What Is Flexible Sigmoidoscopy and IRC?

A flexible sigmoidoscopy is a very similar procedure to that of colonoscopy, but the flexible sigmoidoscopy test can only see the lower portion of the colon, while a colonoscopy can examine the entire colon (large intestine). Most often, sigmoidoscopy is performed as a screening test for colon cancer. However, the procedure can be both diagnostic and therapeutic. Diagnostic procedures are used to diagnose a problem, whereas therapeutic procedures are used to  treat a condition. One condition that sigmoidoscopy can be used to treat is hemorrhoids, sometimes in conjunction with infrared coagulation (IRC), which uses infrared light to shrink hemorrhoids. 

What Are Hemorrhoids?

Hemorrhoids are swollen veins that develop in the anus and lower rectum. They can either be internal (inside of the rectum) or external (skin around the anus). It’s estimated that three out of four adults will experience hemorrhoids at some point in their lifetime. They can develop during pregnancy, from straining too hard while making a bowel movement, or from heavy lifting, among other things. Often, patients can use over-the-counter medications to treat hemorrhoids, but there are cases where hemorrhoids are more severe, and OTC medications are not effective. Symptoms of external hemorrhoids include:

• Pain 
• Anal bleeding
• Swelling around the anus
• Itching or irritation

Symptoms of internal hemorrhoids include:

• Painless bleeding, particularly while having a bowel movement
• Pain
• Irritation

While you may know you have a case of hemorrhoids, bleeding from the anus doesn’t necessarily mean that it is related to hemorrhoids. You should always consult a doctor if you notice blood on the stool or on the tissue when you wipe. Because bleeding is a symptom of many gastrointestinal disorders and conditions (including colon cancer), your doctor may order a flexible sigmoidoscopy or colonoscopy to diagnose the hemorrhoids and rule other conditions out, followed by IRC, which will treat the hemorrhoids. 

What Is Flexible Sigmoidoscopy?

Sigmoidoscopy is similar to colonoscopy, however, it is slightly less invasive. Your gastroenterologist will use a sigmoidoscope to examine the lower part of the large intestine (colon). A sigmoidoscope is a long, thin tube that has a camera attached to the end. This provides images for your physician, so they can diagnose the problem. Common diseases and conditions diagnosed using sigmoidoscopy include colon cancer, inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis (UC), polyps, which are precancerous cells, rectal ulcers, and hemorrhoids. 

To prepare for sigmoidoscopy, you will likely be asked to adhere to a liquid diet for 24 hours leading up to the procedure (water, broth, etc.). You will also be given a special laxative by your gastroenterologist that will empty your colon for the exam. Do note that every doctor’s office has specific instructions. Unlike colonoscopy, sedatives or anesthesia do not have to be used, because the test is less invasive. As such, you can be awake for the procedure. The doctor will insert the sigmoidoscope, which allows your doctor to examine your rectum and lower intestine. For hemorrhoid treatment following the procedure, your doctor may suggest hemorrhoid banding or IRC therapy. Banding is often used larger internal hemorrhoids, while IRC is a first-line treatment for smaller hemorrhoids.

With most sigmoidoscopy, patients are taken to a recovery room, where they are monitored for about an hour before discharge. However, if your physician intends to perform IRC, this will follow your sigmoidoscopy. During most sigmoidoscopy exams, patients will not be administered sedatives or anesthesia, so they can drive themselves home if they like. 

What Is Infrared Coagulation (IRC)?

Your gastroenterologist may recommend IRC as an alternative to surgical removal of hemorrhoids (hemorrhoidectomy) or hemorrhoid banding. During IRC therapy, your gastroenterologist will insert a small probe into the anus. The probe emits infrared light, which shrinks and shrivels internal hemorrhoids. It is a straightforward, noninvasive outpatient procedure, however, it will take up to a week for the hemorrhoids to die. You will likely not notice when it occurs. IRC is first-line treatment for symptomatic internal hemorrhoids that are not prolapsing (internal hemorrhoids that push out of the anus). In certain cases, IRC can also be used for hemorrhoids that prolapse. 

What Are the Risks of Flexible Sigmoidoscopy and IRC?

Both sigmoidoscopy and IRC are both low-risk, outpatient procedures. However, there are rare risks and side effects associated with both. Sigmoidoscopy poses a risk of colon perforation or bleeding, and IRC poses rare risks of urinary problems, pain, rectal bleeding, and infection. Be sure to contact your physician if you experience side effects or symptoms after either procedure. 

What Can I Expect After Flexible Sigmoidoscopy and IRC?

IRC is minimally invasive, and you can resume normal activities immediately. After sigmoidoscopy, you resume regular activities as well, except in cases where anesthesia was used. IRC is effective in around 70 percent of patients, however, it is possible to have recurring hemorrhoids. If IRC was not effective at treating your hemorrhoids, your doctor may discuss surgical options with you. If IRC was effective, you can help prevent recurrent hemorrhoids by eating a fiber-rich diet and drinking plenty of water per day.