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Thread: Going to have a flexible sigmoidoscopy. Have some questions

  1. #1

    Going to have a flexible sigmoidoscopy. Have some questions

    First my bowel routine. Bowel program is every other night. I take 1 colace every morning, and the morning of the bowel program I take 4 senna s. At night, use a magic bullet inserted in bed, wait about 10 minutes then up in the shower/commode.
    I have scheduled the procedure the day after my bowel program. I have told them about autonomic dysreflexia. I get a little dysreflexic when I pass stool so I'm assuming I will during the procedure. They're going to use sedation. I won't be out, just loopy. Is that enough? Anything else I need to tell them?
    The day before procedure questions:
    Says for breakfast I can eat light solid food foods. My breakfast is Bran buds and yogurt. Would that be considered light?
    Just want to make sure I understand this correctly. By mid day the day before I need to start all liquid diet. Correct?
    The 10 ounces Magnesium citrate before 6pm. Should I still take that with all the other stuff I'm taking? If so, how long does it usually take to work? I usually start my BP around 9:15pm.
    Again, just to make sure I'm understanding it correctly. My last liquid meal before the procedure needs to by 5pm the day before, correct?

    The day of procedure questions:
    The fleet enemas. How have others done these? I can't control whats going on down there, so how will I hold it in? And once the 5 to 10 minutes are up, getting into the the shower/commode before everything comes rushing out sounds tricky.

    Thanks. Any other advice is also welcome.
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  2. #2
    That is a pretty aggressive prep for a sigmoidoscopy. That would be more for a colonoscopy at our center. Avoid high fiber foods for 2 days prior to the procedure...so maybe some fruit or a smoothy for breakfast the day before instead of bran cereal. Best to do your bowel program the evening before the procedure. Mag citrate will take about 4 hours to work, and you are likely to have results from this after your bowel care...so pad up well before going to sleep. Liquid meals should not include any soda, juice, jello, or popsicles that are purple, orange, or red. For sodas, best to stick to lemon-lime or ginger ale, and for jello, lemon or lime.

    It is also unusual to use conscious sedation during a sigmoidoscopy for people without sensation. Sedation will not prevent AD, so your blood pressure should be monitored constantly during the procedure. if you get AD, then they should stop and administer either Nifedipine 10 mg. (crushed) or Nitropaste 1". Alternatively, they may want to do a local anesthesia injection right at the anus. This is what our GI physician, Bard Cosman, does, and he has published research on the effectiveness of this for AD prevention/management in sigmoidoscopy in persons with SCI that your physician should review before you have the procedure.

    Lidocaine injections: https://link.springer.com/article/10...350-005-0095-8

    How lidocaine gel does NOT help with AD: https://link.springer.com/article/10...100347?LI=true

    http://journals.lww.com/dcrjournal/A..._Injury.8.aspx

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
    My gastroenterologist sees no reason to do a sigmoidoscopy. He says fewer and fewer sigmoidoscopies are being done because they provide such little information, especially in spinal cord injured.

    Do the prep and have a colonoscopy at appropriate age and intervals.

  4. #4
    Most of our sigmoidoscopies are done to evaluate for hemorrhoids or rectal fissures, to see if you are a candidate for surgical treatment. A full colonoscopy is not needed for that.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  5. #5
    Quote Originally Posted by SCI-Nurse View Post
    That is a pretty aggressive prep for a sigmoidoscopy. That would be more for a colonoscopy at our center. Avoid high fiber foods for 2 days prior to the procedure...so maybe some fruit or a smoothy for breakfast the day before instead of bran cereal. Best to do your bowel program the evening before the procedure. Mag citrate will take about 4 hours to work, and you are likely to have results from this after your bowel care...so pad up well before going to sleep. Liquid meals should not include any soda, juice, jello, or popsicles that are purple, orange, or red. For sodas, best to stick to lemon-lime or ginger ale, and for jello, lemon or lime.

    It is also unusual to use conscious sedation during a sigmoidoscopy for people without sensation. Sedation will not prevent AD, so your blood pressure should be monitored constantly during the procedure. if you get AD, then they should stop and administer either Nifedipine 10 mg. (crushed) or Nitropaste 1". Alternatively, they may want to do a local anesthesia injection right at the anus. This is what our GI physician, Bard Cosman, does, and he has published research on the effectiveness of this for AD prevention/management in sigmoidoscopy in persons with SCI that your physician should review before you have the procedure.

    Lidocaine injections: https://link.springer.com/article/10...350-005-0095-8

    How lidocaine gel does NOT help with AD: https://link.springer.com/article/10...100347?LI=true

    http://journals.lww.com/dcrjournal/A..._Injury.8.aspx

    (KLD)
    Yeah I was a little surprised by the prep work. I had discussed this with a GI doc in the past, and he made it sound like it's just 2 enemas before hand.


    It says take the Mag citrate before 6pm. So maybe about 4-4:30 for my 9:15 bowel program.


    Should I call them and tell them I need to be put totally out? Will that get rid of the chance for AD? Or can I still get it?

    Quote Originally Posted by gjnl View Post
    My gastroenterologist sees no reason to do a sigmoidoscopy. He says fewer and fewer sigmoidoscopies are being done because they provide such little information, especially in spinal cord injured.

    Do the prep and have a colonoscopy at appropriate age and intervals.
    Quote Originally Posted by SCI-Nurse View Post
    Most of our sigmoidoscopies are done to evaluate for hemorrhoids or rectal fissures, to see if you are a candidate for surgical treatment. A full colonoscopy is not needed for that.

    (KLD)
    I'm getting it done because of bleeding 1-2 times a month. The blood is bright red. No blood in the stool. I'm only 34 and have no family history of colon cancer. I have 1 large external hemorrhoid and my PCA can feel some internal ones when doing digital stimulation. Based on the questions asked by the GI specialist and the answers I gave, she thought a sigmoidoscopy was good.

  6. #6
    No, general anesthesia will not prevent AD unless the anesthesiologist uses a ganglionic blocking agent, which would be pretty aggressive for a sigmoidoscopy. Suggest you discuss this again with the physician doing the procedure before you proceed, and request that he review the articles I posted above.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  7. #7
    How have others done fleet enemas? Says to hold for 5 to 10 minutes.

  8. #8
    Lay on your left side for 5 to 10 minutes.. hold it the best that you can.
    CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  9. #9
    Will be having my procedure in a little bit. My normal bowel program schedule is every other night. Had one last night, should I continue with my schedule and do one tomorrow night? Or with the limited diet, fleet enemas and citrate, should I skip tomorrow's and do one the day after?

  10. #10
    My recommendation would be to stay on schedule. Even if you don't have much in you, your body is already trained. Plus after the procedure, more stool may move down.
    ckf
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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