After completing the rectovaginal exam and throwing his gloves in the garbage, the doctor glanced back at Briony’s chart and then looked at her with a calm expression. “Briony, I just want to do one more quick check. When I examined your abdomen earlier, I noticed your bowels weren’t very active. I’m going to palpate your abdomen again, just to check for any tenderness, lumps, or signs that might need further attention.”

He placed his hands gently on her abdomen, starting with light pressure. “I’m going to feel around your tummy to make sure everything’s normal. If you feel any pain or discomfort, let me know, alright?”

Briony felt a little nervous, but the doctor’s steady hands and reassuring voice helped her relax. As he moved his hands over her stomach, Briony felt a little pressure, but nothing too uncomfortable. “You’re doing great,” the doctor said softly as he palpated her abdomen. “It's a little bit more rigid than I like Briony."

He pressed a little deeper, gently feeling for any areas of tenderness. Briony felt a mild discomfort in one spot but didn’t feel any sharp pain. “A bit tender here,” the doctor noted quietly. She felt embarrassed as he prodded and pressed at the top of her pubic hair line.

After a moment, the doctor moved his hands down to her groin area. “Now, I’m going to check for a hernia. I’ll press into your groin, and then I’d like you to cough for me, just to see if any bulging occurs.”

Briony nodded, and as she coughed, the doctor gently pressed into the area. “Perfect!” he said. “No sign of a hernia here. That's great news.”

Once he had finished the abdominal exam, the doctor took off his gloves and said, “OK sit up now. Briony, based on what I’ve felt I’m a bit concerned about your abdominal tenderness and bowel movements. It could just be constipation, but it might also be something more serious, so I’d like to ask a few questions to understand better.”

He continued, “Can you tell me about your eating habits? Are you getting enough fiber or drinking plenty of water?”

Briony shared what she usually ate, and the doctor nodded. “Thanks. Now, how often are you having bowel movements? Any pain or difficulty?”

Briony cringed and explained her recent struggles with irregular bowel movements. The doctor listened carefully and then said, “It sounds like constipation, but with the stiffness I felt in your abdomen, I think it’s worth looking into further. It could be something simple, like diet-related, or something more serious.”

I think we need to take a closer look at your lower colon to rule out any serious issues. I recommend a sigmoidoscopy, which is a procedure that lets us examine the inside of your rectum and lower colon.”

He continued, “It’s a simple procedure, where a flexible tube with a camera is gently inserted to look for any abnormalities. It’s not painful and it’ll give us more information to make sure there’s nothing serious going on.”

The doctor paused to ensure she understood. “It’s a routine test, and I’ll explain everything in detail before it’s done. How do you feel about moving forward with this?”

Briony didn't know what to say at first, "Do you think it's really necessary?"

"I do I'm afraid." The doctor grimaced, "You haven't had any proper investigations before and we need to make sure you're up to date for your insurance."

"Umm I guess we should go ahead." Briony groaned.

The doctor smiled reassuringly. “Great, we’ll get started right away. Before we begin the procedure, though, we need to make sure your lower colon is clear, so you’ll need an enema. I'll just fetch the nurse." Briony was left feeling completely mortified.

The nurse she had met earlier entered the room, smiling warmly. “Hi sweetie, I’m here to help with the preparation,” she said brightly. “What I’ll do is assist you with the enema to clean out your lower bowel. It’s a simple procedure, and I’ll make sure you’re as comfortable as possible. I’ll have you lie down on your left side, with your knees drawn up. Then I’ll gently insert a small tube into your rectum and introduce the liquid. It may feel a little uncomfortable but it won’t last long.”

Once Briony was settled, the nurse gently opened the enema kit and prepared the solution. “This is just a warm, mild solution that will help clear your lower bowel. I’m going to insert a small, lubricated tube into your rectum. You may feel some pressure, but it shouldn’t hurt.”

Briony took a deep breath as she lay down on her side, her fists curled into balls, she was desperately trying to relax as the nurse carefully positioned the small, soft tube at the opening of her rectum. The nurse spoke softly to reassure her. “Ok deep breath as I insert the tube into your bottom, I'll make sure to go slow."

The nurse gently inserted the tube, moving slowly and carefully. “There you go hun, all set. Now, I’m going to slowly introduce the liquid, and you’ll feel a bit of pressure in your abdomen as the liquid fills your lower bowel."

Briony felt a mild pressure as the nurse slowly administered the solution. The sensation was strange, but not painful. The nurse kept checking in with her, saying, “You’re doing great sweetie!"

Once the enema was finished, the nurse gently removed the tube, making sure Briony was comfortable. “Okay, now that we’ve got the enema in, you’ll need to hold the solution in for a few minutes,” the nurse explained. “This allows the liquid to work and clear out your lower colon. After that, you’ll be able to go to the bathroom to release the liquid, and then we’ll be ready to start the sigmoidoscopy.”

Briony felt a mild fullness in her abdomen as she held the solution, but it wasn’t unbearable. She took slow breaths, focusing on staying relaxed, knowing that the process would soon be over. After a few minutes, Briony felt the urge to go. “Okay, I’m ready,” she said softly.

