Anoscopy (Anal Exam)

Experiencing pain or unusual symptoms in your anal or rectal area can be worrisome. Along with the discomfort, addressing these symptoms is important for your well-being and health. 

That’s where anoscopy or high-resolution anoscopy (HRA) comes in. These procedures offer a closer look at these areas, helping in the early detection of potential issues. Read on to understand what this procedure entails and why it matters. 

What is anoscopy and high-resolution anoscopy?

An anoscopy is a medical procedure used to examine the inside of your anus and lower rectum to look for signs of injury or disease. The anus and lower rectum are located at the end of the gastrointestinal (GI) tract, where you remove waste (poop) from the body.

Anoscopies are used by specialists known as gastroenterologists and can be performed in their office, an outpatient surgery center or a hospital. Gastroenterologists use a tiny, hollow plastic or metal tube with a tiny light called an anoscope. The anoscope is gently inserted into the anus to give the specialist a clear view of the anal canal and lower part of the rectum.

A high-resolution anoscopy is a more advanced procedure that uses a specialized medical device called a colposcope. A colposcope resembles a pair of binoculars mounted on a stand with a bright light source. It has magnifying lenses that provide a close-up view of tissues, similar to a colposcopy used during a gynecological exam. 

An high-resolution anoscopy may be used to check for more serious issues like abnormal growths that could be cancerous.

How is anoscopy different from a colonoscopy?

While an anoscopy looks only at the anal canal and lower rectum, a colonoscopy examines the entire colon – from the large intestine to your anus – and uses a different instrument. A colonoscopy is a longer procedure that involves more preparation and some recovery afterward.

Why might I need an anoscopy?

Your health care provider might recommend an anoscopy for a few reasons:

• Rectal bleeding: An anoscope can check for the cause of the bleeding. This could be due to things like hemorrhoids, tears in the tissue or other issues in the anus and rectum.
• Anal pain or discomfort: An anoscope can help your provider see if there are any problems causing discomfort, such as swelling (inflammation), sores (lesions) or infections.
• Screening for abnormalities: An anoscope can be used as a screening tool to check for problems in the anus or lower rectum, such as abnormal growths or polyps. Finding these early can be important for treatment and preventing more serious issues. 
• Diagnosing conditions: An anoscope can help your provider diagnose anal cancer, rectal prolapse, anal fissures, hemorrhoids and viral infections like anal warts, anal gonorrhea, herpes and other sexually transmitted infections (STIs). 

Possible complications of an anoscopy

Anoscopies are generally safe procedures, but like any medical treatment they carry potential risks. These risks, though rare, include:

• Bleeding after a tissue sample (biopsy) is removed.
• A small tear or hole (perforation) in the wall of the colon or rectum.
• Infection if the equipment is not properly cleaned and sterilized.

It’s important to talk to your provider if you have any worries or questions about getting an anoscopy. They’ll help you understand everything and ensure your safety during the procedure.

How to prepare for an anoscopy

Before an anoscopy or high-resolution anoscopy, you don’t usually need to do anything special to prepare. Unlike a colonoscopy, you do not need to do any bowel prep. 

Your provider may ask you to stop certain medications or adjust your dosage temporarily, especially if these medications can cause a risk of increased bleeding. You may also need to avoid using douches, enemas, creams and anal sex 24 hours before your visit.

Let your provider know if you have allergies or reactions to medications, latex or tape and if you are pregnant or think you may be pregnant.

What to expect during an anoscopy

Anoscopies can be performed as an outpatient procedure or as part of a hospital stay. How the test is performed may vary depending on your condition and your provider’s practices. 

In general, it follows this process:

• You will undress from the waist down and change into a gown. You may also need to remove any jewelry or accessories. This ensures that you are comfortable during the procedure and allows your provider easy access to the area being looked at.
• You will lie on your side on an exam table with your knees bent toward your chest (in the fetal position) or a similar position. This helps the provider have a clear view of the anus and rectum.
• Unlike other endoscopies, you do not need anesthesia or sedation. Your provider may use numbing gel to make the procedure more comfortable. Anoscopy may be uncomfortable but should be painless.
• Your provider may perform a digital rectal exam before or after the procedure. With a lubricated, gloved finger, they will gently feel inside your rectal area to determine whether there is something abnormal. 
• The provider will gently insert a lubricated anoscope into your anus. The tube has a light on the end to help see for any abnormal areas. If using a high-resolution anoscopy, your provider may apply a liquid or dye into the lining of the anus to help see certain areas more clearly. 
• If the provider sees any suspicious areas, they may take a small tissue sample and send it to a lab for examination. This is usually done with a tiny instrument passed through the scope.
• When the exam is done, the scope will be taken out.

The entire procedure typically takes only a few minutes. It could take longer if your provider uses an HRA or needs to take tissue samples. 

Recovery from an anoscopy

Your provider will be able to go over what they found. If they took samples, they will let you know when the results return later. In some cases, like hemorrhoids or STIs, your provider might be able to treat your condition right away.

In most cases, you can go home soon after you are done and resume normal activities. There are usually no restrictions on physical activity or diet. 

You may be a little sore or experience mild pressure in the anal area immediately after the procedure, but this typically goes away quickly. It’s normal to have a small amount of bleeding from the anus after an anoscopy, especially if a biopsy was performed. This bleeding should be minimal and stop on its own.

To help relieve any pain or discomfort:

• Take a sitz bath (soak pelvic area) or apply a warm, wet compress to your anal area for 15 minutes. 
• To prevent constipation, drink plenty of water and eat a diet high in fiber. A fiber supplement or stool softener may be recommended.
• Avoid aggressive wiping after you poop.
• Take an over-the-counter (OTC) pain reliever.

If you had a biopsy, your provider will provide instructions on how to care for the biopsy site and when to expect results. They may recommend you avoid anal sex and the use of anal toys for one week to prevent the risk of infection. They may also suggest not lifting anything over 20 pounds for one week.

Serious complications are rare, but call your provider if you have any of the following symptoms:

• Heavy bleeding from your anus or dark or black stools
• Fever and chills
• Dark or bloody stools (poops)
• Feel dizzy or faint
• Have not had a bowel movement 3 days after your procedure

Call 911 or have someone take you to the nearest emergency department if you experience any of the following:

• Sudden chest pain
• Difficulty breathing and swallowing or gasping for air 
• Sudden loss of consciousness

What happens if the results are abnormal?

If your provider finds anything unusual, like inflammation or signs of a condition, they will talk to you about what it means and what to do next. They might suggest additional testing, treatments and follow-up care.

If you have any questions, ask your provider to help you understand.

Expert care 

Has your health care provider suggested an anoscopy? Let Banner Health's experts guide you. We offer personalized consultations and advanced procedures for various digestive conditions.