Bowel sigmoidoscopy. That it is preparing to study how to make, how much lasts a survey among women, men, better than a colonoscopy, the differences

Sigmoidoscopy (RRS, rectoscopy) - one of the simplest and most effective methods of investigation of the lower intestine. Success depends not only on the doctor's qualifications and the quality of the equipment, but also on the patient.

Knowledge of what is bowel sigmoidoscopy and how to prepare it properly to help reduce the minimum time an unpleasant procedure to get the correct result and avoid a return visit to the proctologist.

procedure Overview

Rectoscopy relates to endoscopic procedures, the purpose of which rectal examination and its conjugate Department of the sigmoid colon: that is, the part of the large intestine that is located at a distance of no more than 40 cm from the anus.

Endoscopy - a procedure which aims visual diagnostics of internal organs using an endoscope - optical light transmission device. As the endoscope is used rectoromanoscope - a device consisting of a hollow tube equipped with a lighting element and an air injection system.

Typically, the kit includes tubes of different diameter and length designed to perform the following rectoscopy:

1. anoscopy - examination of the anus and the adjacent portion of the rectum when submerged by no more than 5 cm. Since the survey anoscopy area is below the anus sphincter (muscle groups, performing the function of shut-off valve), it does not require pre-treatment: cleanse the bowel.
2. proctoscopy - rectum examination at a distance of less than 15 cm.
3. sigmoidoscopy - to dive up to 40 cm, examined the rectum and proximal portion of the sigmoid colon.

In the latter two cases, the need to pre-treatment bowel.

Indications for intestinal sigmoidoscopy

To detect abnormalities of the intestine in the early stages, RRS is recommended every 2-3 years to pass all the people older than 40 years and every year - people over 60 years. Also, the doctor will recommend regular screening patients engaged in sedentary work, often parous women, persons suffering from chronic alcoholism.

This type of endoscopic examination may be appointed a person of any age (including children) regardless of profession and way of life, in the presence of the following symptoms:

1. Complaints of pain or itching in the anus.
2. Systematic constipation alternating with diarrhea episodes in the absence of other symptoms of an infectious disease.
3. excited bowel syndrome, excessive flatulence.
4. Shortness of morbidity and defecation process, unpleasant sensations after.
5. Change the smell and color of feces, the presence in it of blood, pus, mucus.
6. The impossibility of complete bowel movements, a strong feeling of a foreign body.

The patient may be directed to a rectoscopy with suspected inflammatory bowel disease, benign neoplasm or cancer, and to clarify the diagnosis before surgery or to verify the results treatment. In some cases, RRS is preceded by colonoscopy, barium enema (x-ray examinations of the intestine) or other endoscopic procedures.

As the survey is conducted

Unlike other bowel diagnostics, rectoscopy painless and requires no anesthesia (except when examined a little child or want to perform some surgical procedures), but unpleasant.

intestine Sigmoidoscopy: preparing next to it - the patient will be offered to remove all the laundry from the waist down and take a position:

1. To kneel, leaning on hands, bent at the elbows. This position is considered to be optimal, it facilitates the introduction of sigmoidoscopy in the sigmoid colon and reduces the procedure time. However, due to the patient's psychological discomfort professionals sometimes have to abandon it.
2. Lie on your left side with your knees bent. This posture is more pleasant and comfortable for the patient, but it creates some difficulties for the doctor. It can be applied in the case where the procedure will be a long, suggesting surgical procedures.
3. In exceptional cases (during rectoscopy elderly people and small children), the patient is placed on his back in proctology chair, legs bent at the knees.

Before the procedure, the doctor examines the area of ​​the anus, inserting a finger into it to a depth of 7-8 cm in order to detect possible contraindications and readiness assessment to RRS conduct.

