What is anoscopy and how is this procedure performed?

Anoscopy is a diagnostic technique that is widely used in proctology and allows you to assess the condition of the rectum, identify pathological changes at a distance of 12 cm from the anus (size and location of hemorrhoids, neoplasms, inflammatory processes and bleeding), as well as take a smear or material for histological examination. research.

Anoscopy can also be used for therapeutic purposes: for the administration of medications, physiotherapy, coagulation of hemorrhoids, etc.

Preparation for the procedure

Although the procedure is quite easy, you must undergo special preparation before anoscopy:

• Diet restriction. During the diagnosis, the intestines must be emptied, so the day before the test, the patient should not eat anything for 12 hours before the test. This rule must be strictly observed, since if the digestive system is not completely emptied, the study may be uninformative. The patient will have to perform the unpleasant procedure again.
• Purgation. In the evening before the procedure, you need to perform a cleansing enema. The second time it must be completed a few hours before the test. If the patient is in serious condition and it will be difficult for him to tolerate enemas, you can use a strong laxative, for example, the drug Fortrans. The drug is administered into the body 4 times with an interval of 15 minutes. For each appointment, the patient is given 500 ml of solution, the total volume of the laxative is 2 liters. This procedure allows you to cleanse the intestines of feces without the use of enemas.

Preparatory stage

In order for the procedure to take place as quickly as possible, it is necessary to understand exactly how to prepare for the examination. The preparatory stage begins with a preliminary initial examination, during which the proctologist fills out a medical card to find out the characteristics of the disease.

This takes into account the duration of the disease, symptoms, and hereditary predisposition. Only after this the specialist issues a referral for anoscopy, and also explains what it is.

In order for the proctologist to properly assess the health of the anus, it will be necessary to clean the ampoule and distal rectum from accumulated feces and mucus. Preparation begins in the evening, when a person copes with natural bowel movements. After it, it is recommended to do a cleansing enema.

For this, two liters of water at room temperature is enough. In this case, the cleaning procedure using an enema should be repeated the next day approximately a couple of hours before the scheduled visit.

Here it is important to take into account the correctness of the cleansing measures, since not all ordinary people know how such an intervention is carried out. If the patient is in an inpatient department of a hospital, or does not have the necessary skills, then it would be safer to seek qualified help from a medical professional.

The reason that can complicate the administration of an enema is often an extensive inflammatory process associated with the formation of hemorrhoids. Even knowing how professionals perform the manipulation will not help here, because with an anal fissure and bleeding it will be too painful to insert an enema cannula.

In this situation, it is more effective to use ready-made pharmaceutical products aimed at releasing feces and mucus naturally. Moreover, it is better to look for suitable pharmacological agents not through a forum or blogs, but to clarify the list of approved medications in advance with the treating expert.

The problem with the victim’s initiative is that some believe that the drugs to improve anoscopy are the same ones that are required for intestinal diagnostics. But they differ significantly in their spectrum of action.

To simplify the diagnostician’s work, you need to start following a certain diet at home a couple of days before the scheduled visit. It involves avoiding foods that cause severe gas formation. Such products include cabbage, fatty meat, fresh bread, apples, kvass, and carbonated drinks. Moreover, on the day of administration, a light meal is allowed.

Procedure

1. The patient is placed in a position in which it is convenient to examine the anal area: either lies on his side with his legs drawn to his stomach, or sits in a gynecological chair.
2. The doctor conducts a preliminary digital examination of the rectal area to assess the patient’s readiness for the procedure and to detect contraindications to the examination from the rectum.
3. After a digital examination, an anoscope, an endoscopic device that has lighting and optical technology, is inserted into the rectum through the anus.
4. The device moves inward using slow circular movements to a depth of approximately 8 cm.
5. The obturator is removed from the anoscope, after which a sequential examination of the intestinal mucosa is carried out.

During the manipulation, the doctor can assess the condition of the rectum and anal canal, detect pathological changes in their walls (hemorrhoids, neoplasms, inflammatory processes).

When the anoscope is inserted, the patient does not feel severe pain; only slight discomfort is felt when the device is inserted through the anus. Therefore, the procedure does not require the use of local anesthesia.

