Anoscopy: what happens and does it hurt

At a glance

An anoscopy is a simple, brief examination that allows a doctor to look directly at the anal canal and lower rectum. It uses a short, rigid instrument called an anoscope — essentially a small, clear tube — that provides a view of the area that cannot be achieved with a finger examination alone.

It is commonly used to evaluate hemorrhoids, fissures, and other anal conditions. The procedure takes a few minutes, does not require sedation, and is typically done in a clinic or outpatient setting.

Why it is done

An anoscopy provides direct visual access to:

• Internal hemorrhoids — to assess their size, grade, and whether they are bleeding
• Fissures — to see the location and extent of a tear
• Polyps or growths — any abnormalities in the anal canal lining
• Inflammation — signs of proctitis or other inflammatory conditions
• Sources of bleeding — to identify where rectal bleeding is coming from
• Post-procedure assessment — to check healing after treatments

It provides information that a digital rectal examination (finger exam) cannot, because the doctor can actually see the tissue rather than just feeling it.

What happens

Before the procedure

• The doctor explains what they will do and why
• They ask about current symptoms and any conditions that might affect the procedure
• Your consent is obtained
• A chaperone is offered if you would like one

Positioning

You will typically be asked to lie on your left side with knees drawn up, similar to a rectal examination. In some settings, you may be asked to kneel on the examination table.

The procedure

1. External inspection — the doctor looks at the outside area first
2. Lubrication — generous lubricant is applied to the anoscope
3. Insertion — the anoscope is gently inserted. It is a smooth, tapered instrument, typically 7 to 10 centimetres long
4. Viewing — the central component (obturator) is removed, allowing the doctor to see the anal canal lining directly
5. Assessment — the doctor examines the tissue as the anoscope is slowly withdrawn, noting any abnormalities
6. Removal — the anoscope is gently removed

The examination typically takes two to five minutes.

After the procedure

• You can get dressed immediately
• The doctor discusses their findings
• There may be very mild soreness or a feeling of needing to open the bowels — this passes quickly
• You can resume normal activities straight away
• No recovery period is needed

How it feels

People commonly describe:

• Pressure — similar to the sensation of a bowel movement
• Brief discomfort — particularly during insertion
• A stretching sensation — as the anoscope opens the anal canal
• Less painful than expected — this is the most common feedback
• Over quickly — people are often surprised by how brief it is

If you have an active condition

• Fissure — the examination may cause more discomfort. Local anaesthetic gel can sometimes be applied beforehand. Tell your doctor about the fissure so they can be as gentle as possible.
• Hemorrhoids — swollen hemorrhoids may make the insertion slightly more uncomfortable
• Recent procedure — the area may be more sensitive

Compared to other examinations

Tips for the appointment

• Breathe deeply — particularly during insertion, to help relax the area
• Bear down gently when asked — this helps the instrument pass more easily
• Speak up — if you need the doctor to pause, slow down, or stop
• Ask questions — understanding what is happening reduces anxiety
• Wear comfortable clothing — easy to remove and put back on
• It will be over quickly — reminding yourself of this can help with anticipatory anxiety