Rectoscopy itself consists of the following steps:

1. At the end of the tube is put on the obturator. The device is carefully smeared with Vaseline and introduced to a depth of 5 cm.
2. By means of special cranes pumped air into the intestine under the action of which all the folds are straightened. The patient is offered as a natuzhitsya during defecation and rectoromanoscope entered more deeply - for the sphincter of the anus.
3. The obturator is removed, and the device is installed special optics, by which doctor performs the examination of the walls of the rectum, gradually advancing tube deeper, strictly according to the intestinal lumen. To straighten the creases constantly supplied with air.
4. When rectoromanoscope reaches a depth of 13-15 cm, the doctor will ask the patient to take a deep breath and move the weight on his left shoulder, relax right. It is necessary to put the device in the sigmoid colon.
5. If necessary, during sigmoidoscopy can run some simple minimally invasive (ie, suggesting minimal tissue damage) operations, such as removal of small polyps, taking a tissue sample for a biopsy.
6. At the end of the survey instrument is removed carefully.

If the patient was in a knee-elbow position, he is offered a little while to take a horizontal position to avoid the attack of vertigo (ostostatichesky collapse).

The signal for the early termination of the survey is the inability to move a tube on, as well as occurrence of acute pain: these symptoms are directly indicate the presence of large tumors and the other demand diagnostics.

In the absence of obstacles to the promotion of a sigmoidoscopy procedure is painless, but may be the urge to defecate and discomfort in contact with air in the intestine. In addition, tensile intestine can sometimes cause cramps, which are felt by the patient as mild colic.

Duration sigmoidoscopy in men and women

Time spent in the RRS, will depend on the objectives, the behavior of the patient and degree of fitness. In a simple inspection, when the intestines are well cleaned and there is no need for any surgical procedures on the procedure takes no more than 7 minutes.

This rate may be increased to a half if:

1. instrument movement hindered by the unfavorable posture or failure of the patient to follow the recommendations of experts.
2. The intestine contains remnants of feces, preventing Review, and the device has to be removed and cleaned often. When a small amount of feces, he is removed with a cotton swab, otherwise, as well as the presence of blood or mucus, the doctor has to use electric pumps. the whole procedure begins again after clearing of intestines.
3. Is required at the time of sigmoidoscopy to remove a polyp, take a sample of tissue to perform coagulation (cauterizing) vessels for bleeding, remove the foreign body.

results of the study

During rectoscopy material can be prepared for further histological examination revealed the early stages of benign and malignant tumors.

Also following bowel disease found possible:

1. Hemorrhoids - the expansion of arteries venous hemorrhoidal plexus of the rectum manifesting pain in the anus and loss of key elements.
2. proctitis - inflammation of the mucous membrane that lines the inner surface of the colon.
3. anal fissure - ulcer or longitudinal gap anal mucosa caused by chemical or mechanical damage.
4. cRYPTO - a recess (crypt) into the anal canal wall, which subsequently, when clogged bowel contents may become inflamed.
5. paraproctitis - inflammation adrectal fiber that in the acute or chronic form occurs in 20% of adults.
6. Ulcerative colitis.
7. Adenoma of the prostate in men.
8. Endometriosis of the rectum in women.

In addition, visual inspection of the walls of rectum and sigmoid to evaluate their condition and color of the walls to make definite conclusions about the health of the intestine and the need for other procedures (examinations, surgery, conservative treatment).

Preparation for the procedure rectoscopy

bowel sigmoidoscopy, the preparation of which requires careful (and from the doctor and the patient), despite its simplicity, it may be impossible or ineffective. Specialist will compile a complete medical history to identify possible contraindications, and the main requirement for the patient is a thorough cleaning of the intestine.

bowel cleansing prior to the study

An important stage of preparation - removal of bowel contents.

It can be performed using:

• besshlakovoy special diets;
• mechanical means: an enema;
• of drugs: use of laxatives.

Diet before rektromanoskopiey

Such a diet should be followed for three days prior to the procedure. Its purpose - to reduce slagging intestine, to get rid of excess gas and, thus, not only make future studies maximum efficiency, but also reduce the psychological level discomfort.

