# Flexible sigmoidoscopy - sedation or no?



## Cat-a-Tonic

I've been having some issues with rectal pain and blood in my stool lately (I'm not usually a bleeder), so my GI has scheduled a flexi-sig for me on April 7th.  When we discussed the possibility of a flexi-sig a few weeks ago, all he said was that I would come in, do a couple enemas, then he'd scope me up to the left colon.  There was no mention of sedation at that time, so I figured it was a procedure that is done without sedation.

Today the nurse called to schedule it, and she said I'd be having sedation and I'd need a driver.  I was like, huh?  I explained that my GI never mentioned any of this, and she was like, "Oh, okay, I'll put you down for no sedation then."  But now I'm wondering if I should go for the sedation.  I seem to have both internal & external hemorrhoids which are painful at times, so I'm afraid that jamming a scope up there with no sedation is going to hurt like crazy.  I'd like to go back to work after the scope if possible (it's scheduled at noon), so part of me is leaning towards just dealing with the pain and not having sedation.  The other part of me is being a wimp and wants to take the whole day off and have sedation.

If you were me, what would you do?  Go for sedation or do it without sedation?  I should add that this will be my first flexi-sig, so I don't fully know what to expect (I've had 2 colonoscopies before, both with full sedation).  Be brave and deal with it and go back to work afterwards, or opt for the sedation and go home and rest afterwards?


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## Cat-a-Tonic

Update:  The more I thought about it, the more I decided that sedation is for me.  I consulted a co-worker who has UC, and he also agreed that sedation is the way to go.  So I called the nurse back, and asked her to put down that I do want sedation after all.  I also told my boss I'm going to need that whole day off, and she was fine with it.  So, I guess sedation it is!  The nurse said they use versed & fentanyl, which is exactly what I have had for every previous scope and that's always been great, so yeah.  A stubborn little part of me is still thinking no sedation, because I've been using up my work vacation days quite a bit already and it's still early in the year, plus it'll probably cost me more money to have sedation as sometimes my insurance is picky about paying for that type of thing.  But, I think overall, sedation is probably the way to go.  Yeah.


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## mik118811

I've had two flexible sigmoidoscopys and two full colonoscopys, first sigmoid was very uncomfortable but bearable without sedation the three others were unbearable with sedation. I did not have hemorrhoids though so I can't comment on that causing pain although I can't see why that would be any worse than the actual procedure. Should be alot quicker than a full colonoscopy only looking at the left side. Depends how youpersonally felt with the colonoscopys


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## Cat-a-Tonic

Thanks!  I have had 2 colonoscopies in the past, both with sedation, and I felt completely knocked out during both of them and felt fine right afterwards (there was some pain the following day both times, I think because they took a lot of biopsies).  I am thinking that sedation is the way to go this time as well.


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## FrozenGirl

I always have requested sedation for flex sigs. The way I see it, sure maybe I could try and make it through the pain but why. We have enough pain in the rest of our lives.


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## Crohns08

I alway request sedation. I usually have so much inflammation in my colon that scraping a scope through me causes a lot of pain. The longer I can put off feeling it the better.


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## mik118811

Unfortunately I am resistant to sedation (there is a word for it but I can't remember it) had a double dose when I went in for the last one and still ended up feeling everything and being in pain, if only they would knock me out for it. I don't know how people have colonoscopys without any sedation!


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## Cat-a-Tonic

Oh my goodness, mik118811, that sounds awful!  I guess I'm lucky, I respond really well to the sedation.  At my last colonoscopy, the nurse asked me if I had a preference of what music she put on while they scoped me.  I was like, I'm not going to remember it so listen to whatever you want!  And sure enough, I have no recollection whatsoever of any music.  They could have been blasting gangsta rap directly into my skull and I still wouldn't have woken up.  

Thanks everybody for the input!  It sounds like sedation is the way to go for sure.


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## mik118811

So that's what sedation is meant to feel like then, I had always wondered what it should feel like, I remember the whole thing including the distraction techniques from the nurses. And yes if you can not remember it by having it I don't know how you could go without sedation. Also I'm like you on the bleeder part, it's what I hate most about flares


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## Cat-a-Tonic

Yeah, for me the sedation works so well that I once had a whole conversation with my GI after an upper endoscopy, but I don't remember any of it.  I literally don't even remember talking to him - I remember bits and pieces of getting dressed and being driven home.  Once I got home, I complained to my husband that the doctor didn't talk to me after the scope.  My hubby was like, "What are you talking about?  You don't remember?  You talked to the doctor for like 10 minutes!  You seemed coherent!  How can you not remember that??"  I don't know, I just don't remember anything of it!  So I guess I could technically be awake during the scope, just not remember a thing of it.  It definitely feels like being knocked out, and I always wake up from sedation feeling refreshed like I had a nice nap.

