Test Overview

Anoscopy, proctoscopy, and sigmoidoscopy tests allow your doctor to look at the inner lining of your anus, rectum, and the lower part of the large intestine (colon). These tests are used to look for abnormal growths (such as tumors or polyps), inflammation, bleeding, hemorrhoids, and other conditions (such as diverticulosis). These tests use different scopes look at different sections of the colon. Anoscopy. During an anoscopy, a short, rigid, hollow tube (anoscope) that may contain a light source is used to look at the last 2 in. (5 cm) of the colon (anal canal). Anoscopy can usually be done at any time because it does not require any special preparation (enemas or laxatives) to empty the colon. Proctoscopy. During a proctoscopy, a slightly longer instrument than the anoscope is used to view the inside of the rectum. You will usually have to use enemas or laxatives to empty the colon before the test is done. Sigmoidoscopy. During a sigmoidoscopy, a lighted tube that may be either rigid or flexible is inserted through the anus. Your doctor can remove small growths and collect tissue samples (biopsy) through a sigmoidoscope. You will have to use enemas or laxatives (or both) to empty the colon before the test is done. o The flexible sigmoidoscope is about 2.3 ft (70 cm) long and 0.5 in. (1 cm) wide with a lighted lens system. This instrument allows your doctor to see around bends in the colon. A flexible sigmoidoscope allows a more complete view of the lower colon than a rigid scope and usually makes the examination more comfortable. The flexible sigmoidoscope generally has replaced the rigid sigmoidoscope. o The rigid sigmoidoscope is used less often. It is about 10 in. (25 cm) to 12 in. (32 cm) long and 1 in. (2.5 cm) wide. It allows your doctor to look into the rectum and the bottom part of the colon, but it does not reach as far into the colon as the flexible sigmoidoscope. Flexible sigmoidoscopy is one of many tests that may be used to screen for colon cancer. Which screening test you choose depends on your risk, your preference, and your doctor. Talk to your doctor about what puts you at risk and what test is best for you.

Screening tests detect specific diseases before symptoms appear. Several tests can screen for colorectal cancer. Each test has its pros and cons. This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Regular screening can greatly decrease your risk of dying from colorectal cancer. Regular screening is recommended for everyone age 50 and older. Some screening tests look for colon polyps. Most cases of colorectal cancer begin as polyps. When polyps are found, they can be removed before they become cancer or while the cancer is in its early stages. Colorectal cancer rarely causes symptoms at the beginning. Symptoms such as bleeding from the rectum, a change in bowel habits, and weight loss usually occur later, when the cancer is harder to treat.

You may need to begin screening at age 40 or earlier and be tested more often if you or members of your family have a history of colon polyps or colorectal cancer. You may need to begin screening earlier if you have Crohn's disease or ulcerative colitis.

What is colorectal cancer?

Colorectal cancer is the out-of-control growth of cells in the colon or rectum. These cells grow into masses, or tumors. Most colorectal cancers begin as polyps, which are growths attached to the inside of the colon or rectum. Colon polyps are common, but most of them do not turn into cancer. Polyps are found during some screening tests. And polyps that are found by colonoscopy or sigmoidoscopy can be removed right away during the screening procedure. Colorectal cancer is the third most common cancer in men and women in the United States, and is the second leading cause of cancer deaths.1 It most often strikes people who are older than 50 who have no risk factors in their backgrounds other than their age. For more information, see the topic Colorectal Cancer.

What are the symptoms of colorectal cancer?

Early-stage colorectal cancer rarely causes symptoms. Symptoms of colorectal cancer usually occur later, when the cancer is harder to treat. Common symptoms include: Pain in the abdomen. Blood in your stool or black, tarry stools. A change in your bowel habits (such as very narrow stools or frequent diarrhea or constipation). Unexplained weight loss. Constant fatigue.

Why is regular screening important?

Most colorectal cancer cases can be prevented by having regular screening tests and having polyps removed. Survival rates are higher when colorectal cancer is found and treated early before it spreads to lymph nodes or other organs.

Why is my family's history important?

You are twice as likely to get colorectal cancer if one of your parents, brothers, sisters, or children has had it, especially if that person was diagnosed before the age of 50. The two most common inherited causes of colorectal cancer are familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC). Most people with these conditions will develop colorectal cancer if they are not treated. If you have any of these conditions in your background, you will need to be screened at an earlier age and have more frequent screeningthan other people. For more information, see the topic Colorectal Cancer.