The basic principle - the rejection of foods that are high in fiber. It is also recommended to exclude the consumption of alcohol, chocolates, sparkling water and various soft drinks with a high caffeine content, which increases the likelihood of spasm.

Prohibited:

• fresh vegetables, fruits;
• cereals;
• black bread;
• cakes, pastries and any other confectionery products;
• sucrose-based products;
• seeds, all kinds of nuts;
• pasta;
• mushrooms;
• milk and sour milk products excessively;
• all kinds of spices.

The diet of future patient must present low-fat broth, boiled meat or fish, chicken breast, cheese, butter. People who are not prone to constipation can eat fruit after a heat treatment that destroys the rough fibers (e.g., baked in the oven), and low-fat dairy products (fat content not higher 1,8%). Meals - reusable, small portions.

If the show imagination, this three-day diet even will make the diet a pleasant variety.

Sample menu might look like this:

• First breakfast: Casserole of cauliflower with cheese, green tea;
• lunch: cottage cheese soufflé with banana;
• dinner: vegetable soup (without cabbage). On the second - steamed meatballs. On the third - broth hips;
• lunch: glass curdled moderate fat content and acidity;
• dinner - baked fish, tea;
• before bedtime: natural yogurt with no additives and sweeteners.

Serving sizes should not exceed 220 g, and the volume of beverage - 150 ml. intestine Sigmoidoscopy (preparation for the day to which must include a light breakfast and lunch) will be effective. On the day prior to the procedure for breakfast can be consumed one egg, boiled soft-boiled, and in the afternoon - a weak broth with wafer biscuits. Dining can not be allowed to drink water.

The use of enemas

In the first case, a mug Esmarch. Rinsing is performed in the evening on the day before Rectoscopy, and in the morning, immediately before the procedure, but not earlier than 6 hours and not later than 2 hours before. When a shorter interval RRS results may be distorted. Two hours before the patient is taking an enema formulation of a few spoons of castor oil or magnesium sulphurous (150g).

To perform washing, the patient should lie on your left side, knees bent. Mug, into which was placed 1.5 liter of pure water at room temperature, suspended in a special bracket, flexible the hose from which the pre-removed air lubricated with vaseline or a gel and is inserted into the rear pass.

After introduction of the liquid is necessary to delay gastric emptying for 10 minutes. The method is inapplicable when there are cracks, ulcers, hemorrhoids. Also enema contraindicated in inguinal hernia, menstruation (may cause heavy bleeding) pregnancy (stimulates contractions of the uterus, which can cause miscarriage), omission of small pelvis.

To perform the procedure requires special equipment and certain skills, otherwise injuries may occur rectal mucosa. For this reason, this method of cleaning the bowel is used mainly in hospitals. At home the same conditions preferred laxative.

The use of laxatives

Among the advantages of this cleaning method - ease of use and lack of risk of injury of the walls of the rectum. Modern laxative cleans the intestines gently and carefully, without disturbing its flora. It is possible to use one of laxatives advance consultation with a doctor and accurately adhering to the recommended dosage regimen.

microlax

The drug is manufactured in the USA is available in the form of micro-enemas, has a mild effect on the intestinal mucosa. Among the contraindications - Only intolerance laxative ingredients.

For the administration of the drug is required:

1. Clear the area of ​​the body near the anus.
2. Break off a seal covering the micro enema tip.
3. Gently squeeze the container until the contents drops and lubricate tip preparation.
4. Squat and enter the tip into the anus, holding enema vertically.
5. Quickly push down on the container.
6. Clenched fingers, remove the enema.

Part of the drug glycerol irritate the bowel and improves its peristalsis, thereby urge to defecate appear within 5-20 minutes after administration. Preparing for rectoscopy, it is recommended to use two enema night every 10 minutes. Morning for 2-6 hours before the procedure is performed to re-examination.

