Flexible Sigmoidoscopy

What it is

When symptoms point clearly at the lower end of the bowel — bright red bleeding, rectal pain, a change in the shape of stools — there is no need to travel the whole large intestine to find the cause. A flexible sigmoidoscopy covers the part that matters in those cases. A short flexible scope with a camera is passed through the anus into the rectum and up through the sigmoid and descending colon, with air or carbon dioxide introduced to open the bowel out for a clear view. It reaches a fraction of the distance a colonoscope does, which is both its limitation and the reason it is quicker, cheaper, and easier to prepare for. This code is the plain diagnostic exam; removing a polyp through the same scope is a different code.

Why it is done

• To find the source of rectal bleeding or blood seen in the stool
• To investigate persistent diarrhea, constipation, or lower abdominal pain
• To inspect the rectum and lower colon for polyps or inflammation
• To check a known condition of the lower bowel without a full colonoscopy

What to expect

Preparation is usually one or two enemas, or a short laxative regimen, rather than the full day of clear liquids a colonoscopy demands. The exam is typically done without sedation, so there is no recovery period and no need for a driver. A digital rectal exam comes first, then the scope. The sensations are pressure, bloating, and cramping as air goes in — not sharp pain — and they pass quickly once the air is expelled afterward. Most people go back to a normal diet and normal activity the same day. If something abnormal is found, a full colonoscopy is often the next step.

Questions worth asking

• Is sedation planned? Many sigmoidoscopies are done without it, and skipping it removes an anesthesia bill entirely.
• If a polyp or abnormal area is found, will it be removed during this visit under a different code, or will I be brought back for a colonoscopy — and what would that second procedure cost?
• Is the enema or prep kit dispensed by the facility and billed to me, or do I buy it myself at a pharmacy?
• Is this being performed in a GI office, which often has no facility fee, or in a hospital outpatient department, which usually does?