Proctoscopy

A proctoscopy is a safe procedure performed by a doctor with almost no complications. It entails the visual examination of the anal cavity and rectum using an instrument called a proctoscope. This is a short (25cm) hollow metal or plastic tube.

The anus is the opening of the intestine that leads out of the body. The rectum is the 20cm muscular tube that connects the anus to the colon or large intestine (bowel).

Reasons for doing a proctoscopy

A proctoscopy may be performed for the detection of disease of the rectum or anus, or to look for causes of rectal bleeding (for instance, haemorrhoids). It may also be done to monitor the growth of polyps or to check for rectal or anal cancers. Polyps are growths of tissue that can range in size from the tip of a pen to several centimetres. Most polyps are benign but can become cancerous if allowed to grow for a long time.

Preparation

Usually no preparation is needed. You may be asked to take an enema before the procedure. This is medication inserted via the rectum to clean the bowel, and which makes it easier for the doctor to see clearly when performing the proctoscopy.

Patients who take chronic medication for diabetes, heart or lung disease, hypertension or any other medical condition must continue taking them as prescribed. In the case of blood-thinning medication (for instance, warfarin), patients should consult their physician about stopped this, as it increases the risks of bleeding.

Procedure

A proctoscopy is usually done in a doctor's examination room and no anaesthesia is required (it can be done in theatre under sedation). During the procedure (without anaesthesia) the doctor will continuously explain what is being done. If at any stage you feel severe pain or discomfort, you must inform your doctor.

The patient will be asked to remove their clothing below the waist. They will lie down on their left side with their back facing the doctor and will pull up their knees towards their chest.

The procedure will start with a careful examination of the area around the anus, looking for any abnormalities. The doctor will then carefully insert a gloved and lubricated finger into your anus to check for any palpable masses or tenderness. After this the lubricated proctoscope will be inserted into the anus and rectum.

To get a better view, air may be injected through the proctoscope.

Both these latter steps could induce discomfort.

The doctor will now start to look for any abnormalities (like polyps, or haemorrhoids). If any occur, the doctor may need to remove or take a sample of tissue (called a biopsy) for further testing. It usually does not hurt when a biopsy is taken from the rectum. While the proctoscope is slowly pulled back and outwards, the doctor will continue to examine the inside of the rectum and anus for any other abnormalities.

The whole procedure usually lasts less than 15 minutes.

After the procedure

If air was used to optimise the examination, it is normal to feel the need to pass gas.

If there was no sedation, the patient may go home immediately; patients who were sedated will be observed to make sure the sedative wears off. For the latter patient it is also advised that somebody take/drive them home.

A normal diet can be continued after this procedure.

If no abnormalities were found, no follow-up visit will be necessary. Where a biopsy was taken, results will take approximately 1-2 weeks to be processed, with a subsequent visit to discuss them.

Complications

This is a safe procedure, with almost no complications. Bleeding may occur from biopsies or polyps, but is minimal and stops quickly. If rectal bleeding persists, the patient must report this immediately.

Adverse reactions to the sedative may occur, but is rare.