Fortrans

When properly used - absolutely safe product, which will cleanse the bowels, without breaking its microflora, without causing painful cramps, and without changing the natural rhythm of the body occurring in the physiological processes. Among the shortcomings - the possibility of allergic reactions in patients sensitive to the drug.

Another drawback - the need for a large water consumption, since the action is based on funds dilution of feces and slag deposits located in the folds of the intestine, followed by their Disposal. For this reason, it means not prescribed to people with kidney disease, heart, intestinal obstruction

Laxative is a powder, packed in sachets. Norm is calculated at the reception rate of one packet per 20 kg body weight. The contents of the sachet is diluted in a liter of water and drunk gradually, in small sips, for one hour.

To overcome the nausea caused by foul means flavor, allow a few drops of lemon juice. Acceptable use antiemetic drugs: domperidone or Motilak. You can not reduce the volume of liquid, as this will reduce the effectiveness of the drug!

Depending on the time rectoscopy "Fortrans" is used:

1. If the inspection in the morning, the afternoon before, in 14-15 hours take 2 bags of make-hour break and take rest.
2. If the time of the afternoon, taking the first 2 bags transported for 18 hours, and the remaining portions are made from 7 o'clock in the morning.

Duphalac

It can be used by patients of any age, including children. Action Duphalac based on components means the ability to soften the stool and stimulate contraction of the intestinal wall. The drug is available in the form of suspensions, packaged in portioned vials.

In preparation for the rectoscopy scheduled for the morning, it is recommended the day before the procedure, 2 hours after a light lunch (14-15 hours) to start taking the drug. For this purpose, one vial should be dissolved in 2 liters of pure water and drink in small portions over 2-3 hours.

You can drink a few sips of tea means or juice without pulp.

Complete emptying of the intestine can be expected in the evening, after about 3 hours after administration of the last portion of the laxative. If RRS is scheduled for the afternoon, welcome Duphalac should begin in the evening, 2 hours before bedtime to take a break and continue cleaning with 6:00 in the morning.

Fleet Phospho-soda

The drug can reduce the absorption fluid, whereby it accumulates in the gut, softening its contents. Due to the impact of Fleet Phospho-soda, feces and toxins accumulated in the folds are removed quickly without causing painful spasms during bowel movements.

Means is contraindicated in patients having a renal disease, heart failure, or narrowing of the intestine, as well as those who must restrict their salt intake. Sigmoidoscopy intestine, the preparation of which involves the application of Fleet Phospho-soda, is correlated by time and drug regimens.

For example:

1. When the morning examination: the day before it, taken after breakfast 1 bottle, the contents of which should be diluted in 120 grams of water and then drink another glass of water. The second dose is used at night, after the liquid is drunk glass.
2. In daylight survey for the first appointment is transferred to the lunch time, and the second is used in the morning, the day of the procedure. Dose - the same as in the first case.

Lavacolla

The drug acts similarly as described above, having similar contraindications. Sold in a package containing 15 packets, each of which is required to dissolve in a glass of water. To mask the unpleasant taste is allowed to add a syrup or jam.

Depending on the time of rectoscopy:

1. Morning inspection - the beginning of the drug - 16 hours of the previous day. The time interval between the portions techniques - 20 minutes. It is necessary to drink a full kit, alternating Levkola reception with tea too strong and weak broth.
2. Inspection during the second half of the day - receiving a first bag is performed in 18 hours, further, with an interval of 20 minutes, another 10 bags consumed. The remaining 3 or 4 are used in the morning (from 6 hours) on an empty stomach in the same manner.

What else needs to be done

In preparation for the examination and sigmoidoscopy bowel can be immediately before the procedure perform the actions that will allow the patient to feel more confident and reduce the emotional the discomfort.

