anoscopy

Your anus is the opening at the end of your large intestine. It is where stool (poop) leaves your body. The anus is formed partly from your outer layers of skin and partly from your intestine. Anal cancer is a type of cancer that forms in the tissues of your anus.

Anyone can get anal cancer, but you are more likely to develop it if you:

• You have an infection with high-risk HPV, especially if you have certain types. Most anal cancers are related to HPV infection.
• Have a weakened immune system, from conditions such as HIV or because of medicines you need to take after an organ transplant.
• Have had vulvar, vaginal, or cervical cancer.
• Have many sexual partners.
• Have anal sex.
• Smoke cigarettes.

The signs and symptoms of anal cancer may include:

• Bleeding from the anus or rectum
• A lump near the anus
• Pain or pressure in the area around the anus
• Itching or discharge from the anus
• A change in bowel habits, such as narrower stools, having to go more often, or bowel incontinence

To find out if you have anal cancer, your provider:

• Will take your medical history, which includes asking about your symptoms.
• Will ask about your family health history.
• May do a digital rectal examination (DRE). A DRE is an exam of the anus and rectum. For the exam, your provider will insert a lubricated, gloved finger into the lower part of your rectum to feel for lumps or anything else that seems unusual.
• May order tests that examine the anus and rectum, such as:
  • An anoscopy, an exam of the anus and lower rectum using a short, lighted tube called an anoscope. There is also a type of anoscopy called a high-resolution anoscopy. It uses a special magnifying device called a colposcope along with the anoscope to view these areas.
  • A proctoscopy, a procedure to look inside the rectum and anus using a thin, tube-like instrument with a light and a lens.
  • An endo-anal or endorectal ultrasound, a procedure in which an ultrasound probe is inserted into the rectum.
• May do a biopsy during an anoscopy or proctoscopy.

The treatments for anal cancer include radiation therapy, chemotherapy, and surgery. Which treatment you get will depend on how advanced the cancer is, your overall health, and your preferences.

You may be able to lower your risk of getting anal cancer by getting an HPV vaccine and not smoking. Contact your provider if you need help quitting smoking.

It is currently not known if using condoms can prevent anal HPV infections. But using latex condoms every time you have sex can help prevent HIV, a risk factor for anal cancer. And they also help prevent other sexually transmitted infections (STIs). If your or your partner is allergic to latex, you can use polyurethane condoms.

If you are an adult with HIV, it's important to get an anal cancer screening every year. The screening checks for anything that seems unusual, such as lumps, burning, and precancer cells (cells that could turn into cancer). The screening will include a digital rectal exam. If anything unusual is found, you will have an anoscopy or high resolution anoscopy.

Your anus is the opening at the end of your large intestine. It is where stool (poop) leaves your body.

Problems with the anus are common. They include:

• Hemorrhoids
• Abscesses
• Fissures, small cracks or tears in the lining of your anus
• Anorectal fistula, an abnormal tunnel from your anus or rectum to the skin surface
• Anal itching (pruritus ani)
• Cancer

Your symptoms will depend on which disorder you have. But some of the more common symptoms may include:

• Bleeding
• Discharge
• Itching
• Pain
• Swelling

To make a diagnosis, your health care provider will ask about your symptoms and medical history. Depending upon your symptoms, your provider may:

• Check the skin around your anus for anything that looks abnormal.
• Perform a digital rectal exam (DRE). For this exam, your provider inserts a lubricated, gloved finger into the lower part of your rectum to feel for lumps or anything unusual.
• Order tests, such as an anoscopy.

You may be embarrassed to talk about your anal troubles. But it's important to let your provider know about your symptoms, especially if you have pain or bleeding. The more details you can give about your problem, the better your provider can help you.

Treatments vary, depending on the condition you have.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:

• External hemorrhoids, which form under the skin around your anus
• Internal hemorrhoids, which form in the lining of your anus and lower rectum

Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.
• Frequently lifting heavy objects.

The symptoms of hemorrhoids depend on which type you have:

With external hemorrhoids, you may have:

• Anal itching
• One or more hard, tender lumps near your anus
• Anal pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

With internal hemorrhoids, you may have:

• Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement
• Prolapse, which is a hemorrhoid that has fallen through your anal opening

Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort.

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement.
• Drinking enough fluids every day.
• Not straining during bowel movements.
• Not sitting on the toilet for long periods of time.
• Taking over-the-counter pain relievers.
• Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.
• Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.

You should see your health care provider if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding.

To find out if you have hemorrhoids, your health care provider:

• Will ask about your medical history.
• Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.
• Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.
• May do procedures such as an anoscopy to check for internal hemorrhoids.

If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery.

You can help prevent hemorrhoids by:

• Eating foods that are high in fiber
• Taking a stool softener or a fiber supplement
• Drinking enough fluids every day
• Not straining during bowel movements
• Not sitting on the toilet for long periods of time

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Colorectal cancer is cancer that develops in the tissues of the colon or rectum. Your colon and rectum are part of your digestive system:

• Your colon is the first and longest part of your large intestine. It absorbs water and some nutrients from foods. It also changes the leftover waste products into stool (poop).
• Your rectum is the lower part of your large intestine. It's where your body stores stool.

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancer that affects either of these parts may also be called colorectal cancer.

Colorectal cancer happens when there are changes in your genetic material (DNA). These changes are also called mutations or variants. Often, the genetic changes that lead to colorectal cancer happen during your lifetime and the exact cause is unknown. But certain genetic changes that raise your risk for colorectal cancer are inherited, meaning that you are born with them.

