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What is High Resolution Anoscopy (HRA)?
High Resolution Anoscopy, or HRA, is a procedure that allows for examination and evaluation of the anal canal. Using a small thin round tube called an anoscope, the anal canal is examined with a high resolution magnifying instrument called a colposcope. Application of a mild acidic liquid onto the anal canal facilitates evaluation of abnormal tissue such as anal dysplasia. Anal dysplasia is mainly seen inside the anal canal and on the external perianal skin. HPV (a common sexually transmitted disease) can cause anal dysplasia.
If indicated, a biopsy can be obtained. A digital rectal examination is also done at the time of the procedure. The procedure generally lasts about 15 minutes. It is usually very well tolerated with mild discomfort, if any. Significant risks such as bleeding or infection are extremely rare. Note should be taken that HRA is very different from colonoscopy or flexible sigmoidoscopy, neither of which can adequately examine the anal canal for the problems being detected by HRA. No bowel prep is needed for this examination.
Who needs a High Resolution Anoscopy?
The procedure is used in the treatment and surveillance of anal dysplasia and the prevention of anal cancer. It is performed on patients with an abnormal anal cytology or anal Pap test. Anal Pap tests are obtained on individuals who are at risk for genital or anal HPV (Human Papilloma Virus) infections, even in the absence of signs or symptoms of infection. If your doctor believes that you are at higher risk for developing anal dysplasia, he/she may recommend you receive a HRA.
What can I expect after my HRA appointment?
If you have a biopsy during your HRA, your anus will need several days to heal. To prevent infection/ bleeding, for 1 week after your procedure:
- Avoid lifting anything more than 20 pounds
- Avoid inserting anything into the anus (no anal sex, fingers, toys, or suppositories) until bleeding stops.
Some more tips:
- To help with mild to moderate pain or discomfort, you can take over-the-counter medicine i.e. paracetamol or ibuprofen
- Soaking the area in hot water can help, especially after bowel movements, to reduce pain
- Drinking more water can help prevent constipation.
A small amount of bleeding with bowel movements may happen for a few days, and rarely, infection or severe bleeding may also occur.
What do the biopsy results mean?
If your provider obtained biopsies during the HRA, these results will come back as:
- Normal biopsy - There is no evidence of abnormal changes in the sample
- Low-grade dysplasia - This result means mild or low-grade dysplasia or anal warts; these are low risk changes
- High-grade dysplasia - This result means severe or high-grade dysplasia. All or most of the cells in the sample may be pre-cancerous
Not all lesions get worse. Some do not change and may even disappear.
How can I protect against HPV & Anal Dysplasia?
1) Practice safer sex– use condoms EVERY time you have sex to reduce your risk of getting HPV.
2) Having fewer sexual partners will also decrease your risk of getting HPV.
3) Stop cigarette smoking.
4) If you are between the ages of 9-26, get the Gardasil®, vaccine to help prevent new infections of HPV types 6, 11, 16, or 18 that cause warts and cancer. The vaccine only protects against HPV types you have not had.
Anal dysplasia can be treated successfully, but people with HIV are at higher risk of seeing it reoccur. HIV therapy does not protect against anal dysplasia/ cancer. It is important to see your provider for regular check-ups