Anoscopy

Definition

An anoscopy is an examination of the rectum in which a small tube is inserted into the anus to screen, diagnose, and evaluate problems of the anus and anal canal.

Purpose

This test may be ordered for the evaluation of perianal or anal pain, hemorrhoids, rectal prolapse, digital rectal examination that shows a mass, perianal abscess and condyloma (a wart-like growth). An anascopy may be performed to check for abnormal openings between the anus and the skin, or anal fissures. The test is also used to diagnose rectal cancer.

Precautions

Anoscopy should not be performed on patients with acute cardiovascular problems due to the vasovagal reaction it may cause. This test is also not recommended for patients with acute abdominal problems and those with a constricted or narrowed anal canal.

Description

Anoscopy views the anus and anal canal by using an anoscope. An anoscope is a plastic, tube-shaped speculum that is a smaller version of a sigmoidscope. Before the anoscope is used, the doctor completes a digital rectal examination with a lubricated, gloved index finger. The anoscope is then lubricated and gently inserted a few inches into the rectum. This procedure enlarges the rectum to allow the doctor to view the entire anal canal with a light. If any suspicious areas are noticed, a piece of tissue can be biopsied.

During the anoscopy procedure there may be a feeling of pressure or the need to go to the bathroom. If a biopsy is taken, the patient may feel a slight pinch. The procedure is performed on an out-patient basis, and takes approximately an hour to complete.

Preparation

The patient will be instructed to clear their rectum of stool before the procedure. This may be done by taking a laxative, enema, or other preparation that may help with the evacuation.

Aftercare

If a biopsy is needed during an anoscopy, there may be slight anal bleeding for less than two days following the procedure. The patient may be instructed to sit in a bathtub of warm water for 10 to 15 minutes, three times a day, to help decrease the pain and swelling.

Risks

A simple anoscopy procedure offers minimal risks. There is a limited risk of bleeding and mild pain is a biopsy is performed.

Normal results

Normal values to look for during an anoscopy include an anal canal that appears healthy in size, color, and shape. The test also looks for no evidence of bleeding, polyps, hemorrhoids or other abnormalities.

Abnormal results

While an anoscopy is typically performed to determine is hemorrhoids are present, other abnormal finding could include polyps, abscesses, inflammation, fissures, colorectal polyps, or cancer.

Resources

Books

Altman, Roberta, and Michael J. Sarg. "Anoscopy." The Cancer Dictionary. Checkmark Books, 2000, p. 18.

Periodicals

Colyar, Margaret. "Anascopy Basics." The Nurse Practitioner (October 2000): 91.

Other

Discovery Health. "Medical Tests: Anoscopy." May 5, 2001. 〈http://health.discover.com/diseasesandcond/encyclopedia/1038.html〉.

Lycos Health with WebMD. "Anoscopy." May 5, 2001. 〈http://webmd.lycos.com/content/asset/adam_test_anoscopy〉.

Key terms

Anal fissure — An ulcer on the margin of the anus.

Digital rectal examination — An examination where a gloved, lubricated index finger is inserted into the rectum to check for any abnormalities.

Polyps — A tumor with a small flap that attaches itself to the wall of various vascular organs such as the nose, uterus and rectum. Polyps bleed easily, and if they are suspected to be cancerous they should be surgically removed.

Vasovagal reaction — Regarding the action of stimuli from the vagus nerve on blood vessels.

anoscopy

[a-nos´kah-pe]

examination of the anal canal with an anoscope.

anoscopy

The use of an anoscope to directly visualise the anorectal mucosa and detect haemorrhoids, polyps, anal fissures and rectal bleeding of uncertain aetiology.

anoscopy

The use of an anoscope to directly visualize the anorectal mucosa, and detect hemorrhoids, polyps, anal fissures and rectal bleeding of uncertain etiology

Mentioned in

References in periodicals archive

Our medical center uses conventional anoscopy, performed by 2 colorectal surgeons and their physician assistants.

Anal Cytology: Institutional Statistics, Correlation With Histology, and Development of Multidisciplinary Screening Program With Review of the Current Literature

Only 24 men (11.5%) reported receiving anal cancer screening (Table 2); 10 had received a digital rectal exam (DRE), one received anoscopy, and five had received both (combined total 16 men; 7.7%).

Anal cancer screening knowledge, attitudes, and experiences among men who have sex with men in Ottawa, Ontario

* 46607, Anoscopy; diagnostic, with high-resolution magnification (HRA) (eg colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple

ObGyn Medicare and CPT coding changes that could affect your income in 2015: although Medicare reimbursement looks bleak for the coming year, awareness of some coding changes could help your bottom line

Another group that I'm involved with, the American Society for Colposcopy and Cervical Pathology (ASCCP, http://www.asccp.org/), has courses twice a year designed to begin the training process for high-resolution anoscopy. We train between 70 and 80 people from around the world in each course.

Tackling tough questions on anal cancer incidence, screening, and HPV vaccination

In March 2013, as part of the Capacity Building for HIVHPV Clinical Trials Recruitment Among Minority Underserved Populations of Hispanic Origin project, we conducted an educational activity (1.5 contact hours) with medical students and physicians at the Department of Internal Medicine of the Medical Sciences Campus (MSC) of the University of PR (UPR) entitled "HPV-Related Anal Conditions: Epidemiology, Screening, and Treatment." The activity consisted of a conference led by an infectious disease specialist, trained in high resolution anoscopy (HRA) and colposcopy, who spoke about l) the epidemiology of HPV in anal cancer, 2) anal cancer and related risk factors, and 3) screening, diagnosis, and treatment options.

Recognizing and treating anal cancer: training medical students and physicians in Puerto Rico

The diagnosis of high fistula can be made by anoscopy and digital examination as the indurated tract is often palpable.

REROUTING OF HIGH / RECURRENT ANAL FISTULA WITHOUT SETON

For identification of internal opening, one has to do digital exam, assess sphincter, external orifice location, probe direction residual sepsis and do anoscopy. Fistulography was uncomfortable, inaccurate in 84% of cases in one study.

Dr. Calder Lavery discusses surgical management of ulcerative colitis, recent advances in surgery for rectal prolapse, complex anal pathology, complex fistulas

The response was assessed by cytology, high-resolution anoscopy and biopsy two months after therapy.

Treating pre-cancerous anal lesions in people with HIV, UK

An Anoscopy was performed, revealing no internal hemorrhoids, and the decedent was conservatively treated.

NY: hospital failed to perform colonoscopy: court affirmed summary judment for hospital

* Digital rectal examination with or without anal smear every 1-3 years for homosexual men (BASHH and BHIVA guidelines state that the role of annual anal cytology and anoscopy is not yet proven; however, patients should be encouraged to report any lumps noticed in the anal canal and HIV clinicians need to increase their awareness and knowledge of anal intraepithelial neoplasia).

The times they are a-changing HIV and ageing: a new frontier

Due to the effects of the disease she underwent an ileocolic resection in 1989 and an angular anoscopy in 1998.

Failure to have blood for transfusion: death-$9 million verdict

Wright acknowledged that anoscopy is much more difficult than colposcopy to perform because of the smaller, confined space and the tendency of the anus to move.

Routine anal Pap smear testing gains ground