Namely:

1. Not later than 2 hours before the procedure to make a cleansing enema (if there is no certainty that the intestines cleaned sufficiently reliable).
2. Empty the bladder.
3. Changeling, paying particular attention to the area near the anus, put on clean clothes.
4. Prepare psychologically: that is, to realize that to be a rather unpleasant, but the short and painless procedure, which is capable to deliver in the future many of the problems and to keep healthy. For this you can bear.

Contraindications to sigmoidoscopy

Rectoscopy - the procedure is simple, when done properly, not leading to the injury of the intestinal mucosa, therefore it is not It has the absolute contraindications and may be used for the diagnosis of patients of any age, regardless of floor. However, there are a number of pathologies and conditions under which accounts for some time to postpone examination.

These include:

• availability of fresh painful anal fissure;
• hemorrhoids in the acute stage;
• excessive bleeding;
• narrowing of the intestine;
• presence of acute inflammation in the peritoneal cavity;
• abscess, accompanied by severe pain;
• cardiac or pulmonary insufficiency;
• various mental disorders;
• fever, malaise, severe conditions.

Obstacle to the survey can also be a reception by the patient certain drugs that may interfere with full rectoscopy or distort its results.

For example, aspirin and its derivatives is reduced blood clotting, which can lead to bleeding when removal of polyps, and activated carbon, and iron supplements, prevent appreciate the color of the mucous. For preschool and primary school age special procedure is performed sigmoidoscopy small diameter using anesthesia.

Expectant mothers RRS appointed gestation less than three months and only after consulting a gynecologist. In each case, taking into account the feasibility of the inspection and the extent to which it is dangerous to the fetus.

As for the month, the list they are no contraindications. However, for obvious reasons, it is desirable to wait for the termination of discharge. If an emergency, the period does not become an obstacle for the procedure.

Possible complications of sigmoidoscopy

The only serious complication requiring immediate surgical intervention - a rupture of the intestinal wall. However, if the procedure is performed by an experienced proctologist, acting according to the rules, taking into account the patient's condition, the probability of such an outcome wound zero.

For minor discomfort after rectoscopy manifestations include:

• unpleasant feeling in the anus;
• flatulence associated with the presence of air in the intestine;
• spasms, false urge to defecate;
• slight nausea;
• weak spotting (at surgery: removal of polyps, biopsies, coagulation).

The patient should carefully monitor their own condition and the temperature is raised or the appearance of other disturbing symptoms (sharp pain, excessive bleeding), immediately consult your doctor.

Differences sigmoidoscopy and colonoscopy

The goal of both procedures - bowel examination, but there are many differences between them. First of all, their performance apply different types of devices (rectoromanoscope and colonoscopy) for the study of different areas.

There are other differences:

1. Field surveys at rectoscopy - direct and partly sigmoid colon. At colonoscopy the entire colon is examined, including the appendix.
2. RRS does not require anesthesia, colonoscopy - a procedure painful, it is performed under anesthesia.
3. When used rectoscopy device with a rigid tube, colonoscopy - a flexible colonoscope.
4. Sigmoidoscopy involves examination without additional hardware, while Colonoscopy is used an endoscope equipped with a video camera, which displays the image on the monitor computer.

Differ and indications for these procedures.

In particular, the patient may be referred to colonoscopy when using RRS pathology has not been identified, as well as when such symptoms:

• pain in the lower abdomen, extending to the rectum;
• causeless rapid weight loss;
• suspicion of oncology in the intestine, unattainable at rectoscopy;
• Crohn's disease - an inflammation of the mucosa, submucosa and muscular layer of the gastrointestinal tract that affects most often the lower sections of the small intestine and the entire large intestine;
• severe bleeding from the anus;
• unexplained weakness, persistent anemia.

In general, colonoscopy is considered more informative, but also more difficult to conduct, long and painful process than sigmoidoscopy bowel. In all cases when a problem can handle the RRS, better to give preference to it, first prepare well.

Author: "Ian and K °» Wrriterr

Video of the bowel sigmoidoscopy and indications for its conduct

What is sigmoidoscopy:

Preparation for the procedure: