High Resolution Anoscopy

High Resolution Anoscopy (HRA) is designed to detect pre-cancer, anal dysplasia, of the anal canal. The procedure is very similar to cervical colposcopy, which has been very successful in decreasing the incidence of cervical cancer.

How is an HRA Procedure Performed? 

HRA involves inserting a small plastic scope in the anal canal and inspecting the mucosa under high magnification. Early changes of HPV infection can be seen and diagnosed before they become cancerous. During the procedure you will be lying on a table. The provider places a small clear plastic tube called an anoscope in your rectum. The provider will look through a magnifying scope at the inside of your rectum. The provider will then use white vinegar to make anything abnormal stand out. Usually iodine is used a bit later to help the provider tell abnormal from normal.  At the end of the procedure the provider will take a very small biopsy of abnormal areas to send to the lab. This is the only way to tell for sure what is pre-cancer and what is not. You should not feel the biopsies at all.

Is the HRA Procedure Painful?

The procedure is not painful. Much like the Pap smear in women, the procedure is not comfortable but is not usually described as painful. The scope does produce a sensation of pressure when it is inserted. If patients are anxious, then they should bring a driver so that a mild sedative can be given beforehand at the clinic. The actual procedure itself is about 10-30 minutes, but the waiting time is usually at least an hour.  

After the procedure there is typically some mild soreness. If biopsies are taken then there may be some mild bleeding (usually just spots of blood on toilet paper), this goes away in a few days.

Is There Any Preparation I Should Undergo Before an HRA?

There is no preparation before the procedure. Please avoid enemas or anything to “clean out” the anal canal as that may wash away cells that we need to collect. Avoid placing anything in your anal canal for 24 hours prior to the procedure. If you need to use the restroom, do so immediately before the procedure (one is available in the clinic). Most people are worried about having a bowel movement during the procedure, but due to normal anal anatomy that essentially never happens.

Do I Need an HRA?

The HRA procedure is used to diagnose and treat anal dysplasia before it becomes cancerous. Anal dysplasia comes from HPV, a sexually transmitted virus that affects virtually everyone who has ever been sexually active. Fortunately, anal cancer is rare in the general population. Groups with a higher anal cancer incidence include:

  • Men and women who are HIV positive.
  • Men who have sex with men, HIV positive and HIV negative
  • People with a suppressed immune system, even if HIV negative

If any of the above descriptions fit you then you may want to consider HRA.

I’ve Had a Colonoscopy or Flexible Sigmoidoscopy, Do I Still Need an HRA?

The procedures are different and one does not take the place of the other. Colonoscopy and flexible sigmoidoscopy is used to diagnosed and prevent colon cancer. It involves a scope going several feet into the colon and minimal magnification. HRA is used to diagnosed and prevent anal cancer, which only involves the last few inches of the rectum. The scope only goes a few inches in and there is very high magnification.   

What is Hyfrecation?

Hyfrecation is a technique used to treat anal dysplasia and condyloma (warts). Hyfrecation involves using an electric current to destroy abnormal tissue (electrocautery). The procedure is very similar to HRA. Typically the provider uses a numbing injection (such as lidocaine) so that you will not feel the burning. Recovering afterwards takes a bit longer than a regular HRA procedure, but your provider will provide medications and instructions afterwards to help.