Sigmoidoscopy not good enough?

[Judah]

I am a 31 year old male.  About 5 years ago I went to a colorectal specialist due to rectal bleeding.  I was given a flexible sigmoidoscopy and was diagnosed with moderate proctitis.  Mesalamine enemas were given as treatment, and the bleeding and mucus went away after time.  Now, 5 years later, the bleeding and mucus in the stool has returned again, so I saw my general physician.  I told him about the sigmoidoscopy that was performed, as well as my diagnosis.  He couldn't believe I wasn't given a colonoscopy, and said inflammation could also be in my transverse colon.  My question is, because I was diagnosed with proctitis, is a colonscopy necessary, or could I assume my current bleeding is due to the reoccurring proctitis?  My doctor believes that a colonscopy should have been given in the first place, instead of the sigmoidoscopy.  A colonscopy is fairly expensive and if it is likely not necessary, I do not want to pay for it.

Thanks

[Kevin Pho, MD]

I cannot give any concrete recommendations without personal evaluation.  

A colonoscopy is generally a more comprehensive test than a sigmoidoscopy.  As you know, a sigmoidoscopy only evaluates approximately 1/3 of the colon, it would not be able to tell whether the transverse colon is affected.  

It is possible that the bleeding is caused by the proctitis - however without a comprehensive colonoscopy, you would never know if the ascending or transverse colon was diseased.  

If you are still having symptoms, a colonoscopy would not be unreasonable.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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