Office Sigmoidoscopies

Years ago I had a sigmoid exam in the doctor's office. Beforehand I was given a large tap water enema in the office and then was placed, face down, on a table that tilted up so that my ass was sticking up in the air. This was before the flexible scope and so it was the metal (very cold) rigid type. Even so, it was very arousing - both the enema and the exam.

Since then I have had 2 flexible sigmoidoscopies but was told to take 2 fleet enemas at home. The Fleets are totally worthless in my opinion. Before the last one I told the doc that the Fleets didn't work for me and he had me take two 1-quart soapy water enemas at home. That worked fine but this time the exam was done in the hospital. Very expensive and very icy and clinical.

Does anyone do these exams in the office anymore? If so, are there any docs who will administer the enema in the office?

This won't help you now, but there was a doctor in Manhattan who, like yours, requested his patients use two Fleet enemas prior to their physicals because he used a rigid, not flexible, sigmoidoscope as part of his exams. He has since retired. As for how they were done, with a patient on the exam table on hands and knees with the right shoulder down against the table.

Occas. we use a rigid sigmoid scope to look at the very lower end of the bowel. If someone complains of bright red rectal bleeding and, after examining the person, the MD feels it might be a bleeding hemorrhoid or ulcerative colitis lower in the colon they will use a rigid sigmoid scope to get a quick diagnosis. They are easy to use, easy to clean and are used for diagnosis of suspected lower bowel issues. If you don't give the person a fleets before hand, you run the risk of a surprise upon inspection. Any type of procedure scheduled, requires a prep either the laxative thing or an enema or two. Recently I saw a male with a gun shot wound to his lower pelvic region and based on the exam and x rays, the MD used a rigid scope to see if the lower colon might have been perforated. The person on the recieving end was "under arrest" and therefore had a armed guard with him. The guard, a young guy got to see the whole procedure. The guards facial expression was priceless and I looked at him and said "and they say guns are dangerous". He just laughed.

Rigid scopes are not used much anymore, except, as noted in the other post, to view the very distal part of the colon. Most are only about 25 cm long, so they only go in about 10." Flexible scopes are usually more comfortable and are up to about 60 cm long. However, they both require pretty much the same prep, which is usually enemas (Fleet, soapsuds, etc.). The rigid scopes are still available and are nice (for one experieced, as they can do considerable harm if used improperly) to use during a medfet exam.

I am fascinated by the procedural differences between countries. This seems to be one area in which there are differences; another is that of digital rectal exam of the male. How do such procedures become so firmly entrenched. I guess it is the fault of one authoritative practitioner who writes the best textbook and influences the profession to such an extent.

I have had numerous rectal exams and one colonoscopy, but have never had a sigmoidoscope or anusocopy performed on me. One time during a physical when I was about 30 or 35, the nurse asked the doctor if he needed one of those clear scopes and he said he didn't think we needed that. I was relieved at the time, but might of been quite the experience. I doubt they are done very often unless you complain of some problem such as pain or bleeding, then the colonoscopy might be the exam of choice depending on medical history and your age.

I think Doctors are now afraid to examine their patients anymore. My current doctor i recently begged him just to do some osculations. Everyone is just too sue happy. I recently heard from an OB that he was sued for anacephaly...sigh

Everyone seems to be a specialist of one kind or another these days. For anything other than the very basics, or should I say " bare essentials " you will probably get sent to a specialist and end up going to at least 5 Doctors in order to have a complete physical. One Doc finally admitted to me that it is the only way they can make any money any more due to the near entier medical " business " under the control of insurance companies. Doctors get a flat rate payment for any given procedure and are grossly underpaid by the insurance companies. If a Doctor collects a co-pay from each patient visit , well, the more visits the more money . Why have just one Doctor get a co pay when half a dozen can get a co pay from the same patient as well.

These days you go to a doctor that specialize in colonoscopy and no longer a grneral parctioner ( if those even exist any more ) . I am seriously thinking about getting my physicla done in a foriegn country by one doctor only , like the way they used to do it here. There are very god facilities in some other countries and you can have the whole things done for far less than here and pay cash for it. Don't tell your insurance company though LOL , then kay just cancel your policy !

