Preparation for sigmoidoscopy | In St. Petersburg

Preparation for retromanoscopy

Due to the fact that examining the rectum and lower parts of the sigmoid colon involves inserting an endoscope through the anus, this diagnostic technique requires certain preparation. The entire preparatory stage is aimed at cleansing the intestines in order to facilitate the specialist’s work and improve the quality of visibility of the area being examined. Based on this, preparation can be divided into following a diet and emergency cleansing, which involves the use of microenemas (for example, Microlax).

Contraindications

An absolute contraindication is the patient's serious condition:

severe general condition of the patient;
cicatricial narrowing of the rectum
cardiovascular or respiratory failure;
lack of consciousness due to stroke or traumatic brain injury.

Relative contraindications:

massive intestinal bleeding;
acute inflammatory processes of the anus and rectum;
exacerbation of hemorrhoids with node thrombosis;
acute fissure of the anal area and/or rectum.

Diet

To make sigmoidoscopy as comfortable as possible, you should avoid taking long-digesting foods (bread, fresh fruits, vegetables, nuts) the day before the medical procedure. Most often, sigmoidoscopy is scheduled for the morning in order to maximize preparation for the procedure. In this case, in the evening, on the eve of the study, you should not eat food, but only a mug of hot tea is allowed. The next morning, the procedure is carried out on an empty stomach after going through all the stages of emergency bowel cleansing. If the procedure is scheduled for the evening (after 3 p.m.), then you can have a light breakfast, but not lunch. The cleansing enema procedure is carried out from 12-14 hours.”

Indications

Symptoms that allow you to refer the patient for examination using a proctoscope:

Bleeding, especially dark blood and blood clots.
Discharge of a mucous or purulent nature.
Pain syndrome in the area of the large intestine.
Constant constipation, violation of the act of defecation.
Unfavorable family history (colon cancer in close “blood” relatives)

If the proctologist suspects the presence of cancer, then this procedure is simply necessary in order to stop the spread of cancer in the early stages.

Emergency cleansing

Carrying out emergency cleansing in the classic diagnostic version involves enema of the patient, both immediately before the start of the study and on the eve of the sigmoidoscopy procedure. It is usually recommended to administer three classic enemas - one in the evening and two before the start of the manipulation, with a time interval of 45 minutes. This schedule ensures complete cleansing of the lower intestines, but causes inconvenience to the patient, and therefore more gentle methods of preparing for a diagnostic examination have been developed.

Rectoscopy (sigmoidoscopy)

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If you try to compile the TOP 10 reasons why potential patients do not rush to the proctologist’s office, the need to undergo a rectoscopy will definitely be there, not in the top three, of course, but not in last place, somewhere between the fear of hemorrhoidectomy and colonoscopy, and reluctance to undergo complicated preparation for inspection. At an in-person consultation, when after a preliminary conversation you invite a person for an examination, many patients ask the standard question “will you look at me with this terrible iron tube?” On the pages of our website, we try to prepare potential patients as much as possible for a meeting with our doctors. Unfortunately, it is unrealistic to turn a consultation with a proctologist into one sheer pleasure, but at the same time, many of the patients’ fears are completely unfounded, which is what we try to talk about in each of our articles, in particular “Consultation with a proctologist” and “Anoscopy”. Continuing the topic, this page provides complete and objective information about rectoscopy, which is an optional but not uncommon part of a proctologist’s examination.

What is rectoscopy (sigmoidoscopy)?

Rectoscopy (sigmoidoscopy) is a method of endoscopic (visual) examination of the rectum, the length of which is about 16 cm. Accordingly, according to the standard, when conducting this study, it is necessary to examine at least 16 centimeters of the digestive tube. In the absence of pain, anatomical features of the intestine that prevent inspection, and sufficient preparation, the equipment allows you to examine up to 30 cm, i.e. not only the rectum, but also the terminal part of the sigmoid colon.

How is rectoscopy (sigmoidoscopy) performed?

As with any endoscopic examination, rectoscopy requires a special device, in this case a rectoscope (see photo), which, in essence, is a rigid (as opposed to a flexible colonoscope) hollow cylinder that allows us to visually examine the area of the digestive tract that interests us tubes. There are several options for its design: reusable and disposable, plastic and metal, of different diameters and lengths, but in any case, the diameter of the device is very small - 18-20 mm. Patients often ask, why not make a rectoscope with an even smaller diameter? Unfortunately, the smaller the diameter of the rectoscope tube, the more difficult and less informative the examination and the higher the likelihood of complications (in particular, damage to the intestinal wall). There are children's tubes with a diameter of 12-15 mm, which are always included in the standard set for rectoscopy, but when examining adult patients they are used only in exceptional cases: with strictures (narrowings) of the rectum and anal canal, a very “complex” psychological status of the patient, etc. .d.

