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Rectoscopy is an endoscopic examination that enables the assessment of the mucosa of the large intestine, especially of the rectum and sigmoid colon. It is performed both for diagnostic and therapeutic purposes. Although rectoscopy raises many concerns among patients due to its invasive nature, it is completely painless, safe and short – it usually takes 5 to 10 minutes.
Rectoscopy – indications
Rectoscopy plays an important role in the diagnosis of diseases of the lower gastrointestinal tract. It enables, among others detection of polyps and changes in the rectum, endometriosis, explanation of the causes of frequent diarrhea, problems with defecation or rectal bleeding. It is also performed for therapeutic purposes, such as removing foreign bodies and polyps, stopping bleeding, widening intestinal strictures. It also enables the collection of samples for further bacteriological and histopathological tests.
Rectoscopy – contraindications
Rectoscopy should not be performed in patients with Crohn’s disease, coagulation disorders (especially when the examination is to be performed to take biopsies and remove lesions), peritonitis and ulcerative colitis. Women in advanced pregnancy should also not undergo this examination.
Rectoscopy should not be performed on people with cardiovascular problems (especially severe heart diseases, such as unstable coronary heart disease or significant heart failure) and severe lung diseases.
In addition, contraindications for rectoscopy are also suspected intestinal perforation and in the case of suspected diverticulitis. Rectoscopy cannot be performed when the patient does not cooperate with the doctor performing the examination.
See also: The 10 most common diseases of the circulatory system
Rectoscopy – the course of the examination
At the beginning, the doctor performs a rectal examination, i.e. examines the inside and outside of the rectum with the help of the fingers. The patient should lean on the knees and elbows. It is then inserted into the rectum rectoscope – a device made of a rigid metal tube, enabling precise examination of the mucosa. Initially, the device is inserted approximately 5 cm without visually inspecting the inside of the rectum. Then, after removing the obturator (gently tipped plug) from the rectoscope, allowing its shape to lightly insert the device through the anal sphincter zone, the doctor conducts further observations.
Contrary to various opinions, rectoscopy does not hurt. The tip of the rectoscope is lubricated with an anesthetic, so the patient may feel only slight discomfort. Use of the rectoscope may cause air to be blown into the rectum. You get the impression that you want to have a bowel movement by stimulating the anus. The doctor may remove the tissue sample during the procedure. This is called a biopsy. This is done with very small tools that pass through the rectoscope. However, it all depends on the professionalism of the doctor who conducts the examination. You may also receive sedatives and, in exceptional cases, painkillers. Rectoscopy usually takes no more than several minutes.
See also: Over-the-counter and prescription sedatives – characteristics and effects.
How to prepare for rectoscopy?
Preparation for the test may vary depending on the facility where it will be performed. In some places it is advisable for the patient to eat liquid meals a day or two before the examination. However, some doctors do not require a diet. The day before the examination and on the morning of that day, the patient performs an enema using a special fluid available at pharmacies. Fasting is very important.
It is also worth remembering not to take any laxatives as they can make the test difficult. If a patient with stresses is examined (artificial heart valves, vascular prosthesis, past endocarditis or a significantly decreased level of white blood cells, i.e. leukocytes), an intravenous antibiotic should be administered.
Complications after rectoscopy
You may experience rectal and anus discomfort immediately after the procedure. After rectoscopy, the patient should be able to return to his normal activities and follow his normal diet.
There may be slight rectal bleeding after rectoscopy, especially after removal of polyps, as well as an allergic reaction to the anesthetic gel. Rupture of the colon wall is one of the very rare complications. The patient should see a doctor if, after the examination, he has black stools, his stomach hurts, his abdomen is hard and swollen, he experiences symptoms similar to a cold – fever, chills. In addition, the subject should not drive a car if he or she has taken sedatives.
See also: What does black stool show?
Rectoscopy – test results
The patient can get rectoscopy results right away.
If a biopsy was also performed, the tissue sample will be sent to a lab for testing. It may take days or weeks to get the results. The doctor will contact the patient or ask to come to discuss the biopsy results.
Depending on the test results, you may need more tests or treatments.
Rectoscopy and sigmoidoscopy and colonoscopy
All three are endoscopic examinations of the colon. The only difference between rectoscopy, sigmoidoscopy, and colonoscopy is how far they reach the colon and which parts of it can be assessed.
- Rectoscopy: allows you to evaluate the most end parts of the colon; rectum and anus (sometimes sigmoid colon).
- Sigmoidoscopy: goes beyond the rectum and reaches the higher part of the colon known as the ‘sigmoid colon’ (sigmoid colon). This procedure is performed using a sigmoidoscope (a thin, flexible tube with a video camera on the end) that can extend up to 27 cm beyond the anal opening allowing the doctor to see a much larger area of your colon. A test used to diagnose colon and rectal disease, including colorectal cancer.
- Colonoscopy: This is to evaluate the entire colon (it can detect colon cancer and diagnose the causes of problems such as rectal bleeding or abdominal pain). The instrument used, called a colonoscope, is flexible and can pass through the entire colon to assess any abnormalities. Usually it has a camera and a light source at the end. It is the longest of all three telescopes, reaching the full length of the colon.
Sometimes sigmoidoscopy and rectoscopy are used interchangeably as they both allow the visualization of the most end parts of the colon and use very similar devices (only of different lengths).
See also: How to prepare for preventive examinations?
Can rectoscopy detect colon cancer?
Rectoscopy can detect colon cancer if it is in the rectum or anus, but it ignores tumors higher up in the colon. It allows only the most distal part of the colon to be assessed; of the rectum and the anal canal and can therefore only detect colon cancer that grows in this part of the large intestine. Rectoscopy is therefore not considered an effective screening tool for colon cancer, as it does not very well assess other common colon cancer locations, such as the sigmoid colon.