Your Information

Several tests are available to screen for colorectal cancer: Stool tests. These include: o A fecal occult blood test (FOBT), every year. o A fecal immunochemical test (FIT), every year. o A stool DNA test (sDNA). Experts have not yet set guidelines for how often this test should be done.2 Barium enema, usually done every 5 years. Flexible sigmoidoscopy, usually done every 5 years. A stool test each year and a flexible sigmoidoscopy every 5 years. Colonoscopy, usually done every 10 years. Computed tomographic colonography (CTC), also known as virtual colonoscopy, possibly done every 2 5 years. Experts have not yet set guidelines for how often this test should be done. Flexible sigmoidoscopy (also called a sigmoidoscopy or shortened to "flex sig") and colonoscopy are done in doctor's offices, clinics, and hospitals. A barium enema is done in a hospital or outpatient radiology department. Complications from barium enema, colonoscopy, or sigmoidoscopy include damage to or puncture of the colon. These complications are rare, but are somewhat more common with colonoscopy than with barium enema or sigmoidoscopy. Colonoscopy and barium enemas are not recommended for pregnant women, although a colonoscopy can be done if needed. The decision about choosing a test for colorectal cancer screening takes into account your personal feelings and the medical facts.

Pros and cons of colorectal cancer screening tests

Stool tests (FOBT, FIT, and sDNA) Reasons to have a stool test Increases the chance that cancer will be detected early Can be done at home Does not require sedation Does not cause discomfort May be the least expensive test Are there other reasons you might want to choose a stool test? Reasons not to have a stool test Cannot, by itself, be used to diagnose colon polyps or colon cancer If the test is positive, you may need other tests anyway. It is not as reliable for finding colon cancer as other tests. Are there other reasons you might not want to choose a stool test?

Barium enema Reasons to have a barium enema Provides a good view of the entire colon Is accurate for finding abnormalities, such as narrowed areas or pockets or sacs in the intestinal wall Reasons not to have a barium enema Some polyps and cancer can be missed Polyps cannot be removed during the procedure.

Does not require sedation Is less expensive than colonoscopy Are there other reasons you might want to choose barium enema?

Cannot be used during pregnancy Requires liquid diet and bowel preparation beforehand Can be uncomfortable Are there other reasons you might not want to choose barium enema?

Sigmoidoscopy Reasons to have a sigmoidoscopy Is less expensive than colonoscopy Is accurate for finding polyps in the lower part of the colon (where most polyps occur) Small polyps that are found can usually be removed at the same time. Usually does not require sedation Reasons not to have a sigmoidoscopy Does not examine the upper section of the colon Requires bowel preparation (enema) beforehand Can be uncomfortable Has the risk of complications

Are there other reasons you might want to choose Are there other reasons you might not want to choose sigmoidoscopy? sigmoidoscopy? Colonoscopy Reasons to have a colonoscopy Can both detect and remove polyps in the entire colon during the same exam May be needed if a polyp or other abnormality is found during either barium enema or sigmoidoscopy, or if a stool test is positive Does not usually cause a lot of discomfort during the procedure, because you will be sedated for colonoscopy Is usually only needed every 10 years Are there other reasons you might want to choose colonoscopy? Computed tomographic colonography (CTC) Reasons to have a CTC Provides a good view of the colon as well as the upper and lower belly Is less invasive than a colonoscopy Usually does not require sedation Less risk of complications than a colonoscopy Are there other reasons you might want to Reasons not to have a CTC Requires liquid diet and bowel preparation beforehand Polyps cannot be removed during the test. May miss small polyps Exposure to X-rays May be an expensive test Are there other reasons you might not want to Reasons not to have a colonoscopy Requires liquid diet and bowel preparation beforehand May require sedation and time off from work Not recommended during pregnancy, although it can be done if needed May be an expensive test Has the risk of complications Are there other reasons you might not want to choose colonoscopy?

choose CTC?

choose CTC?

These personal stories may help you make your decision.