Besides genetics, other factors, including your lifestyle and the environment, can affect your risk of colorectal cancer.

Anyone can get colorectal cancer, but certain factors make you more likely to develop it:

• Being older; your risk of getting colorectal cancer increases as you age.
• Having a personal or family history of colorectal cancer.
• Having a history of adenomas. Adenomas are colorectal polyps (growths) that look abnormal under a microscope or are 1 centimeter or larger. Adenomas are not cancer, but they can sometimes turn into cancer over time.
• Having a genetic syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colorectal cancer).
• Having chronic ulcerative colitis or Crohn disease for 8 years or more.
• Having three or more alcoholic drinks per day.
• Smoking cigarettes.
• Being Black; Black people have an increased risk of colorectal cancer and death from colorectal cancer compared to other races.
• Having obesity.

Colorectal cancer may not always cause symptoms, especially at first. If you do have symptoms, they could include:

• A change in bowel habits that lasts more than a few days, such as:
  • Diarrhea
  • Constipation
  • Feeling that the bowel does not empty completely
  • Your stool is narrower or has a different shape than usual
• Blood (either bright red or very dark) in the stool
• Frequent gas pains, bloating, fullness, or cramps
• Weight loss for no known reason
• Fatigue

Because colorectal cancer may not cause symptoms at first, it's important to have screening tests for colorectal cancer. Screening tests look for signs of a disease before you have any symptoms. They can help find cancer early, when it may be easier to treat.

Most experts recommend that start screenings at 45 and continue until at least age 75. People over 75 and those who are at high risk should talk to their providers about how often you need screening and what type of test they should get.

The types of tests include different stool tests and procedures such as colonoscopies and flexible sigmoidoscopy. Talk with your provider about how often you need screening and what type of test you should get.

If you have symptoms that could be caused by colorectal cancer or if your screening test results are abnormal, you may need to have more tests to find out if you have cancer. Possible tests include:

• A physical exam.
• A digital rectal exam. For this exam, your provider inserts a lubricated, gloved finger into your rectum to feel for lumps or anything unusual.
• The tests that are also used for screening (colonoscopy, stool tests, etc.) and biopsy, if you have not already had them.
• Other blood and tissue tests.

Your treatment options usually depend on your age, your general health, how serious the cancer is, and which type of cancer you have.

For colon cancer, your treatment may include one or more of these options:

• Surgery.
• Radiofrequency ablation, a procedure that uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity).
• Cryosurgery, a procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue.
• Chemotherapy.
• Radiation therapy.
• Targeted therapy, which uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells.
• Immunotherapy.

For rectal cancer, your treatment may include one or more of these options:

• Surgery.
• Radiation therapy.
• Chemotherapy.
• Active surveillance, which means having regular tests to see if your rectal cancer has changed. If the tests show the cancer is starting to grow, then you will have treatment to try to cure the cancer.
• Targeted therapy, which uses drugs or other substances that mainly attack specific cancer cells and cause less harm to normal cells.
• Immunotherapy.

Avoiding the risk factors that you have control over may help prevent some cancers. That includes:

• Not smoking
• Limiting alcohol to under three drinks per day
• Managing your weight

There are also other steps you can take to try to prevent colorectal cancer. They include:

• Getting regular colorectal cancer screenings
• Having polyps removed before they can become cancerous
• Getting regular exercise

HIV stands for human immunodeficiency virus. It harms your immune system by destroying a type of white blood cell that helps your body fight infection.

AIDS is the final stage of infection with HIV. It happens when the body's immune system is badly damaged because of the virus. Not everyone with HIV develops AIDS.

There is no cure for HIV, but there are many medicines to treat both HIV infection and the health problems and infections (called opportunistic infections, or OIs) that come with it. The medicines allow people with HIV to have long, healthy lives.

IIf you have HIV, you can help yourself by:

• Getting medical care as soon as you find out that you have HIV. You should find a health care provider who has experience in treating HIV.
• Taking your medicines every day.
• Letting your provider know if you get any new symptoms or health problems.
• Keeping up with your regular medical and dental care.This includes staying up to date with your recommended health screenings and vaccinations. Your provider can let you know which ones you need.
• Managing stress and getting support, such as from support groups, therapists, and social service organizations
• Trying to live a healthy lifestyle, including:
• Eating healthy foods.This can give your body the energy it needs to fight HIV and other infections. It can help you manage HIV symptoms and medicine side effects. It may also improve absorption of your HIV medicines.
• Getting regular physical activity. This can strengthen your body and immune system. It may also reduce the risk of depression.
• Getting enough sleep. Sleep is important for your physical strength and mental health.
• Not smoking. People with HIV who smoke have a higher risk of developing conditions such as certain cancers and infections. Smoking can also interfere with your medicines. Talk to your provider if you need help quitting smoking.
• Avoiding heavy drinking or taking illegal drugs. They can damage your liver, which means your HIV medicine may not work as well. They can also make it harder for your body to fight infections.
• Protecting yourself from OIs. Talk to your provider about medicines and vaccines that prevent certain OIs. Also, be careful to avoid exposure to contaminated food and water.

It is also important to reduce the risk of spreading HIV to other people. You should tell your sex partners that you have HIV and always use latex condoms. If your or your partner is allergic to latex, you can use polyurethane condoms.

The rectum is the lower part of your large intestine where your body stores stool. Problems with the rectum are common. They include hemorrhoids, abscesses, incontinence and cancer.

Many people are embarrassed to talk about rectal troubles. But seeing your doctor about problems in this area is important. This is especially true if you have pain or bleeding. Treatments vary depending on the particular problem.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases