Rectal exam

Assemble the equipment for a Noscopy. In addition to the scope, you'll need lubricant, large cotton swabs, and protective gear for yourself. A slotted or beveled instrument is preferred. This is a beveled anus scope. Check the obturator. It should slide in and out easily. It cannot be fully inserted unless it is properly aligned. The left lateral decubitus position is most comfortable for the patient and requires no special equipment. Position the patient and inspect the anus. Do a rectal examination before inserting the scope. Determine whether there are palpable lesions, prostate abnormalities, perirectal lymph nodes, or areas of discomfort.

Use four quadrant compression to identify deep tenderness. Lubricate the scope and hold it with the bevel anteriorly and place your thumb over the obturator. Gently insert it in the direction of the umbilicus while asking the patient to bear down. Rotate the handle to the 12 o'clock position as you reach the point of full insertion and remove the obturator. Inspect the anal mucosa. Here it appears normal. The bevel or slot at the distal end of the scope allows visualization of one quadrant of the anal canal at a time.

Always replace the obturator before turning the scope to avoid traumatizing protruding lesions by the bevel or slot. Look for internal hemorrhoids which appear as mass lesions protruding into the lumen. Also look for fistulous openings and fissures in the mucosa. Examine all four quadrants at several depths of insertion and then withdraw the scope as the patient bears down so as to distend vascular lesions. The obturator may be left out at this time provided the scope is neither rotated nor advanced.