Proctoscopy (synonyms: anoscopy, anal canaloscopy, rectoscopy) is an invasive endoscopic method for examining the canalis analis (anal canal) and, moreover, the lower portion of the rectum. With the help of proctoscopy it is possible to diagnose proctological diseases such as fissures (tear of the mucous membrane in the area of the anus), hemorrhoids but also oncological diseases (cancer).
Indications (areas of application)
- Anitis (synonym: anal symptom complex) – includes various inflammatory diseases in the anal region; often occurs in conjunction with hemorrhoids.
- Hemorrhoidal disease
- Cryptitis (synonyms: rectal cryptitis, anal cryptitis) – inflammation in the rectal area; inflammation in this area is often combined with papillitis and can lead to anal fistulas and anal abscesses.
- Papillitis (inflammatory reaction of the anal papillae) – papillitis is often the cause of connective tissue proliferation (fibrosis), which can lead to anal fibroma (cat’s tooth).
- Proctitis – inflammation of the rectal mucosa, often involving the anus; may be accompanying symptoms of other intestinal diseases such as ulcerative colitis or Crohn’s disease.
- Periproctitis – inflammation of the surrounding connective tissue of the rectum (rectum) and anus (periproctium); it often finds its origin in cryptitis, but also by chronic intestinal diseases or after trauma (injury). The consequence of periproctitis is often periproctitic abscesses.
- Polyps – benign mucosal growths that protrude into the cavity of the intestine.
- Tumors
Contraindications
- The performance of the examination is mainly dependent on the patient’s bleeding tendency. Unstoppable hemorrhage can be life-threatening in patients with too low a Quick value (the patient’s bleeding tendency).
The procedure
Although proctoscopy is a method that can detect pathological (pathological) processes only in a very limited space, but it is an important procedure in proctology. Especially the detection of internal hemorrhoids is much more successful with this method than with a digital examination of the rectum (rectum) – the doctor performs a palpation examination with the help of his (gloved) finger) – or a colonoscopy (colonoscopy – examination of the large intestine). This detection is made possible by the fact that a proctoscope has an anterior opening with which the hemorrhoids can be moved into the interior of the proctoscope so that they become visible. In order to ensure an accurate assessment of the proctological disease, each proctoscope is equipped with a so-called cold light lamp to provide sufficient illumination. Due to the easy detection of hemorrhoids and the high incidence of this disease in the population, this procedure should be performed during every proctological examination. To the procedure of proctoscopy:
- The actual examination does not require the administration of cleaning solutions or clysma fluid.
- After a comprehensive explanation is given, the patient assumes the left lateral position. The course of the proctological examination takes place without the administration of a sedating drug.
- Similar to rectoscopy, the proctoscope is inserted into the anus using a lubricant. The examiner inserts the thumb into the patient’s anus (anus), preventing contraction of the sphincter ani externus (external sphincter) muscle from pushing the proctoscope back out. To further relax the muscle, the doctor also dwells on the anus with the proctoscope for a few seconds.
- Following this, the examiner can now view the mucosa of the anal canal and, if necessary, detect a hemorrhoid or a low-seated rectal tumor.
- If the patient complains of pain when inserting the proctoscope, this may indicate a possible fissure (tear in the mucosa of the anus).
Possible complications
- Although proctoscopy is a very low-risk procedure, bleeding can occur, as with any endoscopic examination. In very rare cases, perforation (rupture) of the wall may also occur.
- Since even hemorrhages are relatively rare, they may indicate a tumor or an inflammatory process, as there is pre-damage to the wall structure.
With the help of proctoscopy, which has few complications, there is the possibility of identifying tumors and possible precursors early in the anorectal area, so that treatment can be completed. Furthermore, this procedure is the most accurate method for detecting hemorrhoids. As part of the examination, simultaneous treatment of hemorrhoids by, for example, sclerotherapy (sclerotherapy) is also possible.