Description of the procedure

Anoscopy is a relatively simple and painless procedure that is performed after a classic digital rectal examination. The patient can take a knee-elbow position or lie on his back on a gynecological chair. Next, the anoscope, which visually resembles a gynecological speculum in shape and size, is lubricated with glycerin and carefully inserted into the anus, expanding the lumen for proctological examination. As a rule, this procedure does not cause significant discomfort to the patient, and gives the specialist the opportunity to examine the location of hemorrhoids and polyps of the anal canal, as well as evaluate their qualitative characteristics. Proctologists at the NEOMED clinic have extensive experience in performing anoscopy, which makes the procedure safe and painless for the patient.

Contraindications

• acute inflammatory diseases in the rectal area (purulent paraproctitis, Crohn's disease);
• complicated hemorrhoids and accompanying vascular disorders (thrombosis of hemorrhoidal veins);
• stenosing neoplasms of the rectum and anal canal;
• thermal or chemical burns of the mucous membrane of high severity (III and IV);
• anal fissures with acute course;
• tumors in the anal area.

The group of contraindications also includes systemic diseases in which the patient is in serious condition. These are acute infections with severe fever, pathologies of the heart and blood vessels, and pulmonary disorders.

All of the above indications are relative. In case of emergency, when there is a serious risk to the patient’s health, anoscopy can be performed even if there are contraindications.

Rectoscopy (sigmoidoscopy)

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How to prepare for a consultation with a proctologist

If you try to compile the TOP 10 reasons why potential patients do not rush to the proctologist’s office, the need to undergo a rectoscopy will definitely be there, not in the top three, of course, but not in last place, somewhere between the fear of hemorrhoidectomy and colonoscopy, and reluctance to undergo complicated preparation for inspection. At an in-person consultation, when after a preliminary conversation you invite a person for an examination, many patients ask the standard question “will you look at me with this terrible iron tube?” On the pages of our website, we try to prepare potential patients as much as possible for a meeting with our doctors. Unfortunately, it is unrealistic to turn a consultation with a proctologist into one sheer pleasure, but at the same time, many of the patients’ fears are completely unfounded, which is what we try to talk about in each of our articles, in particular “Consultation with a proctologist” and “Anoscopy”. Continuing the topic, this page provides complete and objective information about rectoscopy, which is an optional but not uncommon part of a proctologist’s examination.

What is rectoscopy (sigmoidoscopy)?

Rectoscopy (sigmoidoscopy) is a method of endoscopic (visual) examination of the rectum, the length of which is about 16 cm. Accordingly, according to the standard, when conducting this study, it is necessary to examine at least 16 centimeters of the digestive tube. In the absence of pain, anatomical features of the intestine that prevent inspection, and sufficient preparation, the equipment allows you to examine up to 30 cm, i.e. not only the rectum, but also the terminal part of the sigmoid colon.

How is rectoscopy (sigmoidoscopy) performed?

As with any endoscopic examination, rectoscopy requires a special device, in this case a rectoscope (see photo), which, in essence, is a rigid (as opposed to a flexible colonoscope) hollow cylinder that allows us to visually examine the area of ​​​​the digestive tract that interests us tubes. There are several options for its design: reusable and disposable, plastic and metal, of different diameters and lengths, but in any case, the diameter of the device is very small - 18-20 mm. Patients often ask, why not make a rectoscope with an even smaller diameter? Unfortunately, the smaller the diameter of the rectoscope tube, the more difficult and less informative the examination and the higher the likelihood of complications (in particular, damage to the intestinal wall). There are children's tubes with a diameter of 12-15 mm, which are always included in the standard set for rectoscopy, but when examining adult patients they are used only in exceptional cases: with strictures (narrowings) of the rectum and anal canal, a very “complex” psychological status of the patient, etc. .d.

In many commercial clinics, it is customary to perform rectoscopy with the patient in the left lateral position (according to Simps), mainly because this is considered more emotionally comfortable for the patient. Based on my clinical practice, I can definitely say that this is the wrong approach to the issue. The rectum, despite its name (anatomists are generally people with a very rich imagination), is not even straight, and has several pronounced physiological bends, while being quite closely connected with the final part of the spine. Therefore, when the patient is in a position on his knees and elbows and arches the lower back, the curves are smoothed out, making the procedure much simpler and more informative for the doctor and less painful and dangerous for the patient. In all my personal experiments with rectoscopy on the left side, I was able to “creakly” see up to 14-15 cm, no more. You can, of course, blame natural crookedness, but in domestic clinical recommendations, the opinion of the group of experts who composed them completely coincides with mine - for sigmoidoscopy, the patient’s knee-elbow position is clearly recommended. In addition, patients consistently come to our Coloproctology Center, at least 1-2 times a year, who, after supposedly undergoing rectoscopy, are treated for “hemorrhoids” for six months or a year, and we find tumors at a height of 12-15 cm, and of this size that it is simply impossible not to notice them with a properly performed rectoscopy. The last such case was just a couple of months ago.

