PROCTOSCOPY

Proctoscopy is an examination of the rectum using a special metal scope

called a proctoscope. The rectum is the final portion of the large intestine. It is the
8-inch muscular tube-like section that leads to the anus, the opening of the
intestine out of the body. Waste “bowel movements” and gas pass out of the
body through the anus.

Why is this test done?

A proctoscopy is mainly performed to detect and assess diseases of the rectum

or anus.

How is proctoscopy performed?

This test usually is done in the doctor’s office but can also be done in the
operating room by a colorectal surgeon. You will be asked to remove your
clothing below the waist and lie on your side on a table. The doctor will gently
insert a gloved finger into your anus to check for tenderness or blockage caused
by a mass lesion. The lubricated proctoscope is then carefully inserted into the
rectum. Air is gently pumped in to distend the rectum, and you may feel some
fullness and a need to pass stool. The doctor also may use special instruments
to remove polyps or a sample of tissue (biopsy) for further testing. When the
doctor finishes examining your rectum, he or she will gently withdraw the scope.

Most patients do not require anesthesia for this procedure. You may feel some
pressure or cramping while the scope is in place, but you should not feel any
pain. It is not unusual to feel and hear some air escaping during this procedure.
This is normal and expected, and you should not be embarrassed. If you
continue to have cramps after the procedure, passing gas may help. Walking
around the room after the test may help you to pass the gas. The proctoscopy
test usually takes from five to 15 minutes.

You will usually be asked to use an enema (medication inserted into the rectum
in order to cleanse the bowel) the night before or be given one in the office just
before the test. There may be no special preparation at all. Be sure to check with
your doctor for specific instructions before your test.

Pres-test:
 • Talk with your health professional to find out if you need to stop taking some
medicines, such as warfarin, before the test.
• Talk with your health professional to find out if you need to take antibiotics
before the test, especially if you have a heart murmur, an artificial heart valve,
or an artificial implant (such as a replacement joint).
• Tell your health professional if you have been diagnosed with peritonitis,
diverticulitis, or toxic megacolon or if you have had recent bowel surgery.

• The preparation for these tests usually involves a thorough cleaning of the
lower colon, because it must be completely clear of stool (feces). Even a
small amount of fecal material can affect the accuracy of the test.

• You may be instructed to follow a liquid diet for 1 to 2 days before the test. But do
not drink red food items such as red juice or red Jell-O.
• You may be instructed to not eat for up to 12 hours before the test.
• You may need to have an enema the night before the test and another enema an
hour before the examination.
• You may not need special preparation, especially if you have watery or bloody
diarrhea.

Intra-test:

You will usually lie on your left side during the test. You may also be asked
to kneel on the table with your bottom raised in the air.

Once you are in position:

• Your health professional will gently insert a gloved finger into your anus to check
for tenderness or blockage. For men, your health professional will also check the
condition of the prostate gland.
• The lubricated scope is then inserted. The scope is moved slowly forward into
the rectum and lower colon. During a sigmoidoscopy, puffs of air sometimes are
blown through the scope to open the colon so that your health professional can
see more clearly.
• Suction may be used to remove watery stool, enema liquid, mucus, or blood
through the scope.
• Once your health professional has moved the scope forward as far as possible, it
is slowly withdrawn while tissue is carefully inspected.
• Your health professional may also insert tiny instruments (forceps, loops, swabs)
through the scope to collect tissue samples (biopsy) or to remove growths.
Tissue samples may be sent to a laboratory for examination.

After the scope is removed, your anal area will be cleaned with tissues. If you are
having cramps, passing gas may help relieve them.

The entire examination usually takes 5 to 15 minutes, slightly longer if tissue

samples are taken or if polyps are removed.

If you received a sedative during the test, do not drive, operate machinery, or
sign legal documents for 24 hours after the test. Arrange to have someone drive
you home after the test.

After the test you may resume your regular diet, unless your health professional
gives you other directions. Be sure to drink plenty of liquids to replace those you
have lost during the preparation for the sigmoidoscopy.

How It Feels:

An anoscopy, proctoscopy, and sigmoidoscopy examination can be

embarrassing and uncomfortable. You may have cramping, a feeling of pressure
or bloating, or feel a brief, sharp pain when the scope is moved forward or when
air is blown into your colon.

The removal of tissue samples (biopsy) from the colon does not cause
discomfort. A local anesthetic is used when a biopsy of the anal area is done.
Your anus may be sore for a few days.

You may have mild gas pains and may need to pass some gas after the
procedure. Walking may help relieve the gas pains.

