High Resolution Anoscopy (HRA)

HRA is an office procedure to examine your anal canal under magnification to look for any areas of dysplasia or abnormal cell growth.

At home preparation and instruction:

  1. No anal sex or toys 24 hours prior to the HRA.
  2. No anal douching or cleaning prior to the procedure.
  3. No anal suppositories 24 hours prior to procedure.
  4. It is important to not have sex or douche or enema so you do not cause any trauma to the surface cells we are going to examine. We want everything to look as natural as possible.

HRA procedure

  1. You will rest comfortably on your left side in a fetal position on the exam table.
  2. A digital rectal exam will be performed using a special numbing gel while feeling for any lumps or bumps.
  3. A clear plastic scope called an anoscope will be inserted a few inches.
  4. A vinegar soaked gauze swab will be inserted into your bottom through the anoscope.
  5. The anoscope will be removed and the vinegar soaked gauze will stay inside for 2 minutes.
  6. The vinegar soaked gauze may be a little irritating, which is caused from the vinegar.
  7. After two minutes, the vinegar soaked gauze is removed and the anoscope will be reinserted.
  8. The microscope is then positioned so the anal canal lining is magnified using a surgical microscope.
  9. You will feel a brushing sensation as more vinegar and iodine is applied with a small cotton swab.
  10. The vinegar and iodine help define abnormal cells or lesions so that biopsies can be taken.
  11. If a biopsy (small sample of tissue) is taken, you usually will not feel it. Most biopsies are taken from the area where the outside skin meets the inside rectal skin and there aren’t many nerve endings. You may feel a small pinch or a tug but most people do not feel anything.
  12. After the entire internal anal canal is examined, the anoscope is removed.
  13. Next, the skin around the anal opening (perianal) needs to be examined. A vinegar soaked piece of gauze is tucked next to the opening and left to soak for a minute.
  14. After a minute, the perianal skin will be examined under magnification with the surgical microscope. If any abnormal skin lesions are seen, the lesion will be numbed with an injection and then biopsied.

After HRA Instructions:

  1. Try not to have a bowel movement for an hour after the HRA. Sometimes the anoscope can give you a feeling that you need to go but if you can hold it for an hour, it will give the biopsy site a chance to clot off and not bleed. The biopsy site usually stops bleeding fast because it is very small, about the size of a sesame see.
  2. You will have some blood with your first bowel movement. After that, you will notice some spotting of blood on the toilet paper when you wipe from 2 to 7 days after the HRA. This is normal.
  3. No anal sex or toys for 5 to 7 days after the HRA if biopsies were taken.
  4. No heavy weight lifting on the day of the HRA.
  5. You can do sitz baths of hot water as often as needed if you are having anal spasm or discomfort.
  6. You can take ibuprofen or naproxen or Tylenol if needed if having discomfort.