A proctoscopy is the visualization of the anal cavity and rectum with the use of a protoscope. A sigmoidoscopy is the visualization of the sigmoid colon with the use of a sigmoidoscope. A proctosigmoidoscopy is visualization of the anal cavity, rectum, and sigmoid colon with the use of a sigmoidoscope. Rigid scopes are not as commonly used since the advent of flexible fiberoptic instruments, which are more comfortable for patients. The purpose of these tests is for the investigation of rectal bleeding, evaluation of colonic symptoms, and detection and diagnosis of cancers and other abnormalities such as diverticula in this area of the GI tract. Because the risk for developing colorectal cancer increases with age, the American Cancer Society recommends screening guidelines for individuals aged 45 years and older. These guidelines include flexible sigmoidoscopy or virtual colonoscopy (VC) every 5 years, or colonoscopy every 10 years. Most colorectal cancers develop from a malignant change in a polyp that has been in the lining of the bowel for 10–15 years. These tests can also evaluate hemorrhoids, polyps, blood or mucus in the stool, unexplained anemia, and other bowel conditions. Sigmoidoscopy can be used along with air-contrast barium studies.

1. Have the patient assume the knee-to-chest position for rigid proctoscopy (inserted 25 cm). When the flexible proctoscope is used, the patient must be in the left lateral position. Carefully insert the proctoscope (inserted 35–60 cm) or sigmoidoscope into the rectum.

2. The examination can be done with the patient in bed or positioned on a special tilt table.

3. Inform the patient that they may feel a very strong urge to defecate or pass gas. The patient may also experience a feeling of bloating or cramping, which is normal.

4. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Examination may reveal the following: edematous, red, or denuded mucosa; granularity; friability; ulcers; polyps; cysts; thickened areas; changes in vascular pattern; pseudomembranes; spontaneous bleeding; or normal mucosa. These findings may help to confirm or to rule out the following conditions:

1. Inflammatory bowel disease

   1. Chronic ulcerative colitis

   2. Crohn disease

   3. Proctitis (acute and chronic)

   4. Pseudomembranous colitis

   5. Antibiotic-associated colitis

2. Polyps

   1. Adenomatous

   2. Familial

   3. Diminutive

3. Cancer and tumors

   1. Adenocarcinoma

   2. Carcinoids

   3. Other tumors, such as lipomas

4. Anal and perianal conditions

   1. Hemorrhoids

   2. Abscesses and fistulas

   3. Strictures and stenoses

   4. Rectal prolapse

   5. Fissures

   6. Contractures

Pretest Patient Care

1. Explain the test purpose, procedure, and benefits. Record pertinent preprocedure signs and symptoms (e.g., rectal bleeding).

2. Ensure that a signed, witnessed informed consent form is in the patient’s medical record.

3. Confirm that the patient followed the bowel prep and fasting, if ordered.

4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Normal

• Normal anal, rectal, and sigmoid colon mucosa