If a biopsy was done or a polyp removed, you may have traces of blood in your
stool for a few days.

Risk:
There is very little risk of complications from having an anoscopy,
proctoscopy, or sigmoidoscopy.

• There is a slight chance of piercing the colon (perforation) or causing severe

bleeding by damaging the wall of the colon. However, these problems are rare.
• There is also a slight chance of a colon infection (very rare).

Call your health professional immediately if you have:

• Heavy rectal bleeding.
• Severe abdominal pain.
• A fever.

Results:

Anoscopy, proctoscopy, and sigmoidoscopy tests allow your health

professional to look at the inner lining of your anus, rectum, and the lower part of
the large intestine (colon).

Your health professional should be able to discuss some of the findings

with you immediately after the test. Lab results (such as from a biopsy) may take
several days.

Anoscopy, proctoscopy, and sigmoidoscopy

Normal:• The lining of the colon appears smooth and pink, with numerous
folds.

• No abnormal growths, pouches, bleeding, or inflammation is present.

Abnormal: Some of the more common abnormal findings include:

• Hemorrhoids, which are the most common cause of blood in the

stool.
• Colon polyps.
• Cancer in the colon.
• A sore (ulcer).
• Pouches in the wall of the colon (diverticulosis).

• Redness and swelling of the lining of the colon (colitis).

Your health professional will discuss any significant abnormal results with you in
relation to your symptoms and past health.

What Affects the Test

Factors that can interfere with your test or the accuracy of the results include:

• Stool in the colon or rectum.

• The structure of the colon, such as a colon that has many turns.
• A barium enema done within a week before sigmoidoscopy.
• Rectal bleeding.
• Drinking red fluids or eating red gelatin. This can change the color of secretions
in the colon and may be mistaken for blood.

What To Think About

• Follow-up tests, such as colonoscopy, may be needed after sigmoidoscopy. A

colonoscopy may also be needed to examine the upper section of the colon if
growths were seen during sigmoidoscopy. For more information, see the medical
test Colonoscopy.
• In some cases, the sigmoidoscope may be attached to a video monitor and a
recording device that lets your health professional see the inside the colon and
record the findings.
• Most medical experts recommend colon cancer screening beginning at age 50
for people who have an average risk and earlier for those who have an increased
risk for colon cancer, such as those with a family history of colon cancer. Talk
with your health professional about which colon cancer screening test is best for
you.
• You may not be able to have this test if you have peritonitis, diverticulitis, toxic
megacolon, or if you have had recent bowel surgery.
 VISUAL EVOKED RESPONSE

An evoked potential test measures the time it takes for nerves to respond
to stimulation. The size of the response is also measured. Nerves from different
areas of the body may be tested. Types of responses are:

• Visual evoked response or potential (VER or VEP), which is when the eyes are
stimulated by looking at a test pattern.
• Auditory brain stem evoked response or potential (ABER or ABEP), which is
when hearing is stimulated by listening to a test tone.
• Somatosensory evoked response or potential (SSER or SSEP), which is when
the nerves of the arms and legs are stimulated by an electrical pulse.

Each type of response is recorded from brain waves by using electrodes taped to
the head. The visual evoked response (VER) is the most commonly used evoked
potential test in the diagnosis of multiple sclerosis (MS).

Conducting gel and electrodes are applied to the scalp. The location will depend
on the type of response being recorded. For example, when VERs are recorded,
the electrodes are applied to the rear (occipital region) of the scalp over the brain
areas that register visual stimuli.

Stimuli are delivered:

• For VER by a strobe light or a screen with a checkerboard pattern.

• For ABER by clicking noises or a tone sent through earphones.
• For SSER by an electrical pulse at the wrist or knee. This pulse is a mild
electrical shock.

Responses from the electrodes are recorded. The time between the stimulation
and the response is called the latency, which indicates the speed at which the
nerves pass a signal.

Why It Is Done
This test may be used when MS is suspected and a neurological examination
alone does not provide enough evidence.

For a clear diagnosis of MS, the doctor has to find evidence that multiple parts of
the central nervous system are affected. When there are symptoms clearly
caused by MS lesions of the spine but no visual symptoms, the visual response
may be tested anyway. Abnormal results in such cases mean that there are also
areas of damage (MS lesions) on the brain.
Results
Findings of this test may include the following.

Normal
The time between the stimulation and the nerve's response is within the normal
range.

Abnormal
Some people who are free from symptoms in the nerve area tested will still have
abnormal responses in that area.

Abnormal response times can also be associated with other neurological

diseases or with damaged optic nerves and eyes.

