Proctoscopy (Rigid Sigmoidoscopy)
A proctoscopy (rigid sigmoidoscopy) is a procedure to examine your rectum and anus. A proctoscope is a hollow tube with a tiny light at the end. It can also be used to take tissue samples for biopsies as a cancer screening tool. The procedure helps identify other causes of rectal and anal bleeding, too, like hemorrhoids.
A proctoscopy is a procedure to examine the inside of your rectum and anus. Your rectum is the final section of your lower gastrointestinal tract that ends at your anus. Your anus is the opening of your rectum through which poop leaves your body.
A digestive disease specialist (a colorectal surgeon or gastroenterologist) performs a proctoscopy. They’ll gently insert a tool called a proctoscope through your anus and into your rectum to look for tumors, polyps, inflammation, bleeding or hemorrhoids. A proctoscope is a straight, hollow metal or plastic tube with a tiny light and lens at the end that allows the specialist to make a detailed examination of your rectum. They may insert an instrument that can take tissue samples for biopsy through the hollow tube.
A proctoscopy is a type of endoscopy procedure. Another name for a proctoscopy is a rigid sigmoidoscopy.
Various diseases and conditions can affect your rectum and anus. Your healthcare provider may use a rigid sigmoidoscopy to:
- Detect disease in your rectum or anus.
- Find the source of rectal bleeding.
- Find the cause of diarrhea or constipation.
- Remove or monitor the development of existing polyps or growths.
- Screen for colon cancer or monitor previously treated rectal cancer.
Before your procedure, tell your healthcare provider about any medications you take. Include all:
- Prescription drugs.
- Over-the-counter medications.
- Vitamins and herbal supplements.
Your provider might have you stop taking some or all of these before your test, especially if you take blood thinners. Follow your provider’s instructions.
Preparing your rectum
The most important preparation for a proctoscopy is to thoroughly clean out your rectum. It’s important to do this. The more completely you empty your rectum, the easier it is for your healthcare provider to examine it.
You can use various methods to clean out your rectum. Your provider will recommend the best way for your case. Many providers will recommend using an enema to clear waste. You do an enema by inserting a liquid through your anus and into your rectum. Your muscles hold the liquid there for a short time before you poop. Be sure to follow instructions as directed. You may also take a laxative, a medication that makes you have to poop.
A proctoscopy looks at your rectum but not the other sections of your colon that are higher up, so the preparation isn’t quite as complex for the procedure.
Gastroenterologists can perform a proctoscopy in a hospital, an outpatient endoscopy center or a doctor’s office. The procedure will take place in an exam room or an endoscopy suite. A provider will ask you to remove your clothing below the waist and change into a hospital gown. Then, they’ll ask you to bend over a short table or to lie on your left side with your knees bent.
Your provider will first do a preliminary digital rectal exam with a gloved, lubricated finger. This is to look for tenderness or blockages. Then, they’ll gently insert the lubricated proctoscope. As the scope is slowly and carefully passed through, you may feel as if you need to poop. This is typical.
Your provider may pass air into your rectum to help better see the walls and any issues. You may experience some discomfort (cramping or fullness), but the test usually doesn’t cause pain. Most proctoscopy examinations don’t require anesthesia. But tell your provider if you need pain relief or if you're feeling nervous before the test.
It’s not unusual to hear and feel some air escaping during this procedure. This is normal and expected, so don’t be embarrassed.
When the exam is over, your healthcare provider will gently remove the proctoscope.
The procedure will take five to 15 minutes.
Most people go back to their regular activities right after the test. You may have some bloating or gas if your provider puts air into your rectum. If cramps continue after the procedure, passing gas may help. Try walking around the room to help pass the gas. You may have mild bleeding the first few times you poop. This often happens if you have a biopsy. This is also typical.
A proctoscopy has many benefits, including:
- Your healthcare provider can do it in their office and perform it quickly.
- You usually don’t need sedation.
- Providers can perform a proctoscopy after you use an enema or a laxative. Colonoscopies have a more complex preparation.
There’s little risk associated with proctoscopy. It’s possible that you may experience rectal bleeding as a result of the insertion of the proctoscope or if the lining of your rectum is irritated. You may also develop an infection after the procedure. Both complications are rare.
If your healthcare provider finds anything during the procedure, they’ll share it with you right after the test. If they do find something, they may perform a biopsy during the procedure. They’ll send the sample to a lab for testing, and the results will come back in a few days.
Your provider will let you know if you need a follow-up appointment or more testing.
When should I call my healthcare provider?
If you experience any of the following symptoms after the procedure, contact your healthcare provider:
- Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
- Large amounts of blood in your poop or bleeding that lasts more than three days.
- Severe abdominal pain or a hard, swollen belly.
References
- National Cancer Institute (U.S.). Endoscopies (https://training.seer.cancer.gov/diagnostic/endoscopies.html). Accessed 8/9/2024.
- Tanaka A, Sadahiro S, Suzuki T, Okada K, Saito G. Comparisons of Rigid Proctoscopy, Flexible Colonoscopy, and Digital Rectal Examination for Determining the Localization of Rectal Cancers (https://pubmed.ncbi.nlm.nih.gov/29337775/). Dis Colon Rectum. 2018;61(2):202-206. Accessed 8/9/2024.
- Zelhart MD, Kann BR (2022). Endoscopy. In: Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery. 51–77. Springer, Cham.
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