In our medical office, before the examination, the patient changes into disposable endoscopic shorts, goes to the examination chair, where he stands in the knee-elbow position. Next, the doctor inserts a rectoscope lubricated with Vaseline into the anus and, under visual control, moves it to the maximum depth. During the examination, the intestine is slightly inflated with air using a “pear” (see photo) in order to better control the intestinal lumen. All these manipulations, of course, cause moderate discomfort, both moral and physical, but the patient does not experience severe pain during the rectoscopy process . A proctologist’s office is not a Gestapo department (many patients think of us that way ), so the doctor focuses on the patient’s feelings, and if the discomfort increases significantly, further insertion of the device is immediately stopped. Next, the doctor slowly removes the rectoscope tube, examining the walls of the intestine and anal canal.

The whole procedure takes no more than 3-5 minutes. Among the additional procedures that may be required during rectoscopy, it is worth mentioning a biopsy, i.e. sampling of a section of tissue for further morphological examination, and electrical excision (removal) of small colon polyps. Both procedures slightly lengthen the examination time, but are also very painless.

Indications for rectoscopy (sigmoidoscopy)

To diagnose all “minor” proctological ailments (hemorrhoids, anal fissures, rectal fistulas, anal canal condylomas, etc.), anoscopy is sufficient. Colonoscopy is used for a comprehensive examination of the entire colon. Discussion about why rectoscopy is needed arises both in the process of communicating with patients and even in the medical community.

The reasons for the widespread use of rectoscopy are in the economic and (in some sense) psychological planes. About the economy: a colonoscope and a sigmoidoscope (the latter is closest in capabilities to a rectoscope) are much more complex and expensive endoscopic devices, and require much more complex, time-consuming and expensive sterilization. Therefore, it is simply not economically feasible to have five such devices in order to “quickly” examine everyone in need during the consultation process. In addition, these studies can only be carried out by certified endoscopists; surgeons do not have this opportunity.

About psychology: yes, of course, colonoscopy completely covers all the diagnostic capabilities of rectoscopy, but at the same time it is a more complicated, more painful procedure that requires much more careful and tedious preparation, which patients agree to very reluctantly. When there is a reason to examine the intestine more deeply, a person should be referred to an endoscopist for a colonoscopy, and although all patients nod in agreement, imitating wild enthusiasm, practice shows that less than 50% actually complete this path. Rectoscopy can be carried out immediately, which significantly reduces the number of refusals - looking into the eyes of the doctor who has just been rubbing in you for an hour about how and why it is so important to undergo an examination, it is much more difficult to “jump off”. Yes, of course, rectoscopy allows you to examine only the rectum, but every experienced specialist can give at least a dozen or two examples where such an early diagnosis definitely saved the patient’s life, allowing treatment of a rectal tumor to begin at the earliest possible stage.

In our medical office, we strongly suggest that all patients over 40 years of age undergo proctoscopy, regardless of complaints (cancer prevention). For younger patients, this study is offered only if certain symptoms are present: bleeding, mucus or pus in the stool, difficulty defecating, etc.

Contraindications to rectoscopy (sigmoidoscopy)

The main reason for temporarily refusing to perform rectoscopy is only severe pain. In this case, you can either prescribe treatment and reschedule the procedure for a second appointment, or carry it out with local anesthesia, which is most often used gels with lidocaine (for example, Cathegel). The presence of a scar stricture (narrowing) of the anal canal is also a contraindication to the study, because it may simply be physically impossible to carry out it.

Preparation for rectoscopy (sigmoidoscopy)

With the advent of ready-made microenemas for self-preparation, this process has become significantly simpler and absolutely standard for all manipulations performed by a coloproctologist, with the exception of colonoscopy. More details on this issue can be found on the “Preparation for Inspection” page.

