Anoscopy

Overview

An anoscopy a simple bedside examination that involves examining the lining of the anus and lower rectum using an anoscope or anal speculum to detect any signs of injury or illness. 

A colposcope, a magnifying tool, may be added to the anoscope during a high–resolution anoscopy. It can identify subtle changes in the tissues that may not be detectable by the anoscope alone.

High–resolution anoscopy is used to search for abnormal cells within the anal lining. If abnormalities are identified, a biopsy may be taken for further analysis in the laboratory. 

Reasons for undergoing the procedure

An anoscopy is a diagnostic procedure for various anorectal conditions such as hemorrhoids, anal fissures, yeast infections, sexually transmitted infections, anal abscesses, anal fistulas, anal trauma, rectal prolapse, anal dysplasia, and anal cancer.

It is typically suggested when individuals experience symptoms in the anus or as a screening tool for conditions that may not manifest noticeable symptoms, such as cancer or viral infections, especially if there is a heightened risk.

Anoscopy is also utilized to investigate symptoms such as anal bleeding, discharge, pain, itching, swelling, lesions, protrusions, as well as difficulties with bowel movements or maintaining bowel control.

Risk

Healthcare providers will usually inform patients about potential side effects and provide guidance on managing any mild discomfort or bleeding that may occur during and after the procedure.  

The level of discomfort may vary from person to person depending on their specific condition and whether a biopsy was conducted.

Procedure

An anoscope, also known as an anal speculum, have some differences between models. While some are opaque with slotted sides, others are made of translucent plastic. Some may have straight sides with a beveled tip, and others may have a tapered appearance.

The anoscope is a rigid, hollow, tool that is typically 3 to 5 inches long and 1 to 2 inches wide. Children use a smaller pediatric anoscope. The tool itself should not cause pain. It is lubricated and crafted for a smooth passage through the anus. However, one may experience mild discomfort due to internal pressure, similar to sensations such as bloating or cramping.

Before the procedure

For an anoscopy procedure, no specific preparation is required, although healthcare providers may recommend certain precautions. Emptying the bowels and bladder before the procedure may be suggested. 

The use of an enema may be recommended or omitted, depending on the individual’s specific medical condition. Patients may also be advised to refrain from anal penetration and the use of anal medications or products.

During the procedure

An examination for an endoscopy usually takes a few minutes to complete. However, if it involves a biopsy or a high–resolution anoscopy, it can take longer. Although most people find the procedure easy to tolerate, some may have anesthetic alternatives if their illness causes the anus to be extremely sensitive to touch.

For an anoscopy, patients will have to lie on an exam table, either bending forward, lying on their stomach, or on their side with the knees bend. Before using the anoscope, the healthcare provider will check the anus with a lubricated finger (digital rectal exam). They might apply numbing medication like lidocaine inside, and for more severe cases, use extra pain medications or anesthesia. 

The healthcare provider will do the following during the anoscopy:

• The anoscope is lubricated and gently push it into the anus. Then, the four–inch scope is inserted into the anus and pass into the lowest two inches of the rectum.
• The obturator, a removable plug that guides the anoscope and shields the lens, will be removed to enable clear visibility. 
• The anoscope will be slowly withdrawn examining the tissue along the way. Some types of anoscope may be rotated during withdrawal, while a slotted anoscope, which may be uncomfortable to rotate, might require several passes through the anal canal to examine all sides thoroughly.
• A cotton swab will be used to collect samples of any abnormal substances, like mucus or pus, placing the swab in a culture tube for later analysis to identify infections.
• Another cotton swab will be used to collect a sample of fecal matter and conduct a fecal occult blood test to detect invisible traces of blood if necessary. 
• If there are any suspicious masses, surgical forceps will be employed to carefully pinch off a small tissue sample for further examination through biopsy.

The healthcare provider will do the following during the high–resolution anoscopy:

• A cotton swab coated with an acetic acid solution inserted through the anoscope. After withdrawing the anoscope, the swab remains in place for a few minutes, causing abnormal cells in the anal lining to turn white due to the solution.
• Following this, the provider removes the swab and reinserts the anoscope, this time with the attached magnifying device called a colposcope.
• The healthcare provider will specifically look for any white cells and proceed to take a biopsy of these identified cells.

After the procedure

Depending on the findings of the examination, the healthcare provider might be able to initiate immediate treatment. For instance, if hemorrhoids are identified, various techniques could be employed to promptly treat them. If a biopsy is performed, they will communicate the specific tests being conducted, and one will receive the results at a later time.

Outcome

An anoscopy is typically performed as an outpatient procedure, and in most instances, one can leave shortly after its completion. If anesthesia was administered, a longer stay and assistance with transportation might be necessary.

You may experience some mild discomfort or slight bleeding following the procedure, but these symptoms typically resolve within a day or two. To alleviate any discomfort in the anal area, you can consider taking a warm bath, using ice packs, or applying topical medications.

Since complications are possible, it is important to monitor the condition after the procedure. If one experiences excessive pain or prolonged bleeding lasting more than two days, and symptoms of acute illness, such as fever or nausea, seek medical attention immediately.