Can I suggest to anyone whose doctor wants to do a flexible Sig as part of a routine exam that they request the full Colonoscopy instead? I had a flexible sig and less than a year later was diagnosed with Colon Cancer. Not saying that there aren't extremely good uses for the flexible sig exam, but it IS NOT a substitute for a Colonoscopy.

Can I suggest to anyone whose doctor wants to do a flexible Sig as part of a routine exam that they request the full Colonoscopy instead?

Unless your Primary Care Provider is a Gastroenterologist it is not likely they will be the one performing the colonoscopy, whereas in-office sigmoidoscopy is often performed by General and Family Practitioners. The only practical way to include colonoscopy as part of a routine physical is to check into a hospital for a two day Executive Physical like the President does at Walter Reed.

I had a flex signoidoscopy in a doctor's office several years ago but the doctor was not my regular doctor and was probably a gastro specialist. I don't remember what he was. I was referred to him by my regular doctor. I received some instructions in the mail before the appointment. The instructions included not eating after a certain hour on the day before my appointment and using two enemas. I used one enema the night before and another one the morning of my exam. Neither was that bad and it was easier to do those than prep for a colonoscopy, which I have had once.

I arrived at the doctor's office an hour or two after the morning enema. The nurse showed me into the exam room and told me to undress from my waist down and to cover my lower half with a sheet. No gown was offered. I undressed to just my t-shirt and covered up my bottom half with the sheet.

The doctor eventually came in and asked a few questions. Then he had me lay on my side, uncovered my rear completely, and did a rectal exam with his gloved finger. Part of what he seemed to be doing was lubricating my anus for the rest of the exam. Next, he inserted something that I couldn't see well but it was a cold metal tube that he used to look just inside my rear. Then he pulled that out and got the flex sig device off of the cart. I got that long flexible tube up my butt next and really didn't feel anything except at the beginning of the insertion. I felt nothing much as he inserted the flex sig into me maybe 18 inches. I felt some sensation as he pulled it out but not much there either. He did a second rectal exam with his finger and may have been checking for blood from the exam. He wiped my rear up with his glove but didn't offer me any wipes to finish with.

The doctor told me that everything looked good and that I could get dressed. He left and his nurse came back into the exam room just as I was pulling up my jeans. She had the checkout sheet that I needed to take to the office receptionist and didn't seem bothered that I was not completely dressed when she came back in. I wasn't bothered either since I had expected that a nurse might have been in the room during my entire exam and would have seen more of me than just that. Afterwards, I had no problems. I had been told to expect to be gassy for a couple of hours since he had inflated my colon a little but I didn't have that problem. I just had some lube on the seat of my briefs since he had not cleaned me up well.

I had a flex signoidoscopy in a doctor's office several years ago but the doctor was not my regular doctor and was probably a gastro specialist. I don't remember what he was. I was referred to him by my regular doctor. I received some instructions in the mail before the appointment. The instructions included not eating after a certain hour on the day before my appointment and using two enemas. I used one enema the night before and another one the morning of my exam. Neither was that bad and it was easier to do those than prep for a colonoscopy, which I have had once.

I arrived at the doctor's office an hour or two after the morning enema. The nurse showed me into the exam room and told me to undress from my waist down and to cover my lower half with a sheet. No gown was offered. I undressed to just my t-shirt and covered up my bottom half with the sheet.

The doctor eventually came in and asked a few questions. Then he had me lay on my side, uncovered my rear completely, and did a rectal exam with his gloved finger. Part of what he seemed to be doing was lubricating my anus for the rest of the exam. Next, he inserted something that I couldn't see well but it was a cold metal tube that he used to look just inside my rear. Then he pulled that out and got the flex sig device off of the cart. I got that long flexible tube up my butt next and really didn't feel anything except at the beginning of the insertion. I felt nothing much as he inserted the flex sig into me maybe 18 inches. I felt some sensation as he pulled it out but not much there either. He did a second rectal exam with his finger and may have been checking for blood from the exam. He wiped my rear up with his glove but didn't offer me any wipes to finish with.

