How Rough is a High Resolution Anoscopy

I am nervous and want to hear from people who have been through this. Three weeks ago I went to a colon rectal surgeon with some minor rectal bleeding. He took an anal swap and told me to come back for a colonoscopy. Today he called and told me the results of the swab came back abnormal. Now he wants to do a HRA. I asked the doctor if i could just have a local instead of being put out, but he said no, it was too uncomfortable! I am really wondering? What does this entail? What is the prep like? Are you sedated and with what? How accurate is the swab test? Should I be worried? Never heard of this? I would love to hear from medical providers and in as much detail as possible.

It's a very simple procedure.

https://www.urmc.rochester.edu/surgery/colorectal/procedures/high-resolution-anoscopy.aspx

As a colon cancer survivor, I can't stress hard enough the importance of getting rectal bleeding checked out quickly. The only symptom I had was blood on my stools and no pain. My FP said it was probably a bleeding hemorrhoid, but those hurt. He got me in for my first colonoscopy and they quickly found a large, bleeding villous adenoma in my sigmoid. I had a bowel resection, 4 months of chemo. and 25 straight days of radiation. That was in 2000 and I am cancer free, but I still get scoped every 3 years, looking for new polyps, which they usually find and snip out.

They may want to put you out to do the anoscopy, THEN a full colonoscopy. Just go with the program and take the drugs. You won't feel a thing, but may wake up a little gassy and want to go home back to bed and sleep some more.

They want to sedate me with Propofol for this procedure. They describe it as a twilight effect where I will be out but able to respond to the doctor. It will also have an amnesia effect. So it would seem to me that it may still be uncomfortable, I just won't remember it or anything else that happens. I don't like this at all and am afraid of being drugged like this. Would it be crazy to refuse the Propofol? Are there any doctors or nurses that have advice or can recommend an alternative to this twilight sedation?

If they do an anal/rectal biopsy you will want some pain relief the procedure.

For just a "look around" you don't need anything.

Based on what I have read, I am not sure how he knows he will need to, but he is talking about doing a biopsy. Is Propofol and that level of sedation, the only thing they can administer? I just don't want the amnesia effect and would prefer to be fully conscious. What else can they do?

Tell them to shoot you up with lidocaine.

Ok, I did tell the doctor that I did not want the Propofol, after some resistance he said it was up to me. I said then unless you object as medical professional, I do not want it. After doing some pretty extensive review it actually seems unusual to use Propofol with this procedure. My guess is they can do the procedure faster , so he can do more of them, my guess it's a business thing. I am glad I spoke up. I will report back when I have the exam.

My barber had prostate cancer and had a prostate biopsy. They put a scope into the rectum and needles punch through the rectal wall, into the prostate to retrieve tissue. He had no local and told me it did pinch a bit. He was told to take a Fleet before coming in for the biopsy.

That sounds much more intense than the exam of a HRA. I can't believe the get away with this unnecessary anesthesia. The cost, the risk, doesn’t make sense. To me it just seems like if you are going to allow someone to examine you like that, you don't want to be in some twilight state with amnesia afterward. If they hurt you, they hurt you, just because you don't remember it, some how that is better?

In your profile you say, "i love the idea of relinquishing control."

JUST DO IT and get that exam done.

It's scheduled. But without sedation.

BIG MISTAKE! Just an update. I had the procedure on Tuesday. It was a huge mistake to use only a local. I did not realize that as part of the HRA they would use electro cauterization! Not only was it used to stop the bleeding of the biopsy they took but the doctor used it in the removal of any abnormal tissue he found that he first biopsied and then as he put it, obliterated. While they gave me at least 6 shots of the local, it did little to offset the pain of the electro cauterization which if you don't know is a process where an electrified super heated needle is inserted into the tissue to seal any bleeding and to remove any unwanted tissue. The worst part was he was only able to check 2 of 4 areas, so there may still be abnormal tissue there. By the way this is all before even testing the tissue. Now that it is over I am recovering, and the pain is kind of constant but not that bad. Although after the procedure I was given a script for Oxycodone. The thing that bothers me is that along the line, the doctor, his staff or the staff at the clinic where I had this done never said, this is a painful procedure, you really need to have the propofol and no one mentioned the electro cauterization. They also had to have extra staff to hold me down as they performed the procedure. Why didn't they say it would hurt so much and employed the electro cauterization? I never saw anything about that in any description of an HRA, on any of the many reputable medical sources I looked at. I am embarrassed at having made such a poorly informed decision. God, what ridiculous waste or resources and at the end of the day, it may need to be redone!

The anus and anal canal has much more sensitivity and more diversity in the neuro receptions than the rest of the colon. As I said above, for just a "look around" you don't need anything, but if they do an anal/rectal biopsy you will want some pain relief the procedure.

Did the gastroenterologist say "I told you so?" 😁 You did mention in an earlier post that he offered resistance to your desire not to use propofol.

I opted to just have the local. but with the electro cauterization it just was too painful. I think the doc felt bad that he did not tell me about the electro cauterization but you would have thought someone might have said a local is not appropriate for the procedure, they knew. I mean they brought extra staff to hold me down, would it not have been easier to just say this is a very painful procedure, I was not being unreasonable just trying to avoid being put out.

BIG MISTAKE! ...I am embarrassed at having made such a poorly informed decision.

It does not seem to me that you need to be embarrassed. Not only was it the physician's responsibility to inform you of what to expect, particularly of the probable consequences of your decision, but you also attempted to inform yourself, through other sources you deemed legitimate. A bad experience for you, for sure, but through no fault of your own.

It was the patient's fault. He didn't want to do the procedure the way the doctor said it should be done.

If pain is the only sensation and the rest of the procedure went as planned, the fault is clearly with the patient because he didn't listen to the doctor.

It's like going to the dentist and saying I don't want novocaine (against the recommendation of the dentist) and then complaining that it hurts when the tooth is prepared. The tooth got treated the same way, but it was a painful process. This anoscopy was the same. He should have listened to the voice of experience.

Patients don't know as much as they think they do and I do not apologize for my lack of sensitivity on this topic.

I'm with Susie. If the doctor advised you to have propofol and was reluctant to do it without it and you had it anyway without it, you probably should've known better. Do tell him your symptoms before you have the colonoscopy. I find it hard to believe it would be dangerous. You definitely need to have it done. You don't say how old you are but with a finding such as you describe a look at your entire colon is of paramount importance. Sensation beyond the anus is much less. For gods sake take the light anesthesia. I frankly don't have a tremendous amount of sympathy for patients who know better than I. I've sutured lacerations in several people who initially wanted no local anesthetic. They quickly changed their minds.

I TOTALLY understand where Susie and Liquidsky are coming from. Their argument is undeniably valid. OTOH, only the OP and the doctor involved know the entirety of the communication between them. In MY opinion, even though the decision is ultimately the patient's, the burden is on the professional, who is rightfully held to a higher standard, and if he elects to go into a situation that he perceives against the patient's best interest, he better have his ass covered six ways to Sunday. It sounds to ME, based solely on the information we have, like the doctor did not adequately inform the patient. Let me put it another way, had the patient been more fully informed, he would have made a different decision,

The doctor did not properly explain this procedure. He never mentioned the election cauterization until after the procedure in recovery. Yet this is clearly his standard procedure.

I don't think medical professionals are exempt from explaining why they recommend something.