Do you only bleed during flares?  I never used to bleed, then 2 years ago I mildly flared up and started bleeding sporadically (like once every 3 weeks or so).  I had a colonoscopy at that time and I was told the bleeding was from internal hemorrhoids.  I was on Entocort most of last year and didn't bleed at all during that time.  Then, about a month ago, I started bleeding every day, sometimes multiple times a day and sometimes a lot of blood, so this is much more than I used to bleed when it was just once every few weeks.  Not sure if this is still "just hemorrhoids" or if it's from the IBD or what, so that's the reason for the flexi-sig.  The blood is bright red so presumably it's coming from somewhere in/near the rectum and the source should hopefully be found on the flexi-sig.


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## lookame

I've had 2 colonoscopy especially with full sedation, a flex seg without sedation and a flex sig turned colonoscopy with full sedation. The first colonoscopy with sedation they had to give me a little more because I woke up in pain, second colonoscopy I don't remember, first few sig without sedation was aweful! Last scope I remember bits and pieces.

the flex sig w/o sedation sucked. I thought it's be nice to discuss what was going on and see the scope...nope. I was in pain and couldn't think about anything Not even ask my GI what he thought what was going on. 

Last scope we were debating whether to put me under right before the scope. He made the last minute decision to put me under and I'm glad he did. It allowed him to get a good look at my colon (first actual colonoscopy with this GI) and he could take biopsies. Without sedation I have a feeling he could only get a small look at my colon instead of being able to see the full extent of damage.


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## ducky

The first sigmoidoscopy I had was to diagnose Crohns.  I was seriously ill with a swollen, ulcerated colon and a rectal fissure but the specialist was very cavalier; he never used sedation.  I was in SO much pain and made SO much noise that he changed his ways and gave me sedation ever after. My new specialist, a real gastroenterologist, does colonoscopies so there is no question - they always give sedation for that. 
Using sedation makes the procedure take longer and you have to have a friend drive you but I find it less traumatising. Plus, I feel so wiped out after the prep and procedure, it's nice having someone there for support.


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## mik118811

Catatonic - yes bleeding is my first sign, this flare I started getting small bleeding then multi trips to the toilet  then d started, now even with prednisolone I'm still flaring. Sig a few weeks ago showed mild inflammation and the bleeding is from that haven't ever been told I have hemorrhoids though but my bleeding is generally bright red/maroon depending on how much. Everyone's sedation does sound very different to mine I could only dream of not remembering it. Still it only lasts a small amount of time


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## LibraryGal

I'm so glad you opted for sedation. I've had many flex-sigs w/o sedation and they've never been pleasant to say the least. I didn't know you could have sedation f/this procedure until I was having such a bad flare that the GI doc told me I needed to be sedated because of my level of pain. I can remember having colonoscopies in the 70's using a valium IV drip! The pain was unbearable but that's how it was done. I am so thankful for the sedation! I hope your F/S goes well and they are able to get things figured out. Take care.


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## Lady Organic

I never get sedation for sigmoidoscopies, only for full length colonoscopy. I didnt even know that was a possibility until I met my new GI a few years ago. So I experiemented the hard way and that was fine with me. I had it with small H last year and its no more painful. Well of course a sigmoidoscopy is always painful, but not as much as a full colo. I prefer being awake because i can fallow the exam on video and see my disease and be fully focused when it is time to discuss with the GI afterwards. Injection of the solution and for it being into effect takes only a few seconds. You could have the tube inserted prior by the nurse and only ask for the injection if the procedure is too painful at insertion bc of your H. also a sigmoidoscopy only last a few minutes 5 ot 10 max. good luck.


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## Starlight

Call me a wimp, but I wouldn't even consider doing any kind of scope without sedation. If they ever tell me they will not sedate me...adios I'm outta there! My past few scopes I have been given propofal. Love that stuff! You go to sleep quick, I never remember a thing and you wake up pretty fast and surprisingly clear headed afterwards. I do have a high drug tolerance so I have shocked many doctors on how much it takes to knock me out and keep me out. 

I think you made a good decision on opting for the sedation. Why worry and be uncomfortable if there's something they can give you to help you relax?


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## Cat-a-Tonic

Hey everybody, a bit of an update - I had my flexi sig today and I did have sedation.  Weirdly though, the sedation didn't work fully!  (It was versed & fentanyl, which has usually been very good for me in the past.)  I don't remember much, and I wasn't in pain, so I guess that's the good news.  I do have bits and pieces of memories - I can recall opening my eyes, trying to look at the monitor and see what was going on with my scope, but my glasses weren't on so everything was blurry and I couldn't see what was happening.  And according to what my GI told my husband afterwards, I was actually awake and talking (woozy and acting silly from the sedation, but definitely awake) during the entire scope.  Yikes!  I knew I woke up at some points, but I didn't know I was awake the entire time!  So my GI said that for all future scopes, I'm getting propofol rather than versed & fentanyl.  I believe propofol is anesthesia, not sedation, so hopefully that will work out better and I won't be awake and saying random crazy things next time.    I'm still glad I chose sedation rather than no sedation, because I only have bits & pieces of memories and no pain.  If I hadn't had sedation, it would surely have been painful and I'd remember all of it!  And now I know that I get to be knocked out properly next time, which is a good thing too.  So yes, I'm glad I opted for sedation even though it didn't work very well.


