You have been scheduled to undergo a Flexible Sigmoidoscopy. Please follow these instructions carefully so the examination will be successful. The day prior to the procedure you will need to prep. The prep involves taking a laxative that will completely clear the lower portion of your colon of stool. This prep will cause diarrhea.

Date of Procedure: ___________________             Arrival Time: ___________________

Location of Procedure:
_____ Cape Health Surgery Center 665 Del Prado Blvd. S Cape Coral 33990 right across the street from the Cape Coral Hospital.
_____ Cape Coral Hospital 636 Del Prado Blvd. S. Cape Coral 33990 – main entrance first left into outpatient services.

Remember you must have someone to drive you home.

Shopping List: Fleets enema or generic enemas x 2, Dulcolax or generic tablets x 4

On _______________ after 3pm you will only be allowed clear liquids. No solid foods or milk products. Items that you may drink are water, tea, coffee, apple/white grape juice, broth, Gatorade, jell-o, and Popsicles.

On _______________ at 4 p.m. take 4 Dulcolax tablets with 8 ounces of a clear liquid of your choice.
Be sure and continue to frequently drink clear liquids the rest of the evening to keep you hydrated.

On ________________ at ________________ you may have nothing else to eat, drink, or chew.

On ______________ at ________________use the one Fleets Enema per rectum at home. 15-30 minutes follow with the second Fleets Enema per rectum at home.

On __________________ the day of your procedure you may continue to have CLEAR LIQUIDS ONLY until 4 HOURS PRIOR to your arrival time. Please note if you drink any liquids within the 4 hour window your procedure will be delayed or cancelled.


If you take blood thinners you may be at an increased risk of bleeding if tissue is removed. You may continue aspirin unless otherwise instructed to stop by your doctor. The risk of stopping your blood thinner must be individualized for each patient. If you had a stent placement within the past 12 months or have a history of TIA’s, talk to your physician before stopping these medications. Please remind staff at the Endoscopy unit that you are taking blood thinners.

Stop taking: Coumadin Plavix Other _______________ on _______________

Please resume your medication after the procedure is completed or as directed by the doctor.

On the day of the procedure please refrain from smoking. Bring a complete medication list, your insurance information, your glasses, and if you are asthmatic your inhalers.

Your procedure will take approximately 30 minutes. You will spend 30 minutes in the recovery room. You will be able to resume normal activities the day after the procedure unless otherwise instructed.