How to Use an Anoscope: Anoscopy & Rectal Exam Guidelines

Does the thought of examining your patients' rectums leave your head spinning? I understand: The thought of performing your first anoscopy can be rather intimidating. However, the procedure is actually quite simple, and I'm here to help you through it.

So take a deep breath and gather your supplies. Ahead, you'll learn what you need for this exam, and I'll walk you step by step through how to use an anoscope.

Before you know it, you'll be ready to perform this procedure on your own, and all qualms about conducting anal exams will have faded from memory. But first, read on to become an expert at using an anoscope.

What You Will Need When Using an Anoscope

This is a procedure that is usually performed on an outpatient basis in a doctor's office or a hospital setting. To perform an exam on a patient, you will need the following supplies:

Anoscope

The primary tool used for this procedure is an anoscope. This two-part device is comprised of a hollow outer sheath and a solid inner obturator. The obturator has a rounded end to ease insertion. This piece is removable after insertion.

Anoscopes can be made of metal or plastic. Typically, metal anoscopes are reusable, but they must be sterilized between uses. Most plastic anoscopes are disposable.

Not only do disposable plastic anoscopes require less preparation and post-procedure cleaning, but they are also advantageous because of their clear construction. You can see through the transparent material to detect fissures or other concerns with the tissue under the scope.

Lubricant

Typically, an anoscope is about 2 inches wide, which is comparable to the width of a normal bowel movement. In other words, the body is used to accommodating an object of that size. Even still, inserting a probe from the opposite end can require some coaxing.

Therefore, it is important to generously coat the instrument with lubricant before attempting insertion. This will ease the effort required of the medical practitioner and will increase comfort for the patient. A water-based, medical-grade lubricant is recommended.

Light

To perform a careful and thorough exam, the rectal area must be fully illuminated. Practitioners have several options for this requirement. Some anoscopes have built-in lights.

Others do not come with attached lights, which gives the doctor the freedom to use the preferred light of his or her choice. A penlight or other handheld device can work well because it allows the practitioner to direct the beam precisely where it is needed. If you do not have a free hand, an assistant can hold the light.

Another option is to use a light that is mounted on your forehead.

Swabs

A rectal exam opens up the anus and the rectum so you have access to the tissue inside. Once access has been granted, you may need swabs with which to clean the passage or to examine the health of the region.

For example, long cotton swabs are useful for wiping away fecal matter or excess lubricant in the examination area. Culture swabs may be necessary if an infection is suspected.

Gloves or Other Protective Garments

The doctor and nurses involved with the procedure should dress in the appropriate protective gear to reduce the transmission of infection and to protect their clothing during the exam.

Gown and Drape

Only the patient's buttocks must be exposed during the procedure. For comfort and a sense of privacy, you can provide a gown with which the patient can cover his or her top half. Alternatively, you may choose to have the patient keep wearing his or her shirt. To cover the legs, a drape can be placed over them.

Supplies for Further Procedures

If other procedures will be done in conjunction with the exam, the medical team should also gather the necessary supplies for those steps before beginning the procedure. For example, if a tissue biopsy may be required, the doctor should come prepared with the necessary surgical tools to collect a tissue sample.

Additional supplies will vary based on the procedures that are performed in conjunction with the exam.

Step-by-Step Instructions for How to Use an Anoscope

#1 Position the Patient

Doctors have multiple options for how to position a patient for a rectal exam. One common position is the left lateral decubitus position. For this style, the patient lies on his or left side with buttocks near the edge of the examination table and knees and hips bent.

In the jackknife position, the patient is folded at the waist over an exam table, and the buttocks are elevated for easy access. See a patient receive an exam in this position in the video "Jackknife Position."

Cover the rest of the body with gowns or drapes.

#2 Lubricate the Instrument

If you are not already wearing your protective gear, put it on now before continuing with the procedure.

Then, use the water-based lubricant to generously coat the outside of the anoscope. Hold the obturator in place so that its exposed parts are coated as well.

Watch the video below closely, and you'll spot lubricant on the anoscope:

#3 Insert the Anoscope

Moving the anoscope into position is a two-handed procedure. With one hand, separate and hold the buttocks. The other hand is used for inserting the anoscope.

Ask the patient to take a deep breath and push down with the muscles used for a bowel movement. Slowly and steadily push the anoscope into the anus until it is fully inserted. Hold the obturator in place while doing this.

Although the patient may feel some discomfort, this is not generally a painful procedure. If the patient does mention pain, take note of the point at which it began. This may be an indication of a problem in the tissue at that site.

Watch the insertion process in the video below:

#4 Take Out the Obturator

Once the anoscope is fully inserted, you can remove the obturator. However, you should reinsert the obturator before each turn of the anoscope to prevent the scope from catching on any skin lesions or other imperfections in the tissue. Remove the obturator again to perform any further examination.

In the below picture of a SapiMed anoscope, notice the two pieces of the anoscope. The outer sheath is transparent plastic. The inner obturator is white plastic

#5 Perform an Exam

With the sheath of the anoscope in place and the obturator removed, observe the rectal mucosa. An anoscope with a beveled edge will often provide the best view of the tissue. Use the light to illuminate the area.

Concerns for which to look include but are not limited to:

At this time, you may need to take a swab or perform a secondary procedure, such as obtaining a tissue sample for a biopsy.

This image from Queen's University School of Medicine shows a fissure that can be viewed through the wall of a plastic anoscope.

#6 Remove the Anoscope

Most exams with an anoscope take only a few minutes. Once your exam is complete, you may withdraw the anoscope from the rectum.

If you do not replace the obturator before removing the anoscope, be sure to pull the instrument straight back. As a precaution, you may simply prefer to replace the obturator before removing the device. In fact, that's what the expert in the video below recommends:

Once the anoscope has been removed, finish by cleaning any lubricant or other fluids from your patient.

Ready for Your First Procedure?

Do you now feel more fully prepared to perform an exam on a patient's anus and rectum? Although you may feel uncomfortable at first, I hope that you will soon find that the procedure is quite simple and quick.

If you have any questions about how to use an anoscope, please leave a comment below. Also, after you try this procedure the first time, let me know how it goes.

Please share this piece with your medical friends so they, too, can perform an anal exam with confidence.