The nurse smiled and nodded, “No problem, take your time. Just come back when you’re done.”

Briony scuttled to back to the bathroom, where she relieved herself of the enema solution. She felt quite disgusted as she used the wetwipes to clean herself up, blushing furiously as she reentered the exam room.

The doctor was waiting for her, ready to proceed. “All set?” he asked kindly.

Briony nodded, feeling a bit more relaxed now that the preparation was over. “I guess,” she replied.

“Great,” the doctor said with a reassuring smile. "One final check before we get going." Briony nearly groaned - how much more could she possibly take?

"Please could you get on your hands and knees so I can ensure that the procedure worked correctly and doesn't need to be repeated?" Briony went bright purple, she hated the idea of having another enema. Her arms shook a little as she positioned herself on the table, the doctor's hand gently encouraged her to put her knees farther apart.

"OK Briony, I'm going to use another speculum, a bit like the one I used for your pelvic exam, but this one has three prongs, see?" A gloved hand brandished a gleaming rectal speculum infront of Briony's mortified face.

"I'm going to use lots of lubricant, so it should feel nice and slippery as it sliiiiides right in. There you go." Cold metal invaded Briony's asshole, slowly at first and then all at once. She heard a screwing sound. "Opening it nice and gently, a liiiitle bit more." It was a shocking feeling, an expanding in her lower body, cool air and colder metal. "And I'm just adjusting my lamp so I get a nice clear view." Briony didn't think she could blush any harder, her face was burning hot. "Yes it's nice and clear back here, we can go ahead with the next procedure." Briony practically trembled with relief as the speculum was closed and withdrawn. She could feel her asshole taking a second to return to it's normal size and lubrication dripping between her butt cheeks.

“Now we’ll go ahead with the sigmoidoscopy. You’ll lie down on your left side again, and I’ll walk you through everything step-by-step. If you feel any discomfort at all, just let me know, and I’ll adjust.”

The doctor picked up the sigmoidoscope — a small, black flexible tube with a light and camera at the tip — and explained, “This is the instrument I’ll be using. It has a camera, so I’ll be able to see your colon on the screen. It’s also very flexible and designed to be as gentle as possible.”

He flipped the gown up exposing Briony's lower half then pulled her cheeks apart with one hand. He gently inserted the sigmoidoscope into Briony’s anus, speaking softly as he did. “You might feel some pressure as I gently guide the camera in, but it’s just a normal part of the exam. I’ll go slowly to make sure it’s as comfortable as possible.”

Briony felt the tube being inserted slowly and gently. The doctor spoke again, “Now I’m going to advance the scope a bit more past your anus and through the rectum so I can get a good view of your lower colon. You might feel some fullness or cramping as I fill the area with air — that helps open things up so we can see clearly.” She heard him pumping something that sounded like a bicycle pump and increased pressure inside her bottom.

Briony felt a slight discomfort as the air was introduced, but the doctor reassured her, “This is normal. Just take slow breaths, and we’ll get through this quickly.”

As the doctor continued to guide the sigmoidoscope, he explained the process step by step. “I’ll be looking at the lining of your lower colon to check for any abnormalities, like inflammation, polyps, or other signs of issues. It might feel like a bit of pressure or mild cramping, but it shouldn’t be too bad.”

Briony could see the doctor’s concentration on the screen as he moved the scope carefully, examining the area. “You’re doing great,” he said with a smile. “We’re almost done. I’m just going to take a quick look around, and then we’ll be finished.”

The procedure took just a few more minutes. The doctor was gentle and efficient, and before long, the sigmoidoscope was slowly and carefully removed. “That’s it,” the doctor said, smiling at Briony. “The sigmoidoscopy is finished. You did really well.” Briony breathed a sigh of relief. “Just one final thing I'm afraid, Briony. We need to get a final rectal swab so if you get on your hands and knees on the table please."

Briony felt her cheeks flush a little, uncomfortable with the idea. She looked away for a moment, her nerves showing. “I know it’s a routine part of the exam,” she said softly, “but it still feels… a little awkward.”

The doctor’s tone remained warm and understanding. “I completely understand how you feel,” he said, pausing to make sure she felt heard. “But after everything today, hopefully you feel more comfortable now - you’ve been doing great, and there’s absolutely nothing to be embarrassed about. I see this all the time, and it’s just another quick check to make sure everything’s in order.”

She still felt mortified, naked on her hands and knees on the table. The doctor used one hand to spread her anus, pulling the skin apart with his thumb and forefinger. He pushed a large swab inside her shoving it in and rotating it, it felt soft after the sigmoidoscope but still uncomfortable enough to make her wince.

“All done,” the doctor said, stepping back with a reassuring smile. “That’s the last part, and you did great. I know it can feel a little awkward, but really, there’s nothing to be embarrassed about. You handled it really well.”

As Briony got dressed she thought about struggling to get a ten minute GP appointment in the UK - maybe the NHS wasn't so bad after all!