In many commercial clinics, it is customary to perform rectoscopy with the patient in the left lateral position (according to Simps), mainly because this is considered more emotionally comfortable for the patient. Based on my clinical practice, I can definitely say that this is the wrong approach to the issue. The rectum, despite its name (anatomists are generally people with a very rich imagination), is not even straight, and has several pronounced physiological bends, while being quite closely connected with the final part of the spine. Therefore, when the patient is in a position on his knees and elbows and arches the lower back, the curves are smoothed out, making the procedure much simpler and more informative for the doctor and less painful and dangerous for the patient. In all my personal experiments with rectoscopy on the left side, I was able to “creakly” see up to 14-15 cm, no more. You can, of course, blame natural crookedness, but in domestic clinical recommendations, the opinion of the group of experts who composed them completely coincides with mine - for sigmoidoscopy, the patient’s knee-elbow position is clearly recommended. In addition, patients consistently come to our Coloproctology Center, at least 1-2 times a year, who, after supposedly undergoing rectoscopy, are treated for “hemorrhoids” for six months or a year, and we find tumors at a height of 12-15 cm, and of this size that it is simply impossible not to notice them with a properly performed rectoscopy. The last such case was just a couple of months ago.

In our medical office, before the examination, the patient changes into disposable endoscopic shorts, goes to the examination chair, where he stands in the knee-elbow position. Next, the doctor inserts a rectoscope lubricated with Vaseline into the anus and, under visual control, moves it to the maximum depth. During the examination, the intestine is slightly inflated with air using a “pear” (see photo) in order to better control the intestinal lumen. All these manipulations, of course, cause moderate discomfort, both moral and physical, but the patient does not experience severe pain during the rectoscopy process . A proctologist’s office is not a Gestapo department (many patients think of us that way ), so the doctor focuses on the patient’s feelings, and if the discomfort increases significantly, further insertion of the device is immediately stopped. Next, the doctor slowly removes the rectoscope tube, examining the walls of the intestine and anal canal.

The whole procedure takes no more than 3-5 minutes. Among the additional procedures that may be required during rectoscopy, it is worth mentioning a biopsy, i.e. sampling of a section of tissue for further morphological examination, and electrical excision (removal) of small colon polyps. Both procedures slightly lengthen the examination time, but are also very painless.

Indications for rectoscopy (sigmoidoscopy)

To diagnose all “minor” proctological ailments (hemorrhoids, anal fissures, rectal fistulas, anal canal condylomas, etc.), anoscopy is sufficient. Colonoscopy is used for a comprehensive examination of the entire colon. Discussion about why rectoscopy is needed arises both in the process of communicating with patients and even in the medical community.

The reasons for the widespread use of rectoscopy are in the economic and (in some sense) psychological planes. About the economy: a colonoscope and a sigmoidoscope (the latter is closest in capabilities to a rectoscope) are much more complex and expensive endoscopic devices, and require much more complex, time-consuming and expensive sterilization. Therefore, it is simply not economically feasible to have five such devices in order to “quickly” examine everyone in need during the consultation process. In addition, these studies can only be carried out by certified endoscopists; surgeons do not have this opportunity.

About psychology: yes, of course, colonoscopy completely covers all the diagnostic capabilities of rectoscopy, but at the same time it is a more complicated, more painful procedure that requires much more careful and tedious preparation, which patients agree to very reluctantly. When there is a reason to examine the intestine more deeply, a person should be referred to an endoscopist for a colonoscopy, and although all patients nod in agreement, imitating wild enthusiasm, practice shows that less than 50% actually complete this path. Rectoscopy can be carried out immediately, which significantly reduces the number of refusals - looking into the eyes of the doctor who has just been rubbing in you for an hour about how and why it is so important to undergo an examination, it is much more difficult to “jump off”. Yes, of course, rectoscopy allows you to examine only the rectum, but every experienced specialist can give at least a dozen or two examples where such an early diagnosis definitely saved the patient’s life, allowing treatment of a rectal tumor to begin at the earliest possible stage.

