View source for Anoscopy

==Overview==
*The use of an anoscope to visually inspect the anus, anal canal, and internal sphincter
*Helpful in identifying causes of rectal bleeding
**Up to 50% of rectal bleeding is falsely attributed to hemorrhoids when internal examination is not used<ref>Gudur A, Shanmuganandamurthy D, Szep Z, Poggio JL. An Update on the Current Role of High Resolution Anoscopy in Patients With Anal Dysplasia. Anticancer Res. 2019 Jan;39(1):17-23.</ref>

==Indications==
*Evaluation of bright red bleeding
*Evaluation anorectal symptoms (anal pain, discharge, protrusions, or pruritus)
*Evaluation/treatment of rectal foreign bodies

==Contraindications==
===Absolute Contraindications===
*Imperforate anus
*Bowel Perforation
*Significant active bleeding
===Relative Contraindications===
*Severe anal pain
*Recent anal surgery

==Equipment Needed==
*Gloves
*Anoscope (Reusable or disposable)
**Adults: 7-cm (typically 19-mm diameter) anoscope; slotted or non-slotted
**Pediatrics: 8-mm to 14-mm diameter
*Light source (often built into disposable anoscopes)
*Lubricating jelly (and topical anesthetic jelly if patient has severe anal pain)
*Cotton swabs
*If needed:
**Fecal occult blood test 
**Culture tube and swab 
**Biopsy forceps
[[File:Anoscopic Exam Photo.jpg|thumb|Use of anoscope for internal inspection of the lower rectum]]

==Procedure==
*Position the patient (lithotomy position or left lateral decubitus w/ knees flexed toward chest)
*Pull buttock apart, inspect the external area
*Perform digital rectal exam with lubricated, gloved finger (use topical anesthetic jelly if needed and wait 1-2 minutes prior to anoscopy)
*Lubricate the anoscope and the central guide plug (obturator)
*Slowly insert the anoscope fully, maintaining pressure on the obturator.
**If obturator slips or falls out during insertion, remove anoscope completely and repeat procedure
*Once inserted, remove the obturator (keep it nearby if needed again)
*Slowly withdraw, rotate (if non-slotted anoscope), and visual the entire circumference of the canal
*Perform any biopsies (if above dentate line) or cultures as needed

==Complications==
*Tearing of perianal skin/mucosa
*Abrasion or tearing of hemorrhoidal tissue
*Infection (rare)<ref>London S, Hoilat GJ, Tichauer MB. Anoscopy. [Updated 2021 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459324/</ref>

==See Also==
*[[Rectal Foreign Body]]
*[[Anorectal Disorders]]

==External Links==
*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/how-to-do-gastrointestinal-procedures/how-to-do-anoscopy?query=anoscopy Merk Manual - How To Do Anoscopy]
*[https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=88 Emergency Medicine News - The Anoscope for Foreign Bodies in the Rectum]

===Videos===
*{{#widget:YouTube|id=DraK34z4lFk}}

==References==
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[[Category:Procedures]]