Wise Health Decision Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having a screening test for colorectal cancer. Discuss the worksheet with your doctor. Circle the answer that best applies to you. I am worried about having discomfort during a colonoscopy, sigmoidoscopy, or barium enema. I want to have the test that is going to see as much as possible. I'd rather have one test every 10 years than another test every 5 years. I prefer a test that I can do by myself at home. I do not want to miss any work to do this test. If I have a sigmoidoscopy or barium enema, I will be able to go back to work the same day. I don't want to have two procedures; I would rather my doctor remove any polyps I might have at the same time that I have a colonoscopy. I have health insurance and can afford the cost of the test. My health insurance won't pay for a colonoscopy but will pay for another type of test. I am worried about the risk of puncturing or damaging my colon during a colonoscopy. Yes No Unsure Yes No Unsure Yes No Unsure Yes No Unsure Yes No Unsure Yes No Unsure Yes No Unsure Yes No Unsure Yes No Unsure Yes No Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason for making your choice. Return to the topic: Colonoscopy Colon Polyps Colorectal Cancer Fecal Occult Blood Test (FOBT) Sigmoidoscopy

References
Citations

1. American Cancer Society (2005). Colorectal Cancer Facts and Figures: Special Edition 2005, pp. 120. Available online: http://www.cancer.org/docroot/STT/content/STT_1x_Colorectal_Cancer_Facts_and_Figures__Special_Edition_2005.asp. 2. Levin B, et al. (2008). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the U.S. MultiSociety Task Force on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians, 58(3): 130160.

Sigmoidoscopy Introduction
Sigmoidoscopy is a procedure in which a doctor looks in your large intestine. A length of flexible tube connected to a fiberoptic camera is used. A light is transmitted through the scope to the tip by a bundle of light fibers. The doctor uses this light to look at your intestine through an eyepiece or video screen. Your doctor may do this very safe procedure for several reasons. o Sigmoidoscopy is the best way to diagnose colon cancerthe second most common cause of cancer death in the United States. This procedure may also be used to help investigate problems such as bleeding, abdominal pain, or diarrhea.

Three findings are possible from this procedure. o You are healthy, and no other studies are needed. (Even though the sigmoidoscopy is the most important technique in the evaluation of colon cancer, a very small percentage of people with normal sigmoidoscopy findings may later be found to have colon cancer.) A diagnosis of your particular disease is made. You may need additional testing, consultation, therapy, or follow-up.

o o

Several leading medical groups recommend routine screening of men and women aged 50 years and older for colon cancer and benign (harmless) polyps every 3-5 years. Younger people may require this procedure if they have close relatives with colon cancer. A similar screening procedure is known as a colonoscopy. The basic difference is that the tube goes farther up the colon with a colonoscopy.

Sigmoidoscopy Preparation
Sigmoidoscopy is well tolerated by the vast majority of people. This procedure is usually done in a doctor's office without the need for any anesthesia or sedation. Your doctor may require you to use a strong laxative (called a bowel cleanser) to clear your bowel of fecal contents before sigmoidoscopy. Several medications are available for bowel cleansing, including polyethylene glycol 3350 (GoLYTELY, NuLYTELY), magnesium citrate, (Citroma), and senna (XPrep). These medications produce diarrhea, which can be uncomfortable, but unless the bowel is empty of stool, the test can be limited and may need to be repeated at a later date. Your doctor may also require a special diet, such as a clear liquid diet, starting 1-2 days before your scheduled sigmoidoscopy. Some people also need to use an enema (liquid is forced into the colon through the anus) before bedtime. The next day, you may take your normal medications. About 1 hour before the procedure is to begin, you will need to have an enema. The clear diet and enema help clear the intestine so your doctor can see well.

During the Procedure

The doctor will have you lie down on your left side with your knees bent and pulled up slightly toward your head. The doctor will examine your rectum first with a finger lubricated with special jelly. The tip of the scope is then lubricated with the same jelly and slowly inserted into your rectum. The doctor will slowly advance the tube through your lower intestine. In order to help the doctor see, a small amount of air and water may be placed in the intestine through the end of the scope. If the doctor encounters a suspicious area of intestine, he or she may remove a small piece of the tissue for analysis. This is done with the same scope and is known as a biopsy. The doctor will end the procedure and tell you the outcome of your study.

