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Anoscopy: Overview, Indications, Procedure

Anoscopy is the direct visualization of the anus using a speculum. It is used to screen, diagnose, and evaluate perianal and anal problems.

OVERVIEW
Used in
● Emergency departments
● Primary care settings

RATIONALE
● To screen, diagnose, and evaluate perianal and anal problems

INDICATIONS
● Rectal or anal bleeding or unusual discharge
● Perianal or anal pain
● Hemorrhoids
● Rectal prolapse
● Digital examination that reveals a mass
● Perianal abscess and condyloma

CONTRAINDICATIONS
● Acute cardiovascular problems—may stimulate the vasovagal reaction
● Acute abdominal problems
● Unwilling patient
● Stenosis of the anal canal
◗ Informed consent required
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PROCEDURE
Anoscopy

Equipment
● Anoscope
● Light source
● Gloves—nonsterile
● Drape—nonsterile
● Water-soluble lubricant (K-Y jelly)
● Large cotton-tipped applicators—nonsterile
● Monsel’s solution—to control bleeding (ferric subsulfate)
● 4 × 4 gauze—nonsterile
● Biopsy forceps
● Container with 10% formalin

Procedure
● Position the client in the left lateral decubitus position.
● Drape the client.
● Put on gloves.
● Tell the client you are going to touch him or her by the rectum.
● Spread the gluteal fold and examine visually.
● Have the client bear down and observe for hemorrhoids or prolapse.
● Lubricate your second digit with K-Y jelly and perform a digital examination.
● Lubricate the anoscope with K-Y jelly.
● Have the client take slow, deep breaths to relax the sphincter.
● Insert the anoscope slowly and gently into the anus toward the umbilicus.
● Remove the obturator.
● Visualize the rectal mucosa, noting the vasculature, pectinate line, transitional zone, and drainage.
● Remove fecal matter and drainage with a large cotton swab if necessary.
● Obtain a biopsy specimen if needed using the biopsy forceps. Place the tissue specimen in a container with 10% formalin.
● If bleeding is present, apply Monsel’s solution and pressure.
● Remove anoscope gently, and observe the mucosa for any injury.

Client Instructions
● Slight bleeding is normal after this procedure because of the possibility of an abrasion, tearing of the mucosa or anus, or hemorrhoids.
● If slight bleeding persists for more than 2 days, notify your health-care provider.
● To decrease pain and swelling, sit in a tub of warm water for 10 to 15 minutes three times per day.

BIBLIOGRAPHY
Pfenninger JL, Fowler GC. Procedures for Primary Care Physicians. St. Louis, MO: Mosby;
2011.

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