The doctor told me that everything looked good and that I could get dressed. He left and his nurse came back into the exam room just as I was pulling up my jeans. She had the checkout sheet that I needed to take to the office receptionist and didn't seem bothered that I was not completely dressed when she came back in. I wasn't bothered either since I had expected that a nurse might have been in the room during my entire exam and would have seen more of me than just that. Afterwards, I had no problems. I had been told to expect to be gassy for a couple of hours since he had inflated my colon a little but I didn't have that problem. I just had some lube on the seat of my briefs since he had not cleaned me up well.

[quote author=DrJ58 link=topic=45631.msg368072#msg368072 date=1309967211]

Unless your Primary Care Provider is a Gastroenterologist it is not likely they will be the one performing the colonoscopy, whereas in-office sigmoidoscopy is often performed by General and Family Practitioners. The only practical way to include colonoscopy as part of a routine physical is to check into a hospital for a two day Executive Physical like the President does at Walter Reed.

[/quote]

DrJ58, I am unaware of Canadian medical practices, but I believe most physicians would arrange for a colonoscopy if requested by the patient. As I said in my post, there are many uses for a flexible sig, but a substitute for a colonoscopy isn't a very good use. In my case, the flexible sig missed a tumor that was higher in my colon than the scope would reach. I'm just trying to make sure that anyone concerned about colon cancer doesn't make the same mistake I did.

In the US, a PCP might arrange for a colonoscopy, but s/he wouldn't likely be performing the actual procedure. That is generally done at a freestanding endoscopy center by a gastroenterologist. This is especially true if sedation is involved. That's not something your PCP wants to fool around with.

Actually Tuber, Canadian medical practices are the same as the USA however it is a Socialized system with no private insurance. If a patient has a family history of colon cancer they may be referred for a screening colonoscopy earlier, however no one under 50 would get one simply because they asked. Screening colonoscopy is recommended every 5 years for anyone 50 and over. Flexible sigmoidoscopy is at the discretion of the physician and most GPs and Family Practitioners in Canada perform the procedure in a hospital out-patient clinic and not the office. A Flex Sigmoid is often backed up with an Air Contrast Barium Enema, and a patient is referred for a colonoscopy if there is any indications Patients with acute conditions will receive very prompt attention however there are year long waiting lists for screening colonoscopy.

Thanks to all for the information. I'm sure it's very useful to lots of Forum readers. If I might be excused for one last note: my point and the message I'd like everyone to receive is that colonoscopies can save your life by early detection of potential problems. As a Polyp, it's no big thing. As stage 4 cancer ...

We recommend patients receive a screening beginning at age 50 then every 10 years, however if problems (polyps, etc) are discovered then we usually tell them to be seen again in 5 years. Of course if someone is having GI problems, regardless of age, they should report it to their doctor. If the physician feels a scope is indicated then your insurance usually pays. It's not uncommon at all for patient's under the age of 50 to be scoped.

It was during a sigmoidoscopy exam at my interns office that he found a polyp and sent me to get a lower GI barium enema. Since then get a colonoscopy exam every 2-3 years as I'm prone to polyps.Last exam they found a couple of polyps very close to the cecum, which he wouldn't have found with a sigmoid or flexible sigmoid scope. And the tiny cameras you can swallow still require a thorough cleanout and if polyps are found,still need to do a colonoscopy to remove them. Worst part is the prep the day before; the colonoscopy itself is a piece of cake, especially if anesthetized. Yes there is always the slight risk of a punctured colon which would require hospitalization and immediate surgery, but very rare, especially in the hands of a skilled gastroenterologist. They should be willing to tell you their experience record before you sign up for the exam. My doc says the risk is about 1 in10,000. Sure beats waiting until a polyp turns cancerous and requires colon surgery. wish there was a 'humane' way to prep the colon for the exam though,like a series of enemas or a colonic instead of the oral laxatives all day on the day before the exam.

