Table of Contents
Introduction:
Anoscopy is a bedside technique that does not require anesthesia or intestinal preparation. This technique allows the examiner to see inside the anus and distal rectum. The test helps in finding several anorectal conditions such as internal hemorrhoids, proctitis (inflammation of the rectum), laceration (tears in the lining of the anus and rectum), fistulas (an abnormal connection between the rectum and skin), ulcers, and tumors. This article will cover the indication limitations and how the anoscopy test is performed.
What Is an Anoscopy?
An anoscopy is a bedside medical procedure that uses an instrument to view the anus and rectum. The instrument used to view the interior of the anus and rectum is called an anoscope, which is usually made of stainless steel or plastic. The instrument allows the doctor to check for indications of damage or illness; the anoscope inspects the lining of the lower rectum and anus. A similar operation known as high-resolution anoscopy involves attaching a magnifying instrument called a colposcope to the anoscope. A colposcopy can detect small changes in tissues that may go unnoticed by the anoscope alone.
What Is Anoscopy Used For?
Doctors use anoscopy procedures for the following main reasons:
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Evaluation of rectal bleeding, which could be due to hemorrhoids, proctitis, or neoplasm (cancerous growth).
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Screening of anal cancer, particularly in high-risk patients with HIV infection.
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Evaluation of intra-anal condyloma (anal warts).
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To investigate anal or perianal pain.
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To look for abnormal connections (anal fistula).
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Evaluation of anal traumas.
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To provide a closer look at a mass palpated during a routine examination.
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To rule out perianal itching.
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To investigate abdominal pain, changes in bowel habits, and anal discharge or prolapse.
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Removal of a foreign body.
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Evaluation of fecal impaction.
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To treat prolapsing hemorrhoids with rubber band ligation.
Who Performs Anoscopy?
A gastroenterologist or a colorectal surgeon may perform an anoscopy. Both are gastrointestinal illness specialists who perform endoscopic procedures to examine the intestines.
How to Prepare for an Anoscopy?
No specific preparation is required, but a medical professional may suggest:
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Avoid penetration in the anal area.
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Avoid anal medications.
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Before the anoscopy procedure begins, empty the bladder and bowels.
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Enema may be used depending on the condition.
How Is Anoscopy Procedure Performed?
An anoscopy can be performed at a healthcare provider's office or in an outpatient facility.
The procedure is performed in the following steps:
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Patient Positioning: To make the process easier, the patient is positioned in several ways. The most commonly used position is the lateral decubitus position (left side or right lying position), with legs flexed and pillows or foam padding placed in between. The patient may also be put in the knee-shoulder or prone posture (lying on the stomach).
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Anesthesia: Occasionally, a topical anesthetic is used, with two percent Lidocaine jelly placed into the anal canal at least ten minutes before inserting the anoscope. In some extreme or severe cases, doctors may administer extra pain medication or anesthesia.
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Digital Rectal Examination (DRE): Before performing an anoscopy exam, the doctor visually assesses the area with a lubricated, gloved finger and then conducts a digital rectal examination (DRE) to look for any bleeding or visible lump.
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Anoscopy Exam: An anoscope is inserted with an obturator. The obturator is a plug-like piece that helps guide anoscope during insertion. The doctor thoroughly lubricates the anscope with standard lignocaine jelly, then carefully inserts the anoscope and moves it forward while rotating it slightly from side to side. Once the anoscope is fully inserted, the obturator is removed. This allows the doctor to see inside the anus. If necessary, the doctor may swab the debris and blood for further analysis during the anoscopy exam. The doctor then slowly removes the anoscope. After the anoscope is removed, some muscle tightening may occur.
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High-Resolution Anoscopy Exam: High-resolution anoscopy (HRA) uses a colposcope, a special microscope, to magnify the view of the rectum and anus. A three percent Acetic acid solution is applied to the perianal skin and mucosa for two minutes to highlight the abnormal cells. Another solution, Lugol iodine, is then applied. Abnormal lesions usually turn whitish when in contact with Acetic acid and will not take Lugol iodine solution.
After a few minutes, the doctor will reinsert the anoscope and colposcope. The doctor will use the colposcope to examine any cells that have become white. If abnormal cells are discovered, the healthcare professional will perform a biopsy.
What Happens After the Anoscopy Procedure?
Anoscopy is an outpatient procedure, which means one can leave right after the test is done and resume normal activities. The result of an anoscopy test will determine the appropriate treatment for a diagnosed condition or whether there is a need for any other test.
How Long Does the Anoscopy Procedure Take?
A routine anoscopy exam lasts only a few minutes. However, it may take longer if a high-resolution anoscopy exam is to be performed or the clinician takes samples during the anoscopy test.
What Are the Complications of the Anoscopy Procedure?
Anoscopy is a safe procedure. However, like with any medical procedure, there is a possibility of complications, but these are rare and may include;
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Discomfort after the anoscopy exam.
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Tearing of the perineal skin or mucosa.
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Abrasion or rupture of hemorrhoids.
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Infection after the operation is possible, but it occurs very rarely.
Proper lubricant application can avoid discomfort and abrasion. Anoscopy poses a low risk of infection; however, antibiotics can be recommended before the procedure in some high-risk patients. In patients with previous surgery, the doctor takes extra caution during the procedure to minimize discomfort.
Conclusion:
The anoscopy procedure plays an important role in diagnosing several anorectal conditions. An anoscopy may appear awful initially, but it is usually short and simple for most people. For individuals with anal symptoms, the anoscopy exam leads to a diagnosis and appropriate treatment. One must understand that healthcare providers are not embarrassed by examining the anus as they see it every day. The main concern of healthcare professionals is identifying the cause of the symptoms and determining what will provide relief. Routine anoscopy examination can play a major role in maintaining anorectal health and early identification of potentially dangerous conditions.
