Anoscopy

Anoscopy is performed easily in the office to evaluate and treat many anorectal conditions. Scopes can be 7 to 10 cm long and 2 to 3 cm wide and range from a slotted or beveled metal version to a disposable plastic tubular version. The tubular version can be used for diagnosis, whereas the slotted style allows for ease in treating most anorectal conditions.

For a thorough examination, the patient can be placed in a comfortable lateral decubitus position with hips flexed. The examiner may require nonpermeable protective clothing and eyewear. The anal tissues should be examined for tags, hemorrhoids, fissures, dermatitis, condylomata, and masses. A digital rectal examination should precede anoscopy to assess for internal pain or mass.

During examination the thumb can be pressed against the internal index finger to determine tenderness, induration, or abscess formation in the perianal tissues in all quadrants. The lubricated anoscope with obturator is introduced fully into the anal canal with gentle, constant pressure. Once fully inserted, the obturator is removed and the anorectal mucosa visualized through 360 degrees during gradual withdrawal. Adequate lighting is essential. Valsalva maneuver may distend vascular lesions for ease in visibility. Anal Pap smears can be obtained if warranted for anorectal cancer concerns and biopsies performed using a Kevorkian or Tischler biopsy forceps. Hemostasis is obtained using silver nitrate sticks. (See Tuggy Video: Anoscopy.)

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