Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

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A flexible sigmoidoscopy is a procedure to examine the inside of the lowest part of your colon (large intestine). Your colon is the lowest part of your digestive system, running from the end of your small intestine to your rectum. The colon is where your body stores waste between bowel movements. The entire colon is 4 to 5 feet long, but a flexible sigmoidoscopy examines the lowest 2 feet, called the descending colon, the sigmoid colon, and the rectum.

During the procedure, we insert a thin, flexible tube into your rectum and move it slowly through your colon. A video camera at the tip of the tube allows us to search for abnormalities in the colon wall. If we find abnormalities (polyps, which are small tissue growths, for example), we may take a biopsy (a small sample for testing) or remove the abnormal tissue.

A flexible sigmoidoscopy usually takes less than 15 minutes. Most people are not sedated for the procedure. Though the preparation and recovery time is not as long as for a colonoscopy, you will need time to prepare for the procedure and to recover afterwards. Sigmoidoscopy differs from colonoscopy in the following ways:

  • A flexible sigmoidoscopy examines the lowest 2 feet of the colon, while a colonoscopy examines the full length of the colon (all 4 to 5 feet). This lower part of the colon is the more common area for cancers to occur.
  • A flexible sigmoidoscopy takes about 15 minutes, while a colonoscopy usually takes between 1 and 2 hours, including recovery.
  • A special diet is required before a colonoscopy and may be required before a flexible sigmoidoscopy as well.
  • Recovery time is shorter for a flexible sigmoidoscopy, and you do not need to arrange for a ride home after your procedure because sedation is not used.
  • There is a much higher risk associated with a colonoscopy, since more of the colon is being examined.

Let us know if you have a strong family history of colorectal cancer, or if you have a history of polyps or inflammatory irritable bowel disease (IBD), as we may wish to do a more intensive examination of the colon.

Why It Is Done

Screening or treatment for colorectal cancer

A flexible sigmoidoscopy can be performed to screen for colorectal cancer, or to treat or prevent colorectal cancer by removing abnormal tissue. Flexible sigmoidoscopy is one of many screening options for colorectal cancer.

Screening for colorectal cancer typically begins at age 50, but if you are at high risk for colorectal cancer, we may recommend that screening begin at an earlier age. High-risk patients should have a colonoscopy rather than a flexible sigmoidoscopy to examine the full length of their colon.

Diagnosis of other bowel diseases

We might recommend a flexible sigmoidoscopy to help diagnose or manage conditions such as:

  • Ulcerative colitis, an inflammatory bowel disease that causes inflammation and sores (ulcers) in the lining of the colon (large intestine).
  • Crohn’s disease, an inflammatory bowel disease that affects the last part of the small intestine and the first part of the large intestine (colon).
  • Diverticular disease, which occurs when pockets develop in the colon wall. Sometimes these pockets can become infected or inflamed, causing pain and discomfort (called Diverticulitis).
  • Hemorrhoids, which are dilated, twisted blood vessels in and around the rectum and anus. They are common and can cause pain, itching, and bleeding during a bowel movement.

How You Prepare

Why preparation is important

A flexible sigmoidoscopy requires that your lower colon be empty before the test begins. This allows us to see the inside of your colon clearly and makes it easier for us to recognize and treat any abnormal tissue.

To clear your colon, we may ask you to give yourself several enemas about 2 hours before your appointment. An enema is a procedure you can do at home. With a disposable enema kit, you use a special bottle to squeeze liquid into your colon. This causes you to have several bowel movements and clears your colon of any stool.

You may also be asked to modify your diet or take a laxative. The laxative will cause frequent bowel movements, flushing out your colon and preparing you for the procedure.

Your doctor will advise you on the specific procedure for clearing your colon.

A word on medications

Most medications are fine to continue taking before your flexible sigmoidoscopy. In some cases, we may recommend that patients avoid ibuprofen (a few brand names are Advil, Aleve, Motrin, Nurprin, Medipren).

How It Is Performed

A flexible sigmoidoscopy does not generally cause pain, although some patients report pressure or discomfort similar to gas pains. In most cases, we do not sedate patients before the procedure. If you are concerned about discomfort, please discuss your concerns with us before the procedure.

During the exam

The procedure usually takes less than 15 minutes. You will lie on your left side on an exam table. We use a thin, flexible tube called a sigmoidoscope to examine the inside of your colon. The tube is about the thickness of a person’s ring finger. It has a light and a small video camera on one end and transmits images to a video monitor where we can clearly see the inside of your colon.

We gently insert the sigmoidoscope into your colon through your anus after applying lubrication. The scope blows a puff of air into your colon, which inflates it and makes it easier for us to see. We will move the scope slowly along the length of your lower colon.

We stop about 2 feet into the colon. Then we slowly move the sigmoidoscope backwards and remove it. Retracing our steps gives us a chance to examine the colon walls for a second time.

A flexible sigmoidoscopy is not usually painful. Some people describe feeling like they need to go to the bathroom right after the scope is inserted. That feeling usually goes away after a few minutes. Some people describe pressure or cramping that is similar to gas pains or bloating during the exam.

Sampling and removing abnormal tissue

If we observe abnormal tissue, we use small tools inserted through the scope to take a biopsy (small sample) of tissue or remove the abnormal tissue entirely. Sampling and removing tissue is not painful, because there are no nerve endings on the inside wall of the colon. Special instruments and medication are used to stop any bleeding that may occur.