Back in the 90s my husband had to have a sigmoidiscopy and was told to do two Fleets before going to the office for the procedure. He didn't buy them and the night before asked me to run the pharmacy for him. I told him that I had a perfectly good enema bag and knew how to take care of him. Up until that point he didn't even like to talk to me about enemas, but after the two that I gave him he decided that it might be fun for us to occasionally enjoy them together. It was, as they say, his defining moment. 😃

I visit a mistress every month, she is a trained nurse, she has a 2 foot long rigid sigmoidoscope, she gets it nearly all the way in me, it takes time, and I have to move positions now and then, but when its in, I feel so full. We have also used it as a rigid endoscope, and inserted it down my throat, wow, very scary

In the early 90s while back East on a business trip I contracted a nasty intenstinal parasite and other bugs that produced a set of most unpleasant and persistent symptoms. It took the better part of a year for my doctor, an internist, to get it all sorted out. Over that period of time I had two flex sigs in his office and two barium enemas at the radiology center as diagnostic procedures. Prep for the flex sigs involved strong laxatives and Fleet enemas during the 24 hours before the pocedures, and a liquid diet for a couple of days prior. Everything had to be squeaky clean. The flex sigs were pretty much as others have described: digital rectal exam and lube, a quick look with a proctoscope, then more lube followed by the sigmoidoscope. My position was on the table on all fours, head and right shoulder down, bottom up in the air. Naked from the waist down for the entire thing but covered with a paper sheet; the doctor made an opening in the paper to expose my anal region and instert the scope. There was a nurse in the room to assist and I was glad for the basic privacy afforded by the paper sheet. There wasn't any real discomfort except when the scope had to go "around the corner" where the small intestine transects the belly; I felt that. The sensation as the scope was finally slowly withdrawn was exquisite as I recall. I passed gas for several hours afterward, the air injected into the intestine to improve the view through the scope. I remember spending several hours at home on my hands and knees afterward, butt up in the air, spreading my cheeks as the air bubbles worked there way up and out. The second time was easier as I knew what to expect. Am now 68 and get colonoscopies every 5 years. The prep is much easier these days ("Go Lightly?"). The only thing I feel is the initial lubrication and the start of insertion and then I'm out light a light thanks to the IV drugs they give me. I wake up back in the recovery room not remembering anything about the procedure. Actually, I kind of miss the old way with the flex sigs in my doctors office. A detail I almost forgot: for the second flex sig there was no nurse present, just my doc. I was naked from the waist down but there was no paper sheet offered (guess it was not needed since it was just us guys there), and I was in what I later learned was called the Sims position.

During nursng school I had a rotation in the out patient Gi clinic where I observed several proctoscope exams. my duties was to give the patient an enema, then place the on the table for the procedure. The scope was visible as the patient was moved to the table. They were placed face down knees spread apart then the table was tilted.most of the complaints came as the air was introduced to the colon. It was over in about 10 minutes.

For several years, our family doctor was an internist who encouraged flexible sigmoidoscopies, which he did in office, for patients over forty, if I remember correctly. He did one on my sister at a younger age but I do not recall why. He did one on my wife, at age forty I think. He gave up his practice to pursue other interests before I had my turn. I was not looking forward to it but I was aroused by it when my wife underwent the procedure.

I've never had one, but I can't wait until I'm older and the doctor orders one for good measure.

I've had two performed in the doctors office. For the first one the prep was a couple of piils and some type of liquid laxative the day before, then a fleet enema at home the morning of the exam. When I arrived at the doctors office the nurse took me to the room and had me undress from the waist down and gave me a paper cover-up. The exam was done in the sims position. The doctor examined me with his finger and then started the scope. The nurse stood by his side and applied lube to the scope as he inserted it. After only a couple minutes he said I wasn't cleaned out enough and withdrew the scope. He asked me if I would like to go home and clean out better or stay there and have them do it. I opted to stay and he told the nurse to administer two enemas to me and then check the results.

The nurse took me to a room with a bathroom attached and had me take a seat on the table. I watched as she opened up a cabinet and got out a disposable enema bag. As she was filling it she asked if I had ever had an enema other than a fllet and I told her I had but it had been a while (I lied). I had a full erection as she had me lay down and assume the sims position. I don't think she ever noticed my hard dick as she was doing her job. She gave me that enema and then another one. After the second one she told me not to flush the toilet so she could check the results. Then she said it looked like I was OK to proceed and took me back to the procedure room. This time the exam went smoothly and the doc said everything looked normal. When I had the next one performed a couple of years later the doctor had changed the prep instructions to include enemas until clear before coming in for the exam.

Sounds like a sigmoid scope could be a fun toy to add to the collection!

