High-resolution Anoscopy (HRA) is a specialized procedure, and there are few doctors skilled in the technique. This can lead to lengthy wait times for appointments. If you cannot make it to your appointment, please let us know at least 72 hours in advance. This way we can cancel your appointment and give the time slot to another patient from the wait list. You can schedule, cancel, or reschedule your appointment by calling 332-243-0177 or by using the secure electronic patient portal MyMountSinai.

If you are anxious about your procedure or have questions, please let us know. We will make every effort to provide a comfortable experience. Some patients may benefit from taking anxiety medication 30 to 60 minutes before the exam. Your referring doctor or one of our experts can prescribe this medication, after an initial consultation.

Preparing for the Procedure

You do not have to do anything special to prepare for the procedure. You can eat, drink, and take your medications as usual. Feel free to shower in the morning, but do not douche or use enemas.

Please arrive 15 minutes prior to your appointment time so you can check in, complete any paperwork, and prepare for the procedure. If you are more than 15 minutes late, we will still try to see you, but may need to reschedule your procedure.

The Procedure

The first step to an HRA is a digital anorectal examination. This involves putting a gloved, lubricated finger into the anus to feel for any abnormalities. Then, we insert a lubricated instrument called an anoscope a few inches into the anus. You will likely feel some discomfort but it shouldn’t be painful.

Then we apply a special dye containing vinegar and iodine to the tissue. We use an operative microscope to illuminate and magnify these areas. This allows us to evaluate in minute detail whether there are abnormalities. If we need even more information, we might take a tissue sample for testing. This is usually not painful, but sometimes we need to use additional local anesthetic to make sure you remain comfortable.

After the Procedure

You will need to follow certain directions after the HRA procedure. You may feel the urge to use the bathroom. This is a normal feeling and usually caused by irritation of the anal canal, not because there is a bowel movement or stool. Please try not to move your bowels for an hour; the feeling will usually pass. If you do go to the bathroom, you may see a bit of blood. This usually improves gradually over the course of a few days. If you had a biopsy or treatment, you will feel a gauze pad at the opening of your anus. Leave it there for an hour and then throw it away.  

While we may have treated any abnormal areas, HPV can stick around in the anus and cause more issues in the future. It is important to come back for follow-up appointments, to make sure you stay healthy. We talk to you about your personal needs for future treatments or follow-ups. We usually schedule these appointments through the secure electronic patient portal MyMountSinai, so please make sure you have a current and active account.

The Healing Process

If the procedure involved treating warts and/or precancerous areas, the anesthesia you received will probably last for another couple of hours. After it wears off, you may feel some discomfort and pain. Generally, over-the-counter pain relievers like ibuprofen, naproxen, or acetaminophen will be enough to address/ease discomfort after the procedure. Be sure to talk to your doctor about any medical conditions you have that might stop you from taking these medicines. We will talk to you about individualized strategies.

If you received treatment, the local anesthesia should last for up to five hours. You might want to take the first dose of an over-the-counter pain reliever before the effect of the local anesthesia wears off. This will ensure a smoother recovery process. Unless your doctor has said otherwise, or if you are allergic, you can take either one of these:

• Ibuprofen – 600-800 milligrams every eight hours
• Acetaminophen, extra strength – 1000 milligrams every six hours

You can help yourself heal by making sure your stool/bowel movements are soft. Drink plenty of fluids and increase your fiber intake around the time of the procedure. Stool softeners like docusate sodium can also be an option.

In rare cases, the sphincter muscle can cramp and cause additional discomfort. You can treat this with by soaking your bottom in a bathtub filled with warm water (called a sitz bath).  

If your pain is severe and not relieved by medication or these other suggestions, call the nurse at 212-604-1721 (Chelsea patients) or 332-243-0100 (Harlem Center patients).

What to Do About Bleeding 

It is not unusual to have a little bleeding following the procedure, especially during bowel movements, for up to one week. Bleeding may last longer if you are constipated or if we treated areas inside the anus.  

If the bleeding is light, you may want to keep a tissue in your underwear for a few days. If you have heavy bleeding or bleeding that does not stop quickly after bowel movements, call us at 212-604-1721 (Chelsea patients) or 332-243-0100 (Harlem patients) immediately or go to the nearest emergency room.  

Other Advice 

Here are some additional guidelines to help ease your recovery: 

• Do not insert anything into your anus and do not engage in receptive anal (bottom) sex until any bleeding or pain has stopped if you just had a biopsy. If you also had treatment, you should wait two to three weeks before resuming these activities.
• Avoid heavy lifting (more than 20 pounds) for one day.
• Otherwise, you can go about your daily routine.

Follow-Up Instructions

If you were treated for conditions caused by the human papillomavirus (HPV), you will need follow-up care. HPV can continue to cause changes in your cells and tissue and might require more treatment in the future. It is therefore important to come back for follow-up appointments to make sure everything looks and stays healthy. The doctor or nurse will be in contact with you to explain the need for future treatments or follow-ups, based on your results. We usually contact patients through the MyMountSinai portal, so please make sure you have a current and active account.