anoscopy

Anoscopy is a medical procedure that enables direct visualization of the anal canal using an anoscope, a short, rigid instrument with a light source. The examination is commonly performed in outpatient settings to assess the lower rectum and anal canal for conditions such as hemorrhoids, fissures, polyps, infections, bleeding, and tumors, and to obtain biopsies or perform minor therapeutic interventions.

Equipment and technique: Anoscopy uses a short hollow tube, typically 6 to 10 cm long, sized to the patient. The patient lies on their side (left lateral decubitus) or in the prone jackknife position. The anal area is lubricated, and topical local anesthesia may be used. The anoscope is gently inserted to the anal canal, and the lumen is opened to allow visualization of the mucosa. The clinician may perform a digital rectal examination before or after and may take biopsies or remove small polyps under direct vision.

Indications: evaluation of rectal bleeding, anal pain, discharge, itching, and palpable masses; surveillance after hemorrhoidal procedures; and biopsy of suspicious lesions.

Contraindications and precautions: severe anorectal pain or obstruction, suspected perforation, anal stenosis, or patient intolerance. Consider alternative imaging if visualization is not feasible.

Risks: discomfort, bleeding, infection, and, rarely, perforation; complications are uncommon when performed by trained clinicians.

Alternatives: proctoscopy, flexible sigmoidoscopy, colonoscopy, or imaging studies, depending on clinical context.