Rectoscopy: What to Expect During the Procedure

What Is Rectoscopy and Why Is It Done?

Rectoscopy is a diagnostic procedure where a doctor examines the inside of your rectum using a rigid tube called a rectoscope. It is performed to investigate symptoms such as rectal bleeding, changes in bowel habits, or to screen for conditions like hemorrhoids, polyps, or colorectal cancer.

Rectoscopy—also known as proctoscopy or rigid sigmoidoscopy—is one of the most common procedures performed in gastroenterology and colorectal surgery clinics worldwide. The procedure provides direct visualization of the rectal mucosa (the inner lining of the rectum), allowing physicians to identify abnormalities that cannot be detected through external examination or imaging tests alone.

The rectoscope itself is a narrow, rigid tube made of plastic or metal, typically about as thick as a thumb. One end contains a magnifying lens and light source that allows the doctor to see the rectal lining in detail. The hollow center of the scope enables the doctor to insert various instruments, such as biopsy forceps to collect tissue samples, or suction devices to clear away mucus or blood for better visualization.

Unlike flexible sigmoidoscopy or colonoscopy, which use bendable scopes and can examine much longer portions of the colon, rectoscopy is specifically designed to examine the rectum and the very lowest portion of the sigmoid colon—typically the last 15 to 25 centimeters of the intestinal tract. This focused examination makes rectoscopy particularly useful for evaluating conditions that primarily affect the rectal area.

Why doctors recommend rectoscopy

Your doctor may recommend rectoscopy for various reasons. The most common indications include investigating rectal bleeding, which can range from bright red blood on toilet paper to blood mixed with stool. Rectoscopy helps identify the source of bleeding, whether from hemorrhoids, anal fissures, polyps, or more serious conditions.

Other reasons for rectoscopy include evaluating chronic constipation or diarrhea, investigating unexplained pain or discomfort in the rectal area, monitoring inflammatory bowel disease (such as ulcerative colitis or Crohn's disease), screening for colorectal abnormalities in patients with risk factors, and following up on previously identified polyps or other abnormalities.

Proctoscopy vs. rectoscopy

The terms rectoscopy and proctoscopy are often used interchangeably, though there is a technical distinction. A proctoscope is typically a shorter instrument used to examine just the area immediately inside the anal opening—about 5 to 10 centimeters. This shorter examination is called proctoscopy and is particularly useful for evaluating hemorrhoids and anal conditions.

A rectoscope is longer and allows examination deeper into the rectum, typically 15 to 25 centimeters. In practice, however, many healthcare providers use the terms synonymously, and both procedures follow similar preparation and technique.

How Should You Prepare for a Rectoscopy?

Preparation for rectoscopy is usually simple—you can eat and drink normally before the procedure. Sometimes you may need to use a laxative suppository or enema a few hours beforehand to empty the lower bowel. Always inform your doctor about any medications you take, especially blood thinners.

One of the advantages of rectoscopy compared to colonoscopy is the minimal preparation required. While colonoscopy necessitates drinking large volumes of bowel preparation solution and following a restricted diet for one or more days, rectoscopy preparation is typically much simpler and less burdensome for patients.

In most cases, you can continue eating and drinking normally in the days leading up to your rectoscopy. The examination focuses only on the last portion of the intestinal tract, which means a complete bowel cleanse is unnecessary. However, it is important that the lower rectum is relatively empty of stool so the doctor can see the mucosa clearly.

Your healthcare provider may give you specific instructions based on your individual situation. Some clinics routinely recommend a laxative suppository or small-volume enema a few hours before the procedure. These are inserted into the rectum and work within 15-30 minutes to stimulate a bowel movement, clearing the lower rectum. You may be asked to do this at home before coming to the clinic, or it may be done at the clinic upon arrival.

Medications to discuss with your doctor

Certain medications can increase the risk of bleeding during or after the procedure, particularly if tissue samples (biopsies) need to be taken. It is crucial to inform your doctor well in advance about all medications you take, including prescription drugs, over-the-counter medications, and supplements.

Medications of particular concern include blood thinners such as warfarin, heparin, dabigatran, rivaroxaban, apixaban, and edoxaban. Antiplatelet medications like aspirin, clopidogrel, and prasugrel are also important to mention. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can also affect bleeding risk.

Your doctor will advise whether any medications need to be stopped or adjusted before the procedure. Never stop taking prescribed medications without explicit instructions from your healthcare provider, as stopping some medications (particularly blood thinners prescribed for heart conditions or stroke prevention) can carry serious risks.

Managing anxiety about the procedure

Many people feel nervous or embarrassed about having a rectoscopy. These feelings are completely normal and understandable. It may help to remember that this is a routine procedure performed many times daily by gastroenterologists and colorectal specialists—for them, it is simply a normal part of their work.

If you feel anxious, communicate openly with the healthcare staff. They are accustomed to helping patients who feel uncomfortable and can provide reassurance and support. Remember that the examination is important for investigating your symptoms and ensuring you receive appropriate care for any underlying conditions.

