The HRA appointment is generally scheduled for about 30 minutes. Most people usually only have mild discomfort, if any, after the procedure. Most patients go back to work ortheir normal activity afterwards. Significant risks, such as bleeding or infection, are extremely rare.

An HRA is very different from a colonoscopy or flexible sigmoidoscopy, neither of which can adequately examine the anal canal for the problems being detected by HRA. No bowel prep is needed for an HRA examination.

Persons at high-risk for anal cancer probably need an HRA. If you have been referred for an HRA, it may be because your anal pap and/or high-risk HPV tests were abnormal. While this can mean a number of things, it needs to be determined if you have anal precancer so it can be treated.

The anus, also called the anal canal, is a short tube, about one and a half inches long, at the end of your rectum through which stool leaves

Anal dysplasia is abnormal cells or lesions in the skin lining the anal canal. Anal dysplasia can be low-grade (mild) or high-grade (moderate to severe). Some low-grade lesions may progress to high-grade lesions. High-grade lesions are very common and may progress to cancer. High-grade anal lesions are also called anal precancer.

Not all lesions worsen. Some can remain without any changes and some may even disappear on their own. Anal dysplasia occurs mainly in two places: inside the anal canal and in the skin of the perianus.

Anal dysplasia is caused by the human papillomavirus (HPV).

Some HPV infections will go away on their own within two years. In some cases, the infection does not go away and is then called chronic or persistent. Chronic infection with high-risk HPV may cause anal precancer and could eventually cause anal cancer.

There are no specific symptoms of HPV or anal precancer. The following symptoms can be from anal precancer or cancer, but can also be caused by other common conditions including anal infections, anal trauma, hemorrhoids, and warts.

Bleeding from the anus or rectum

✓ Feeling a lump or mass at the anal opening

✓ Pain or pressure in the area around the anus

✓ Itching or discharge from the anus

✓ Change in bowl habits or increased straining during bowel movement

✓ Swollen lymph nodes (glands) in the anal or groin areas

Regular medical check-ups to review any anal symptoms and perform digital anal rectal exams (DARE) by your health care provider will help detect anal cancers but not anal precancer. Anal Pap smears and anal high-risk HPV tests can help detect abnormalities but not be able to identify anal precancer.

High Resolution (HR) Anoscopists perform HRA to identify anal precancer. HRA examines the anal canal and perianus under magnification with a microscope and uses topical solutions to make anal precancer more visible. People at high risk for anal cancer will need to have ongoing evaluation, treatment and follow up for the rest of their lives to prevent the development of anal cancer as they age.

History – Your provider will ask you about how you are doing, your health habits, past illnesses, medications, treatments and any anal symptoms you may be having.

DARE – The provider will do an exam of the anus and rectum by inserting a lubricated, gloved finer into the anus and lower part of the rectum to feel for lumps, pain or anything that seems unusual.

Anal Pap (Cytology) Test / High-risk HPV Test – A moist Q-Tip swab is passed into the anal canal to collect cells to be observed under a microscope. This procedure helps to check for abnormal cells in the anus and high-risk HPV subtypes. It takes about 15-30 seconds to perform and and causes minimal discomfort.

There is no prep for the HRA. You have your normal daily bowel movement and then come to the appointment as you are. Do NOT use an anal douche, enemas or creams. Do NOT have receptive anal sex 24 hours prior to your appointment.

If an abnormal area is seen, the HR Anoscopist will obtain a small biopsy about the size of a sesame seed and send it the pathologist at a local lab to check for signs of anal precancer or cancer.

If you have a biopsy during your HRA, the biopsy site will need a day or two to heal.

The biopsies are small and heal very fast. To prevent infection or bleeding do the following after your biopsy:

✓ Avoid inserting anything into the anus (no anal sex, fingers, toys, or suppositories) for a few days.

✓ Soaking in warm bath water can help reduce discomfort, especially after bowel movements, though there will be minimal to no discomfort.

✓ Drinking more water can help prevent constipation.