Complications after rectoscopy (sigmoidoscopy)

If in the article about anoscopy we wrote that complications are completely excluded, then with rectoscopy everything is a little less rosy. The device is rigid, inserted deep enough, and rotated to pass physiological curves, so there is a chance of damaging the intestinal wall, up to its complete rupture. But this complication is extremely rare: in all my clinical practice, I have personally seen only one such case (I hasten to note that rectoscopy was not performed in our institution). If the study is carried out carefully, in constant contact with the patient and focusing on his sensations, the likelihood of damage to the intestinal wall is almost zero.

Thus, characterizing rectoscopy, one can recall the bearded Soviet joke: “well, horror, but not horror-horror.” This is a slightly humiliating procedure for a person, but a quick and painless procedure with fairly simple and quick preparation. In conclusion, it’s probably worth mentioning another patient phobia: are such devices processed well enough? In the description and photographs we were talking about reusable rectoscopes, since disposable tubes have become very expensive in recent years, and their cost reaches 75% of the average market cost of the procedure itself. Naturally, they are processed well (using the chemical disinfection method), but for those who are still bothered by this issue, our office offers examination with a disposable rectoscope from SapiMed, although you will have to pay additionally for the cost of the device.

Sincerely, Anatoly Ivanovich Nedozimovany, associate professor of the course of coloproctology at Pavlov State Medical University of St. Petersburg.

Differences between anoscopy and sigmoidoscopy

Both anoscopy and sigmoidoscopy are used to diagnose diseases of the rectum. However, the power of these studies varies. Anoscopy measures only 8-12 centimeters of the anal canal. This segment includes the anorectal region, where hemorrhoids are most often found. But damage to the rectum can also be at a higher level. In this case, the diagnostic capabilities of anoscopy to identify a pathological defect will not be enough.

If necessary, doctors conduct a more detailed examination - sigmoidoscopy. It allows you to assess the condition of the rectal mucosa over 20-25 centimeters. A deeper examination can reveal additional complications of the disease, for example, the source of bleeding from the intestines.

The study plays an important role in the diagnosis of rectal cancer, which is often located in the colorectal area. Using sigmoidoscopy, you can detect anal fissures that are located quite high. Early detection of these defects is very important, since correct and timely treatment allows you to get rid of them with the help of medications, while advanced cases require surgical intervention. The study is carried out if thrombosis of hemorrhoids is suspected, especially in the presence of internal hemorrhoids.

In general, sigmoidoscopy and anoscopy differ in the scope of diagnostic capabilities. Anoscopy is usually used as a method of primary diagnosis of hemorrhoids. Sigmoidoscopy is a more advanced procedure, so it is used to detail data and clarify the diagnosis.

Indications for use

An anoscopy examination is prescribed to confirm/exclude pathology when:

• Constipation or disorders for a long time;
• Mucous and purulent discharge;
• Presence of traces of blood after defecation;
• Suspicions of malignant and benign formations;
• Inflammation in the anal area;
• Prolapse of hemorrhoids;
• Painful sensations during bowel movements;
• The appearance of discomfort (burning, itching, etc.).

Advantages of using anoscopy

Most patients prescribed this procedure ask the question: “Anoscopy – does it hurt?” Visual examination of the surface of the rectum and colon in our medical center is absolutely painless. UNION CLINIC has the most modern endoscopic equipment, which is equipped with various adapters that allow you to select any suitable type of illumination of the work area for a more detailed examination. In addition, the extensive experience of our medical center’s specialists ensures absolute safety and maximum information content of the procedure.

Also among the advantages of anoscopy, it is worth noting the absence of any special preliminary preparation for the study. You only need to cleanse the intestines with an enema of up to 2 liters.

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Contraindications and restrictions

It is impossible to perform anoscopy in cases where there is a narrowing of the lumen of the rectum, anus, as well as in cases of acute anal fissure, combined with sphincter spasm.

Relative contraindications include acute inflammation - proctitis, paraproctitis, as well as thrombosis of the hemorrhoid, fissures without sphincter spasm, fresh burns. In this case, the appropriateness of the examination is determined by the doctor individually.

It is important to note that repeated anal bleeding is not a contraindication, since it is during such an examination that it is often possible to detect the source of bleeding and simultaneously coagulate the vessels. In this case, the doctor will perform the procedure with all precautions so as not to aggravate the situation.