What To Think About

An evoked potential test typically takes half an hour or longer to do.
 ELECTROENCEPHALOGRAM

An EEG, or electroencephalogram, is a test that can help diagnose

epilepsy. During an EEG, the electrical signals of the brain are recorded. This
electrical activity is detected by electrodes, or sensors, placed on the patient's
scalp and transmitted to a polygraph that records the activity.

How It Works

Electrical signals produced by the brain neurons are picked up by the electrodes
and transmitted to a polygraph, where they produce separate graphs on moving
paper using an ink writing pen or on a computer screen.

How to Prepare
To prepare for your EEG you should:

• Discuss any medications you are taking with your physician prior to your
procedure.
• Wash your hair the night before the test. Do not use hair cream, oils or spray
afterward.

What Happens During the EEG?

You lie down on the examining table or bed while about 20 electrodes are
attached to your scalp. You are asked to relax and lie first with your eyes open,
then later with them closed. You may be asked to breathe deeply and rapidly or
to stare at a flashing light - both of these activities produce changes in the brain-
wave patterns. If you are prone to seizures, it is rare that you may experience
one during the test. If you are being evaluated for a sleep disorder, EEG may be
performed continuously during the night while you are asleep. Such a recording,
which may involve an evaluation of other body functions during sleep, such as
respiration and pulse, is referred to as polysomnography.

What Happens After the Test?

The electrodes are removed and the glue that held them in place is washed away
with acetone. You may have to use additional acetone at home to completely
remove the glue. Unless you are actively having seizures or are restricted by
your physician, you may drive home. If the EEG was performed overnight, you
should arrange to have someone drive you home. If you stopped taking
anticonvulsant drugs for the EEG, you can usually start taking them again.
A neurologist examines the EEG recording for abnormalities in the brain-wave
pattern, which may reflect diseases of the nervous system.
 MAGNETIC RESONANCE IMAGING

MRI is a test that produces very clear pictures of the human body without
the use of X-rays. It uses a large magnet, radio waves and a computer to
produce these images.

MRI can often detect damaged areas in the brain or spinal cord that would
be missed by other imaging techniques such as a CAT scan.

Indications:

• To detect MS. MRI is considered the best test to help diagnose MS. However,
5% of people with MS do not have abnormalities detected on MRI, thus a
"negative" scan does not completely rule out MS. In addition, some common
changes of aging may look like MS on a MRI.
• To track the progress of disease. Although they aren't widely needed,
sometimes someone with MS will get repeat scans to determine how fast the
disease is progressing.

Is the MRI Examination Safe?

Yes. The MRI examination poses no risk to the average person if appropriate
safety guidelines are followed. Many people who have had heart surgery and
people with the following medical devices can be safely examined with MRI:

• Artificial joints
• Staples
• Many cardiac valve replacements (check with your doctor)
• Disconnected medication pumps
• Vena cava filters
• Brain shunt tubes for hydrocephalus

Some conditions may make an MRI examination inadvisable. Tell your doctor if
you have any of the following conditions:

• Heart pacemaker
• Cerebral aneurysm clip (metal clip on a blood vessel in the brain)
• Pregnancy
• Implanted insulin pump (for treatment of diabetes), narcotics pump (for pain
medication), or implanted nerve stimulators ("TENS") for back pain
• Metal in the eye or eye socket
• Cochlear (ear) implant for hearing impairment
• Implanted spine stabilization rods
• Severe lung disease (such as tracheomalacia or bronchopulmonary dysplasia)
• Gastroesophageal reflux (a common disease that causes heartburn)
• Weigh more than 300 pounds
• Not able to lie on back for 30 to 60 minutes
• Claustrophobia (fear of closed or narrow spaces)

How Long Does the MRI Exam Take?

Allow two hours for your MRI exam. In most cases, the procedure takes 40 to 80
minutes; during that time, several dozen images may be taken.

What Happens Before the Exam?

Personal items such as your watch, wallet (including any credit cards with
magnetic strips that can be erased by the magnet) and jewelry should be left at
home if possible or removed prior to the MRI scan. Secured lockers are available
to store personal possessions.

What Happens During the Exam?

You may be asked to wear a hospital gown during the MRI scan.

As the MRI scan begins, you will hear the equipment making a muffled thumping
sound that will last for several minutes. Other than that sound, you should
experience no unusual sensations during the scanning.

Certain MRI exams require an injection of a contrast material. This helps identify
certain anatomic structures on the scan images.

Feel free to ask questions and tell the technologist or doctor if you have any
concerns.

What Happens After the Exam?

Your doctor will discuss the test results with you. Generally, you can resume your
usual activities immediately.