During a stint while I was working at a Gastroenterologists office, I observed many people being examined. I was always present to assist the doctor and comfort the patients. I was young, and I wasn't into comforting the patients much back then. Most, for some reason, were men. I was more interested in seeing the mechanics, the slick equipment and devices and the technical aspects and procedures. The physician was also an internist in his early 60s and he had us instruct all patients who came for either a yearly check up and physical exam or any kind of gastro issues to take two Fleet enemas before their appointment. One was to be taken two hours beforehand and the second an hour before hand. So, basically, 95% of the patients got enemas before they showed up.

I learned so much cool and interesting stuff at that position and because this was some time ago and he was an older guy, he allowed his small staff of "girls" to do things that normally a nurse or other skilled practitioner would do. He taught us how to take x-rays, do EKGs, give simple sub-cu injections, and the like. No matter what you came to us for, before you left he gave you a digital rectal exam. I was required to be present for all women patients who came alone, as a chaperone, and I have very clear memories of the sight and sound of this older male doc telling a woman to turn over on to her side for the rectal. I still use the same movements he did, as that was where I first learned to perform a DRE.

The most fascinating thing we did in the office, however, were the rigid sigmoidoscopies. My doc had the patients begin on their side and then roll in to different positions as he advanced the scope and introduced some air into the rectum. Sometimes, he would do the scope, withdraw and do the entire procedure over again, this time with the lights out. He enjoyed explaining things to us and I recall one particularly enjoyable lesson he gave us. The patient was an affluent male, in good shape and obviously used to being in charge. He seemed like maybe he was a lawyer or perhaps another doctor.

This guy was rude to the support staff whenever he came in or called. He was always in a rush and acted very patronizing and demeaning to us. He was a jerk in a Jaguar, in other words. Boy did our doctor give him a thorough and intense exam. Doctor had him turning this way and that, advancing the scope, withdrawing and this guy, who was a real jerk started whimpering and whining like a little baby after about ten minutes. At one point Doctor had him on his side, knees up slightly, lights out. I could see the guys face illuminated from the lights on the instrument panels of the medical apparatus in the room and Doctor said that he wanted my co-worker and me to watch the man's stomach as he began this part of the exam.

At that point the doctor sort of almost leaned into the guy and went in deep and inflated him and we could see the light from the scope through his abdomen, like when you are a kid and you shine a strong flashlight through your hand in the dark. The guy really started complaining then and sort of tried to squirm away from the scope, which is maybe why Doctor was leaning into him and pushing. The doctor ignored him (I know, not great) and continued pushing the scope in, explaining all the while to us what he was doing to the patient. It was so cool. The doctor was educating us as though the patient wasn't even there, like he was using a demonstration mannequin almost, completely ignoring the guy's whimpering and gasping.

As the lights came back on and he began to remove the scope the doctor suddenly became aware of the patient's fussing and machinations and movements and whining and he barked at him and scolded the guy right in front of us, saying harshly, "Stop that nonsense. It's not that bad. Turn on to your other side." The guy didn’t make a peep after that.

After he left my co-worker and I told everyone in the office what had happened. We all agreed the man would probably not come back, but to his credit, he did and he treated us much more respectfully, too. I always wondered if he came back because our doctor had a good reputation or because he enjoyed being scolded by Doctor while he still had the scope in him and he was bare-assed in front of us "girls".

Last year my now-ex was having a lot of issues, he ended up being referred to a gastro, and was told he had to have a sigmoidoscopy, which he had no idea what it was. I accompanied him to his appointment (like I did at all appointments for obvious reasons, ha!) and when we got there he was given an enema and then the sigmoidoscope, I didn't get to see a whole lot of it because I was busy comforting his wimp-ass (no pun!) but what I did see was wonderful, and I could tell he was fairly uncomfortable and a bit embarrassed (which made it sooo much better for me).

No matter what you came to us for, before you left he gave you a digital rectal exam.

I was a little surprised by this. If a patient came in because of persistent heartburn or some other upper GI issue, the doctor still thought a rectal exam was necessary?

Back in the mid 80s I had a sigmoidiscope exam and it was done by our GP. They had me do a Fleet enema at home before hand. The instrument was not one of the new flexible ones, but a rigid stainless steel device. It was the grossest procedure that I have ever had in my life.