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## Lady Organic

great! I never heard of propofol. I always get the ones you got today. Last colonoscopy they didnt work and I was in a lot of pain (screaming) (not the whole time, but for a few minutes). It was just a coincidence that day but the poor lady just before me, was screaming in distress like i had never heard before, its was terrifying! Its tough on us, but that day made me realize that it was not a easy job for a GI having to deal with such moments as well.


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## FrozenGirl

Yeah I had had the "I might have been awake but I'm not really sure" feeling. Glad it all went well. I do better with Demerol or Propofol (and Versed) than with fentanyl as well. Fentanyl ends up with me being somewhat conscious, sometimes in pain sometimes not.


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## DaveD

I have done signs both ways and had 5 or 6 without, then did the prof anesthesia and will never go without it agin.  Very uncomfortable without the drugs and the drugs were 100  per cent knocking me out


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## Ann Morgan

I had a Flexible Sigmoidoscopy probably around 1998!  No sedation. I was uncomfortable physically and psychologically and wish I had been at least lightly sedated. The test did not hurt, but when something goes up my butt I want to be fully sedated. I had a Lower GI a long while ago, hated that test too ( not sedated ). I have had 4 colonoscopies and always 100 percent completely sedated. I have had Versed and then other times Propophol.


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## Lady Organic

just came across this, seems like sedation is not risk free:

Respiratory complications in outpatient endoscopy with endoscopist-directed sedation:
http://www.ncbi.nlm.nih.gov/pubmed/25267952


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## DaveD

Lady Organic said:


> just came across this, seems like sedation is not risk free:
> 
> Respiratory complications in outpatient endoscopy with endoscopist-directed sedation:
> http://www.ncbi.nlm.nih.gov/pubmed/25267952


Medically compromised patients are at a higher risky obviously and nothing is 100 per safe including driving a car, but conscious sedation in a clinical setting with an anesthesiologist has to be as safe as can be.  Try a sigmoidoscopy without sedation and with and make your own decision. I have done it both ways and know with is the only way for me.


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## Lady Organic

i wrote previously i always do the sigmoidoscopy without sedation. with my first GI I didnt have the option of sedation. 
I ask sedation only for the long one and it doesnt always work. The pain is very high in the full colonoscopy compared to the pain for the short colonoscopy.
in Canada we dont have anesthesiologist in the room for colonoscopy with sedation.
The possible respiratory side effects mentionned in the article I posted mostly occur post sedation when patient is returning home. i think its important to be mentionned to patients. I have never been told of possible side effect at the hospital from sedation except short time mental fog.


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## scottsma

No sedation for sigmoidoscopy.No probs. (it wasn't offered either) 

Light sedation for colonoscopy with option of entocort (gas and air).Again no problem,except I didn't stop talking all through it.

But it may be different if you're in a big flare and / or you have ulcers.


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## Bunty

I agree with lady organic, there isn't an anaesthetist in the room for scopes, the sedation isn't general anaesthetic, that would require a whole different set of circumstances.
Sigmoidoscopy is very quick and easy, I had one this last week and am in a flare up, have been since 1st June, which is why the procedure was required. My insides are inflamed and ulcerated but I barely felt a thing, without sedation of any kind.
The thought of these procedures is more concerning and frightening than the actual procedure itself in my opinion.
We're all different though, so it's no big deal at all if someone needs or wants sedation for any invasive procedure, that's their choice and to be defended as such.
Bunty x


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## DaveD

Bunty said:


> I agree with lady organic, there isn't an anaesthetist in the room for scopes, the sedation isn't general anaesthetic, that would require a whole different set of circumstances.
> Sigmoidoscopy is very quick and easy, I had one this last week and am in a flare up, have been since 1st June, which is why the procedure was required. My insides are inflamed and ulcerated but I barely felt a thing, without sedation of any kind.
> The thought of these procedures is more concerning and frightening than the actual procedure itself in my opinion.
> We're all different though, so it's no big deal at all if someone needs or wants sedation for any invasive procedure, that's their choice and to be defended as such.
> Bunty x


I have anestheologist for my colonoscopies and sigmoidoscopies in an outpatient clinic in 1st floor of my gastroenterologist and the insurance pays for it...


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## Bunty

I'm in the UK under the NHS, maybe it's different in other parts of the world where insurance is a separate issue.
Bunty x


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