After the exam

The air that we use to inflate your colon may cause some discomfort and/or bloating in the first few hours after the procedure. You will feel better after you pass gas, which will happen often after the exam.

You will be able to get dressed and go home as soon as the exam is finished. Although you may resume your usual activities as soon as you are able, it may be a good idea to take a few hours to relax and recover. Throughout the day, you may continue to have cramps, feel bloated, or pass gas. This is all normal. If you are hungry, you may drink liquids and eat. We recommend you avoid caffeine, as it can cause cramps.

You may find that your bowel movements aren't completely normal right after your exam. It's even normal to see a little bit of blood in your stool at first, but that should stop after a day or two.

Any pain or bleeding should stop in the first few days. However, you should call us if you:

  • Have a fever of 101° Fahrenheit or higher.
  • Experience a lot of pain or pain that doesn't improve.
  • Have heavy rectal bleeding, with or without stool.
  • Your belly is tender, firm, or swollen.


Most people experience little or no pain during the exam. But like any procedure, there are some risks, which may include damage to the colon or bleeding.

Damage to the colon

There is a small risk that the sigmoidoscope used to examine your colon can tear or puncture the colon wall, called perforation. This is very rare (about 1 in every 25,000 exams), but if it happens, an operation may be needed.

If damage to your colon occurs, we will likely see it during your procedure. In rare cases, damage to your colon may not be noticeable until a day or two after the procedure. Because of this, it's important to call us immediately if you have:

  • A fever of 101° Fahrenheit or higher
  • Significant rectal bleeding (more than a few drops in the first 1 or 2 bowel movements)
  • Pain in your stomach that doesn't go away

There is a slight possibility that you will experience bleeding during or after the flexible sigmoidoscopy if we have removed or treated abnormal tissue. A little bit of bleeding is normal and can usually be stopped with special instruments and medications during the exam. If the bleeding doesn't stop, we may need to repeat the procedure, perform surgery, or perform a colonoscopy.

In rare cases, bleeding does not happen until after you have gone home.

Need to repeat the procedure

We may recommend that you have another flexible sigmoidoscopy if your lower colon was not completely cleaned out before the procedure. This makes it difficult for us to see your colon and sometimes even to move the sigmoidoscope through the colon. Additionally, if there is blockage, obstruction, or scar tissue from a previous abdominal surgery that makes it difficult to view the region, we may need to repeat the sigmoidoscopy.


There are several alternative procedures to a flexible sigmoidoscopy. We can discuss the options and decide together which is best for you.

Whichever option you choose, if we notice evidence of abnormal tissue in your colon, you will most likely need a colonoscopy to sample, remove, or treat those areas.

Fecal occult blood test (FOBT or FIT)

A fecal occult blood test, or stool test, is a very quick test with no known side effects. It is sometimes abbreviated as FOBT or FIT. There are no preparations for this test or special changes to your diet. We will provide all the supplies you need to do this test at home. This test is done with a sample of your stool that you collect using a home test kit and send to us by mail to be tested.

Barium enema

A barium enema is an X-ray of your colon. During the exam, we insert a thin tube into your colon through your anus. With this tube, we fill your colon with barium, a liquid that shows contrast during an X-ray. Then we take a standard X-ray of your abdomen. This allows us to see any abnormal tissue or growths in your colon wall.

You will need to prepare for this exam just as you would for a flexible sigmoidoscopy. We may recommend laxatives or enemas to clear the colon in preparation for the exam and changes to your diet in the day or two before the test.


During a colonoscopy, the entire length of the colon is examined from your rectum to the beginning of your small intestine. While you are under sedation, we insert a long, flexible tube into your rectum and move it slowly through the length of your colon. A video camera at the tip of the tube allows us to search for abnormalities, which we can then sample or remove for analysis.  If we find abnormalities (polyps, for example), we may take a small biopsy (sample for testing) or remove the abnormal tissue.

A colonoscopy is usually considered an outpatient procedure, meaning that you will not have to stay in the hospital overnight. You are sedated for the procedure and will need someone to drive you home afterwards. You will need time to prepare for the procedure by altering your diet and drinking a strong laxative the day before your procedure to clear your colon of waste.

For people at higher risk of colon cancer, a colonoscopy is the preferred method of screening for colorectal cancer because it allows the doctor to see the entire colon.

Your Care with Me

Your personal physician may recommend that you have a flex sigmoidoscopy for screening or treatment of colorectal cancer, or as a diagnostic test for various bowel diseases.

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

My staff will contact you to make an appointment for either a telephone advice or an office visit, and may schedule you for a flexible sigmoidoscopy at that time or later. In some cases we may ask you to attend a class or review an online educational video called “What You Need To Know About Flexible Sigmoidoscopy”, instead of an office or telephone advice visit.

During your office visit, we will discuss your medical and family history. A physical exam is not done since this procedure does not require sedation.. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

My staff will contact you to make an appointment for either a telephone advice or an office visit, and may schedule you for a flexible sigmoidoscopy at that time or later. In some cases we may ask you to attend a class or review an online educational video called "What You Need To Know About Flexible Sigmoidoscopy," instead of an office or telephone advice visit.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:


See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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