Flexible Sigmoidoscopy Consent 🔬
Consent guide for flexible sigmoidoscopy (lower GI endoscopy). Procedure explanation, bowel preparation, sedation options, risks, benefits, alternatives, and patient information for obtaining informed consent.
🔍 Procedure
- Flexible sigmoidoscopy — direct visual inspection of the rectum and sigmoid colon (lower large bowel) using a thin flexible camera passed via the rectum.
- Allows biopsy of suspicious tissue, removal of polyps, and treatment of haemorrhoids (banding or oily phenol injection) where indicated.
- Examines the distal colon only — not the full colon (see colonoscopy if whole-bowel assessment is required).
💡 Indications
- Rectal bleeding or change in bowel habit
- Suspected distal colonic pathology (inflammation, polyps, stricture)
- Surveillance in selected high-risk patients where full colonoscopy is not required
- Assessment of haemorrhoids or distal polyps
📌 Preparation
- Lower colon must be empty — follow bowel-preparation instructions exactly, or receive an enema on arrival per local protocol.
- Typical prep: light breakfast before 08:00 the day before, then clear fluids only; timing of last fluids depends on morning vs afternoon appointment.
- Nil by mouth once bowel preparation has started unless instructed otherwise.
- Complete medication history including allergies, anticoagulants, antiplatelets, iron, and diabetes medications — confirm holding rules with the treating team.
- Aspirin usually continued unless consultant advises otherwise; clopidogrel, warfarin, and DOACs require individual review before the procedure.
- Bring escort details if sedation planned; wear comfortable clothing; leave valuables at home.
🧾 Procedure Walkthrough
- Queries answered in the endoscopy unit; consent confirmed before proceeding.
- Patient positioned on the left side; glasses and dentures removed if applicable.
- Sedation given IV if chosen; nurse monitors blood pressure and pulse throughout.
- Air insufflated into the bowel — cramping or windy discomfort is common and usually brief.
- Consultant discusses findings and follow-up before discharge.
- Shorter procedure than colonoscopy — typically views rectum and sigmoid only.
💉 Sedation Options
- No sedation: procedure performed with patient fully aware; most patients tolerate this; may leave once complete and after speaking with the doctor.
- Conscious sedation: small IV dose producing a relaxed “sleepy” state — not general anaesthesia; patient responds to verbal commands; most will not recall the procedure as unpleasant.
- Regular benzodiazepines or sleeping tablets may reduce sedation effectiveness — document on medication list.
- Patient may request the procedure be stopped at any time.
- Oxygen may be given via nasal cannula during sedation.
⚠️ Risks & Complications
- Common: crampy abdominal pain, bloating, mild discomfort — usually settles soon after.
- Sedation: very slight risk of drug reaction; drowsiness post-procedure.
- Bleeding: if a polyp is removed, bleeding may occur immediately or rarely days later — risk approximately 1 in 200 polyps removed; many polyps are premalignant and removal reduces future cancer risk.
- Perforation: tear in the bowel lining causing peritonitis — less than 1 in 2,000; higher if polyps removed (approximately 1 in 500); may need antibiotics, prolonged admission, or surgery.
- Missed pathology: no test is perfect — significant disease may be missed in up to 5% of cases despite adequate examination.
- Hospital-acquired infection: small risk with any admission.
- Emergency treatment (transfusion, surgery, antibiotics) may be required if complications arise.
- Consent may be withdrawn at any time before or during the procedure.
💬 Common Patient Questions
- Will it hurt? — Some cramping and bloating is normal; sedation reduces discomfort if chosen.
- Will I be asleep? — With conscious sedation you are relaxed but not fully anaesthetised; without sedation you remain fully aware.
- Can I drive home? — Not if sedated — escort required; no driving or machinery for 24 hours.
- How is this different from colonoscopy? — Sigmoidoscopy views only the lower colon; colonoscopy examines the entire colon.
- When will I get results? — Often discussed immediately; biopsy results take several days.
✅ Benefits
- Direct visualisation of rectum and sigmoid colon
- Targeted biopsy and polyp removal at the same visit
- Less extensive bowel preparation than full colonoscopy in many protocols
- Can treat selected haemorrhoids during the procedure
🔄 Alternatives
- Colonoscopy — full colonic examination (preferred if proximal pathology suspected)
- CT colonography — non-invasive imaging; less sensitive for small polyps; no biopsy or polypectomy
- Faecal immunochemical test (FIT) or other screening pathways where appropriate
- No investigation — may miss serious distal colonic pathology
🧠 Special Considerations
- Review anticoagulation and antiplatelet therapy with cardiology/consultant before the procedure.
- Diabetic patients — follow consultant pre-admission insulin/oral hypoglycaemic instructions.
- Discontinue iron one week prior if advised by the endoscopy team.
- Inform team of MRSA, VRE, or other MDRO history.
- Interpreter support if required; assess capacity; separate consent for photo/video recording.
- Following sedation: escort home and stay with a responsible adult overnight; no alcohol for 24 hours; no important decisions or legal documents for 48 hours.
- Seek urgent advice for severe pain, breathing difficulty, fever, haematemesis, or rectal bleeding after discharge.
🗣️ Example Consent Script
- "We are recommending a flexible sigmoidoscopy to look at the lining of your lower bowel using a thin flexible camera passed through the back passage."
- "This can help diagnose bleeding, inflammation, or polyps. We may take biopsies or remove polyps during the procedure if needed."
- "You can choose sedation or no sedation. Risks include cramping, bleeding if polyps are removed, and very rarely a tear in the bowel wall."
- "If you have sedation you will need someone to take you home and stay with you overnight. You must not drive for 24 hours."
- "Do you have any questions before we proceed?"