After the Procedure

After the procedure, you may experience mild abdominal cramping and gas as a result of the air that was placed in your intestine. Some people may have slight rectal bleeding due to minor irritation and trauma from the insertion of the sigmoidoscope

When to Seek Medical Care

You should notify the doctor if you experience severe abdominal pain, nausea, vomiting, or heavy bleeding after a sigmoidoscopy.

Your doctor may instruct you to go to the hospital's emergency department if you experience severe abdominal pain, nausea, vomiting, or heavy bleeding after a sigmoidoscopy.

Sigmoidoscopy (Anoscopy, Proctoscopy)

Test Overview
Anoscopy, proctoscopy, and sigmoidoscopy tests allow your doctor to look at the inner lining of your anus, rectum, and the lower part of the large intestine (colon). These tests are used to look for abnormal growths (such as tumors or polyps), inflammation, bleeding, hemorrhoids, and other conditions (such as diverticulosis). These tests use different scopes look at different sections of the colon. Anoscopy. During an anoscopy, a short, rigid, hollow tube (anoscope) that may contain a light source is used to look at the last 2 in. (5 cm) of the colon (anal canal). Anoscopy can usually be done at any time because it does not require any special preparation (enemas or laxatives) to empty the colon. Proctoscopy. During a proctoscopy, a slightly longer instrument than the anoscope is used to view the inside of the rectum. You will usually have to use enemas or laxatives to empty the colon before the test is done. Sigmoidoscopy. During a sigmoidoscopy, a lighted tube that may be either rigid or flexible is inserted through the anus. Your doctor can remove small growths and collect tissue samples (biopsy) through a sigmoidoscope. You will have to use enemas or laxatives (or both) to empty the colon before the test is done. o The flexible sigmoidoscope is about 2.3 ft (70 cm) long and 0.5 in. (1 cm) wide with a lighted lens system. This instrument allows your doctor to see around bends in the colon. A flexible sigmoidoscope allows a more complete view of the lower colon than a rigid scope and usually makes the examination more comfortable. The flexible sigmoidoscope generally has replaced the rigid sigmoidoscope. o The rigid sigmoidoscope is used less often. It is about 10 in. (25 cm) to 12 in. (32 cm) long and 1 in. (2.5 cm) wide. It allows your doctor to look into the rectum and the bottom part of the colon, but it does not reach as far into the colon as the flexible sigmoidoscope. Flexible sigmoidoscopy is one of many tests that may be used to screen for colon cancer. Which screening test you choose depends on your risk, your preference, and your doctor. Talk to your doctor about what puts you at risk and what test is best for you. For more information on screening tests for colon cancer, see: Colon Cancer: Which Screening Test Should I Have?

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Decision Points focus on key medical care decisions that are important to many health problems. Colon Cancer: Which Screening Test Should I Have?

Why It Is Done
These tests are done to: Detect problems or diseases of the anus, rectum, or lower large intestine (sigmoid colon). These tests are often done to investigate symptoms such as unexplained bleeding from the rectum, long-lasting diarrhea or constipation, blood or pus in the stool, or lower abdominal pain. Remove polyps or hemorrhoids. Monitor the growth of polyps or the treatment of inflammatory bowel disease. Screen for colon cancer or polyps.

How To Prepare Anoscopy

Usually, no preparation is needed for an anoscopy.

Proctoscopy and sigmoidoscopy

Test preparation for a proctoscopy and sigmoidoscopy may be similar. Before the test: Talk with your doctor to find out if you need to stop taking some medicines, such as warfarin, before the test. Tell your doctor if you have been diagnosed with peritonitis, diverticulitis, or toxic megacolon or if you have had recent bowel surgery. The preparation for these tests usually involves a thorough cleaning of the lower colon, because it must be completely clear of stool (feces). Even a small amount of fecal material can affect the accuracy of the test. You may be instructed to follow a liquid diet for 1 to 2 days before the test. You may be instructed to not eat for up to 12 hours before the test. You may need to have an enema the night before the test and another enema an hour before the examination. You may not need special preparation, especially if you have watery or bloody diarrhea. Talk to your doctor about any concerns you have regarding the need for this test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

