High Resolution Anoscopy (HRA)

This procedure allows for close examination and evaluation of the anal canal for any potentially precancerous lesions caused by human papillomavirus (HPV) and anal condyloma (anal warts). This is used in the treatment and surveillance of anal dysplasia and the prevention of anal cancer.

  • Using a small round plastic tube called an anoscope, the anal canal is examined with a high-resolution magnifying instrument called a colposcope
  • Application of acetic acid (vinegar) and iodine solution known as Lugols solution is applied onto the anal canal to facilitate evaluation of any abnormal tissue such as anal dysplasia
  • If indicated, an anal biopsy may be obtained. Biopsies are small samples of tissue that are evaluated on a microscope by a pathologist to confirm if there any HPV-related changes 
  • The procedure generally lasts 15 minutes and is usually well tolerated with mild to moderate discomfort
  • Significant risks such as bleeding or infection are extremely rare
  • This procedure is very different from a colonoscopy or flexible sigmoidoscopy, neither of which can adequately examine the anal canal for problems detected by HRA
  • No bowel preparation is needed for this exam

After the procedure

If biopsies have been obtained, the results will be sent to you within two weeks.

Your provider will then determine the best management plan which can include:
  • Monitoring and observation
  • Hyfrecation (ablation technique using a heated electric wand to destroy abnormal tissue, also known as electrocautery)
  • Topical therapies (Fluorouracil - 5FU, Imiquimod)
  • Referral for HRA-guided surgery with the colorectal surgery team and one of our clinicians at ANCRE

There may be some bleeding and discomfort following biopsies, especially after a bowel movement. This usually lasts a few days, but can sometimes last up to a week. 

To help relieve any pain or discomfort:
  • Take acetaminophen, ibuprofen, or naproxen as directed by your provider
  • Soak anal and pelvic area in a hot water bath or apply hot compress to your anal area for 15-20 minutes
  • Avoid constipation by drinking plenty of water and eating fiber-rich foods. A fiber supplement or stool softener is recommended in some cases.
  • Avoid aggressive wiping after bowel movements
If you develop heavy bleeding, severe pain or a fever higher than 101 degrees following biopsies or treatment, call the clinic immediately and go straight to the emergency room.