High Resolution Anoscopy (HRA)

What Is High Resolution Anoscopy (HRA)?

High Resolution Anoscopy, or HRA, is a procedure that allows for the examination and evaluation of the anus. This procedure helps diagnose and treat anal conditions, including anal cancer and anal dysplasia, a pre-cancerous condition occurring when the cells lining the anal canal undergo abnormal changes. Anal cancer, though rare, is increasing, and occurs when cells within the tissues of the anus become cancerous. While the cause of anal cancer is not entirely known, 91% of anal cancers have been linked to human papillomavirus (HPV) infection, a common sexually transmitted disease. Many cases of anal cancer are diagnosed in early stages when the cancer is most treatable with a higher chance of survival. HRA is an in-office procedure that differs from a colonoscopy. HRA examines the anal canal with a high-resolution magnifying instrument to:

• Locate abnormal cells in the lining of the anus
• Treat precancerous HPV lesions to prevent anal cancer
• Identify signs of HPV or pre-cancerous changes

Who is a candidate for a High Resolution Anoscopy?

Used in the surveillance of anal dysplasia and the detection of anal cancer, HRA is typically recommended for patients who have received abnormal results from other screenings, including an anal Pap test or anal cytology, or are considered high risk. Individuals at increased risk for anal cancer should speak with a physician about screening options, including HRA. Risk factors for anal cancer include patients who:

• Have had prior HPV exposure or infections
• Have had prior anal warts or HPV precancerous lesions (considered a prior HPV infection)
• Have a history of HIV or AIDS
• Smoke or have a history of smoking
• Have multiple sexual partners and engage in anal sex, increasing the risk of contracting HPV (Anal cancer can be contracted by individuals who have not had anal intercourse.)
• Have a weakened immune system, including those who have had organ transplants or take drugs to suppress their immune system
• Have a history of cancer or precancerous lesions of the vagina, cervix, vulva, or penis
• Have been previously treated with radiation therapy to the pelvic area

How is a HRA procedure performed?

The examination typically lasts 20-30 minutes, with patients positioned on their stomach or left side. The anoscope, a thin, short, hollow tube, is coated with an anesthetic cream and inserted just inside the anus.

Dye will be applied using a coated cotton swab allowing examination of the interior of the anus using a magnifying camera to allow high resolution visualization of anal tissue. The camera magnifies the area, allowing your physician to detect any abnormal tissue that is not visible to the naked eye.

If abnormal tissue is found, the patient will be given numbing medication to minimize discomfort, and the tissue will be biopsied and sent to a pathologist for further examination and can be treated if precancerous cells are found.

How to prepare for a High Resolution Anoscopy

No special preparation is needed for this procedure; however, the following tips are suggested:

• Certain medications and supplements can cause an increased risk of bleeding, such as aspirin, ibuprofen, vitamin E, and certain herbal supplements. If you are taking these medications, please notify your doctor before your procedure.
• 24 hours before your appointment, avoid using anal canal douches, enemas or creams, and refrain from anal intercourse.

Recovery after a High Resolution Anoscopy

If you experience a biopsy during your HRA, a small amount of bleeding is normal for one to two days. If bleeding becomes heavy or a fever greater than 101° develops, call your doctor. Do not insert anything into your anus until the bleeding has completely stopped.

For one to two days after your procedure:

• Avoid heavy exercise (walking is allowed)
• Wear loose comfortable clothing
• Avoid prolonged sitting or standing
• Avoid tobacco and second-hand smoke
• Avoid swimming and baths (showering is allowed)
• Drink plenty of fluids (to help prevent constipation)