How It Is Done
You will usually lie on your left side during the test. You may also be asked to kneel on the table with your bottom raised in the air. Once you are in position: Your doctor will gently insert a gloved finger into your anus to check for tenderness or blockage. For men, your doctor will also check the condition of the prostate gland. The lubricated scope is then inserted. The scope is moved slowly forward into the rectum and lower colon. During a sigmoidoscopy, puffs of air sometimes are blown through the scope to open the colon so that your doctor can see more clearly. Suction may be used to remove watery stool, enema liquid, mucus, or blood through the scope. Once your doctor has moved the scope forward as far as possible, it is slowly withdrawn while tissue is carefully inspected. Your doctor may also insert tiny instruments (forceps, loops, swabs) through the scope to collect tissue samples (biopsy) or to remove growths. Tissue samples may be sent to a laboratory for examination. See the following pictures: Step 1: The sigmoidoscope is inserted . Step 2: The doctor examines the wall of the sigmoid colon

After the scope is removed, your anal area will be cleaned with tissues. If you are having cramps, passing gas may help relieve them. The entire examination usually takes 5 to 15 minutes, slightly longer if tissue samples are taken or if polyps are removed. If you received a sedative during the test, do not drive, operate machinery, or sign legal documents for 24 hours after the test. Arrange to have someone drive you home after the test. After the test you may resume your regular diet, unless your doctor gives you other directions. Be sure to drink plenty of liquids to replace those you have lost during the preparation for the sigmoidoscopy.

How It Feels
An anoscopy, proctoscopy, and sigmoidoscopy examination can be embarrassing and uncomfortable. You may have cramping, a feeling of pressure or bloating, or feel a brief, sharp pain when the scope is moved forward or when air is blown into your colon. As the scope is moved up the colon, you may feel the need to have a bowel movement and pass gas. If you are having pain, tell your doctor. The removal of tissue samples (biopsy) from the colon does not cause discomfort. A local anesthetic is used when a biopsy of the anal area is done. Your anus may be sore for a few days. You may have mild gas pains and may need to pass some gas after the procedure. Walking may help relieve the gas pains. If a biopsy was done or a polyp removed, you may have traces of blood in your stool for a few days.

Risks
There is very little risk of complications from having an anoscopy, proctoscopy, or sigmoidoscopy. There is a slight chance of piercing the colon (perforation) or causing severe bleeding by damaging the wall of the colon. But these problems are rare. There is also a slight chance of a colon infection (very rare). Call your doctor immediately if you have: Heavy rectal bleeding. Severe abdominal pain. A fever.

Results
Anoscopy, proctoscopy, and sigmoidoscopy tests allow your doctor to look at the inner lining of your anus, rectum, and the lower part of the large intestine (colon). Your doctor should be able to discuss some of the findings with you immediately after the test. Lab results (such as from a biopsy) may take several days. Anoscopy, proctoscopy, and sigmoidoscopy Normal: The lining of the colon appears smooth and pink, with numerous folds. No abnormal growths, pouches, bleeding, or inflammation is present.

Abnormal: Some of the more common abnormal findings include: Hemorrhoids, which are the most common cause of blood in the stool. Colon polyps . Cancer in the colon . A sore (ulcer). Pouches in the wall of the colon (diverticulosis). Redness and swelling of the lining of the colon (colitis). Your doctor will discuss any significant abnormal results with you in relation to your symptoms and past health.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include: Stool in the colon or rectum. The structure of the colon, such as a colon that has many turns.

A barium enema done within a week before sigmoidoscopy. Rectal bleeding.

What To Think About

Follow-up tests, such as colonoscopy, may be needed after sigmoidoscopy. A colonoscopy may also be needed to examine the upper section of the colon if growths were seen during sigmoidoscopy. For more information, see the topic Colonoscopy. In some cases, the sigmoidoscope may be attached to a video monitor and a recording device that lets your doctor see the inside the colon and record the findings. Experts recommend that everyone age 50 or older who has an average risk for colon cancer get a screening test to look for colon polyps. Some people should start testing sooner, such as African Americans and people with a strong family history of colon cancer. Talk to your doctor about when you should start having this screening test. You may not be able to have this test if you have peritonitis, diverticulitis, toxic megacolon, or if you have had recent bowel surgery. Which screening test you choose depends on your risk, your preference, and your doctor. Talk to your doctor about what puts you at risk and what test is best for you. For more information on screening tests for colon cancer, see: