you understand the procedure and signed the consent form. 
 
You will be asked to remove any dentures and/or glasses, which will be stored under the trolley you are laying on.
 
The nurse looking after you will ask you to lay on the trolley on your left side. If required, Entonox (gas & air) will be available to use during the procedure. 
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Sedation is not routinely used during this procedure however under some circumstances it may be considered.
 
The nurse looking after you will be with you at all times, giving you guidance and support throughout the procedure.

The endoscopist will start the procedure by examining your back passage with a finger (lubricated with gel) to make sure that it is safe to pass the endoscope. The endoscope will then be gently inserted (also lubricated with gel) through your back passage and into your bowel. Air will be inflated into your bowel so that the lining can be clearly seen and to allow for easier movement of the endoscope. The endoscopist may ask you to move positions during the test between from the left lateral position (lying on the left side) to supine (lying on your back). This is to aid visualisation of the colon & comfort.  Sometimes the endoscopist may take a biopsy specimen from the lining of the bowel, which is sent off for further tests to help with the diagnosis. 


Depending on the findings, the procedure normally lasts for around 10-20 minutes.

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Video showing withdrawal of a flexible sigmoidoscopy - slowly to look for abnormalities. The final manoeuvre is a retroflexion to look at the blind spot area near the anus.

After the procedure

When can I eat?

Once you have recovered you will be offered a drink and light refreshments.

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If you have had a sedative, you may sleep for about an hour after the procedure, after which you will be offered a drink and some light refreshments.

Will I have any pain?

You should not have any pain but you may have some discomfort from wind, but this should settle after a while.

When can I go home?

This depends upon whether you had sedation.

Before you leave the Unit, a member of the team will explain what happened during the procedure and whether you need any further appointments. However, if a biopsy or polyps were removed during the procedure, the results will take a further 10-14 days to become available.

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If you have had Entonox only, you do not need to be accompanied home and will be allowed to leave the Unit once you are feeling well enough to do so.


If you have had sedation it can make you drowsy for up to 24 hours after the procedure. Therefore you must be collected and accompanied home.  If you live alone it may also be a good idea to arrange to stay with a friend or relative.

For 24 hours after sedation you must not: 
 

  • drive

  • drink alcohol

  • operate heavy machinery

  • sign any legally binding documents

After you go home

You will be able to return to your normal activities, both at home and at work, when you feel comfortable.

If you have a question or concern after the test, please phone the Endoscopy Unit.

You must consult your nearest A&E department if you: develop severe chest pain, a fever or pass large amounts of blood after the procedure.

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