Equipment

Sigmoidoscopy is performed using special endoscopic devices - sigmoidoscopes (rectoscopes). A modern rectoscope includes a set of hollow tubes of various diameters and lengths, obturators for them and certain other instruments (for example, a telescopic magnifier or optical tube). Lighting is typically provided from a tabletop illuminator using a fiber-optic lighting cable or fiber light guide located inside the tube along its entire length or sometimes only in its proximal part. Rectoscopes with illumination from a miniature incandescent lamp mounted inside the tube at its distal end are also used. Among them, rectoscopes from the Leningrad Production Association (LPO) “Krasnogvardeets” (model 185, intended for adults, and model 170, for children) have become widespread.

Since 1973, LPO "Krasnogvardeets" has been producing rectoscopes with optical fibers, developed at the All-Union Research Institute of Medical Instrumentation, including two models of rectoscopes for adults - Re-VS-3 (large set) and Re-VS-3-1 ( small set) and two models of children's rectoscopes - Re-VS-5 (large set) and Re-VS-5-1 (small set). Rectoscopes are equipped with illuminators for equipment with optical fibers, for example, type OS-100.

Rice. 1. Rectoscope with fiber light guide Re-VS-3: 1 — tube; 2 — eyepiece; 3 — fiber light guide; 4 - light source.

Each tube contains a fiberglass light guide. The set of the Re-VS-3 device (Fig. 1) includes rectoscopic tubes 11, 20, 25 and 30 cm long, dia. 15, 20 mm, as well as proctoscope and anoscope. The Re-VS-5 rectoscope is equipped with tubes 15, 20, 25 and 20 cm long, dia. respectively 10, 15, 20 and 20 mm. All components and units of rectoscopes are unified. Each tube has an obturator. The kit includes a nozzle, a protective cover, a telescopic magnifier, a handle for holding tubes, collet-type cotton holders, a rubber balloon and a set of biopsy forceps - serrated and spoon-shaped. For photography through rectoscopes, a device is produced consisting of an optical tube for photocopying and a photo attachment for endoscopes.

Rice. 2. RMS-1 rectomicroscope: 1 - light source for inspection; 2 - light source for photography; 3 - tube; 4 — docking device for connecting a camera; 5 — camera; 6 - fiber light guide.

A type of rectoscope is a rectomicroscope (Fig. 2), which is used for intravital examination of the rectum and adjacent areas of the sigmoid colon using a contact method at high magnification (up to 220 X) for the purpose of diagnosing early forms of diseases.

For the study of the rectum and sigmoid colon, LPO Krasnogvardeets also produces flexible endoscopes - sigmoid colonoscopes (see Colonoscopy).

Preparation

Anoscopy requires some preparation. There are two ways to do it:

• use of local means for bowel movement: for example, microenemas 2-3 hours before the examination;
• use of a cleansing enema on the eve of the study and 2-3 hours before.

In some cases, it may be necessary to take laxatives orally; the doctor will definitely select the appropriate remedy and dosage.

Sometimes no preparation is required if the patient has natural bowel movements with complete evacuation. When anoscopy is the only planned examination method, a full breakfast is allowed, since the food bolus will not have time to reach the rectum by the time of the examination in the morning or at lunchtime. The doctor will also give detailed explanations about the diet and specific preparation methods, if necessary.

What will anoscopy show?

This diagnostic method allows you to detect many proctological diseases:

• internal hemorrhoids;
• proctitis, proctosigmoiditis;
• tumors and strictures (narrowing) of the anal canal;
• polyposis, condylomas;
• manifestations of Crohn's disease;
• rectal fistulas, fistulas;
• anal fissures.

The procedure is performed not only for diagnostic purposes, but also for the treatment of a number of diseases. For example, it is easy to administer a drug to the site of the disease, remove a polyp under the control of an anoscope, perform electrocoagulation of benign formations or infrared coagulation to treat the early stages of hemorrhoids, and perform sclerotherapy. Simultaneously with the examination, ligation of hemorrhoids, blockade to eliminate pain from fissures, and collection of material for biopsy are carried out.

Anoscopy

Anoscopy

– type of internal examination of the rectum. With it, a device that allows you to examine the surface of the rectum from the inside is inserted 12 cm inside. The device accurately determines the location of the fistula or other source of inflammation. An anoscope is used during the procedure. This is a smooth metal rod without sharp protrusions. The diameter is no more than 1 cm. For convenience, modern devices are equipped with backlighting. This makes it possible to more thoroughly analyze the condition of the mucous membrane, considering all the nuances.