In our medical office, we strongly suggest that all patients over 40 years of age undergo proctoscopy, regardless of complaints (cancer prevention). For younger patients, this study is offered only if certain symptoms are present: bleeding, mucus or pus in the stool, difficulty defecating, etc.

Contraindications to rectoscopy (sigmoidoscopy)

The main reason for temporarily refusing to perform rectoscopy is only severe pain. In this case, you can either prescribe treatment and reschedule the procedure for a second appointment, or carry it out with local anesthesia, which is most often used gels with lidocaine (for example, Cathegel). The presence of a scar stricture (narrowing) of the anal canal is also a contraindication to the study, because it may simply be physically impossible to carry out it.

Preparation for rectoscopy (sigmoidoscopy)

With the advent of ready-made microenemas for self-preparation, this process has become significantly simpler and absolutely standard for all manipulations performed by a coloproctologist, with the exception of colonoscopy. More details on this issue can be found on the “Preparation for Inspection” page.

Complications after rectoscopy (sigmoidoscopy)

If in the article about anoscopy we wrote that complications are completely excluded, then with rectoscopy everything is a little less rosy. The device is rigid, inserted deep enough, and rotated to pass physiological curves, so there is a chance of damaging the intestinal wall, up to its complete rupture. But this complication is extremely rare: in all my clinical practice, I have personally seen only one such case (I hasten to note that rectoscopy was not performed in our institution). If the study is carried out carefully, in constant contact with the patient and focusing on his sensations, the likelihood of damage to the intestinal wall is almost zero.

Thus, characterizing rectoscopy, one can recall the bearded Soviet joke: “well, horror, but not horror-horror.” This is a slightly humiliating procedure for a person, but a quick and painless procedure with fairly simple and quick preparation. In conclusion, it’s probably worth mentioning another patient phobia: are such devices processed well enough? In the description and photographs we were talking about reusable rectoscopes, since disposable tubes have become very expensive in recent years, and their cost reaches 75% of the average market cost of the procedure itself. Naturally, they are processed well (using the chemical disinfection method), but for those who are still bothered by this issue, our office offers examination with a disposable rectoscope from SapiMed, although you will have to pay additionally for the cost of the device.

Sincerely, Anatoly Ivanovich Nedozimovany, associate professor of the course of coloproctology at Pavlov State Medical University of St. Petersburg.

Preparation for retromanoscopy with Fortrans.

A more acceptable and simpler way to empty the intestines can be considered taking the laxative drug “Fortrans”, which will provide a gentle but complete cleansing of all parts of the intestinal tract. The drug acts by retaining fluid and increasing osmotic pressure on the intestinal wall, which causes reflex emptying. The electrolyte composition of Fortrans does not allow disruption of the water-salt balance, and this indicates the safety of the drug.

The dosage is calculated according to the formula: 1 sachet of medication powder per 1 liter of water. For complete cleansing, you need to take 3-4 liters of solution the evening before the procedure, one glass every 15 minutes. The taste of the medicine can be adjusted by adding a slice of lemon to the glass. There is no need to take Fortrans immediately before retromanoscopy. If the study is planned for the second half of the day, it is necessary to divide the intake of the solution into the evening and morning, equally.

Preparation for retromanoscopy with Microlax.

Another way to gently cleanse the intestines is the use of microenemas, of which the drug Microlax is a representative. The mechanism of its work is based on an irritating effect on the intestinal mucosa. In order to prepare for retromanoscopy, it is recommended to administer 4 microenemas: 2 in the evening and 2 in the morning, before the procedure.

Our clinic specialists will advise you both on the correct preparatory period and on the actual conduct of the study. You will find the most reasonable cost of sigmoidoscopy in St. Petersburg in the price list of the NEOMED medical center.

Find out the cost of the “Retromanoscopy” procedure

The essence of the examination

Rectoscopy helps to examine the rectum and the final part of the sigmoid colon. To examine the rectum, a rectoscope is used, which is equipped with:

rigid tube (l=25-30 cm, d=2 cm);
special lenses;
lighting device;
air injection devices.

Such an examination helps a medical specialist give a complete picture of the condition of the intestinal mucosa, assess the likelihood of neoplasms of various etiologies, and the presence of polyps and tumors of the rectum. Symptoms of many rectal diseases can be confirmed or refuted using this type of diagnosis.