Is an Anoscopy Painful?

Anoscopy uses an anal speculum to insert a camera and tools for diagnosis and biopsy of conditions involving the lower digestive tract.

Anoscopy is a procedure to examine the walls of the anus and part of the rectum. It is performed with a rigid tube (anoscope) that is inserted a few inches into the anal canal. Anoscopy enables the doctor to visualize the anal canal and the lower part of the rectum.

The anoscope is also called an anal speculum. Anoscopes may have  lights, or the doctor may use a separate source of light for viewing. A specialist doctor may sometimes use a high-resolution anoscope with a microscope that offers a magnified view.

Anoscopy is not a surgical procedure. It is a minimally invasive diagnostic procedure done in a doctor’s office. The entire procedure may take 20-30 minutes.

Most people feel no pain during an anoscopy. The patient may feel a pressure like an urge for bowel movement, or a pinch if tissue is removed for biopsy. There usually is no requirement for any painkiller or sedation.

Rarely, sedation may be required:

• For people who have a distortion in their anatomy and are unable to tolerate the procedure.
• When the doctor is unsuccessful in removing a foreign body found inside the anorectal canal.

Anoscopy is performed to examine the anus and lower rectum, the lowermost parts of the gastrointestinal tract. The doctor usually performs a digital rectal examination (DRE) first.

In a DRE the doctor inserts a finger and feels the anal canal for abnormalities. Anoscopy is used to visually examine the anorectal region when a DRE does not yield sufficient information for diagnosis, or when a biopsy sample is required.

Anoscopy may be used to detect the cause of anal or rectal

• pain
• bleeding
• itching
• foul smelling discharge

Anoscopy may be required in the following situations:

• Anal fissures: tears in the anal tissue which may be due to
  • constipation
  • large and hard bowel movements
  • persistent diarrhea
  • childbirth
• Crohn’s disease
• Abscesses: pus-filled pockets in the tissue, caused by infection. They may result from
  • blocked anal gland
  • infection of anal fissures
  • sexually transmitted infections
  • inflammatory bowel disease
• Hemorrhoids: inflamed and swollen veins which may be inside the anus or rectum or around the anal opening.
• Polyps: abnormal tissue growth that may be benign or precancerous.
• Proctitis: inflammation of the lining of the rectum.
• Tumors or cancer: less common than colon cancer and may warrant further investigation of the colon.
• Foreign objects in the anorectal canal: more invasive methods may be required if not removable via anoscopy.

An anoscopy is a minor outpatient procedure performed by a doctor to evaluate conditions of the anus and rectum.

Preparation

• The patient must empty the bladder and bowel, if necessary, with a laxative or enema.
• No colon cleansing or diet restriction is required.

Procedure

• The patients typically lie on their side in a fetal position with knees drawn to the chest or may kneel and bend forward.
• The doctor inserts an analgesic jelly in the anal canal about 10 minutes before the procedure.
• The doctor first visually inspects the anal area.
• The doctor makes a digital rectal examination by inserting a finger to ensure there is no mass or obstruction that can be injured by the insertion of the anoscope.
• The doctor slowly inserts the lubricated anoscope while the patient bears down like pushing for a bowel movement.
• The doctor examines the anorectal canal through the anoscope with a light.
• The doctor may remove some tissue for biopsy.
• The doctor slowly withdraws the anoscope.
• Depending on the results the doctor will decide on further course of treatment.
• The patient will be able to leave immediately after the procedure and resume normal activities.

An anoscopy carries nearly no side effects or risks. Patients may experience 

• a slight discomfort 
• light bleeding for a short while if there are hemorrhoids
• a mild pain for a little while if any tissue was removed for biopsy