You will not be completely undressed during the procedure. You will typically be given a gown or blanket to cover yourself, and only the necessary area will be exposed. The room will be private, and staff will take measures to preserve your dignity throughout the examination.

Sedation and pain relief options

Most rectoscopy procedures are performed without sedation because the examination is brief and generally not painful. However, options are available if you feel you need them.

Some clinics offer an oral sedative (a calming tablet) before the procedure if patients are particularly anxious. A local anesthetic gel may be applied to the anal opening to numb the area and make insertion of the scope more comfortable. This is especially helpful for patients who have conditions like anal fissures or hemorrhoids that might cause discomfort during the examination.

If you have previously had an allergic reaction to local anesthetics (for example, at the dentist), be sure to inform the medical staff before the procedure so they can use alternative approaches or monitor you appropriately.

What Happens During a Rectoscopy Examination?

During rectoscopy, you lie on your side with knees drawn up (or kneel on elbows and knees), while the doctor gently inserts a lubricated rectoscope through the anus. The doctor examines the rectal lining through a magnifying lens and may take tissue samples if abnormalities are found. The procedure takes about 10 minutes.

Understanding exactly what will happen during the procedure can help reduce anxiety. A rectoscopy is typically performed by a doctor, often with an assistant present to help position the patient, hand instruments to the doctor, and provide support.

The examination room will be private and equipped with an examination table or bed. The medical staff will explain each step as it happens and check that you are comfortable throughout the procedure. You are encouraged to ask questions at any time and to speak up if you experience significant discomfort.

Patient positioning

There are two main positions used for rectoscopy. The most common is lying on your left side with your knees drawn up toward your chest—this is called the left lateral position. It is comfortable for most patients and provides good access for the examination.

Alternatively, the doctor may ask you to kneel on the examination table, supporting yourself on your elbows and knees—this is called the knee-chest position. While this position may feel more awkward or embarrassing, it can make it easier for the doctor to examine the upper portion of the rectum because of the angle it creates. Your doctor will recommend the position that will provide the best examination based on your specific situation.

Insertion and examination

The doctor will apply lubricating gel to the rectoscope and to the anal area to make insertion as smooth as possible. The rectoscope—a rigid plastic tube about as thick as a thumb—is then gently inserted through the anus and advanced into the rectum, typically 15 to 25 centimeters.

As the scope advances, the doctor looks through a magnifying lens at the end to examine the mucous membrane (lining) of the rectum. The scope has a built-in light source to illuminate the area being examined. Because the rectum is normally collapsed (the walls touch each other), the doctor may need to pump small amounts of air through the scope to inflate the rectum slightly, allowing better visualization of the mucosal surface.

A suction device attached to the scope can be used to clear away any mucus, blood, or residual stool that might obstruct the view. You may hear the sound of the suction device during the examination, and there may be some odor—this is all normal and expected.

Taking tissue samples

If the doctor sees any abnormalities such as polyps, areas of inflammation, or suspicious lesions, they may decide to take tissue samples (biopsies) for laboratory analysis. Because the rectoscope is hollow, the doctor can insert special instruments like biopsy forceps through the scope to collect small pieces of tissue.

Most people do not feel pain when biopsies are taken. This is because the inner lining of the rectum lacks the sensory nerve endings that detect pain—a feature that makes procedures like rectoscopy and colonoscopy much more tolerable than they might otherwise be. You may feel a slight tugging or pulling sensation, but sharp pain is unusual.

The tissue samples are placed in special containers and sent to a pathology laboratory, where they are examined under a microscope. Biopsy analysis can reveal cellular changes that are not visible to the naked eye, helping to diagnose conditions like inflammatory bowel disease, pre-cancerous changes, or cancer.

What does rectoscopy feel like?

Although the inside of the rectum does not have pain-sensitive nerves, a rectoscopy can still produce various sensations. Many people describe feeling pressure during the examination, particularly when air is pumped in to expand the rectum. Some experience a sensation similar to needing to have a bowel movement.

You may pass gas (flatulence) during or after the procedure—this is completely normal and expected, especially after air has been introduced into the rectum. Medical staff are accustomed to this and will not be surprised or bothered.

If you have conditions affecting the anal area, such as anal fissures (small tears) or hemorrhoids, insertion of the scope may cause some discomfort. Let the doctor know immediately if you experience pain. They can often adjust the angle of the scope, pause to let you relax, or apply additional local anesthetic to improve your comfort.

Duration of the procedure

The actual rectoscopy examination typically takes about 10 minutes, sometimes less if no biopsies are needed. The entire appointment, including arrival, preparation, the procedure itself, recovery, and discussion of initial findings, usually takes around 30 minutes.

Rectoscopy in Children

Children can also undergo rectoscopy when medically necessary. Pediatric patients may be given sedation or general anesthesia (being put to sleep) to ensure they remain comfortable and still during the procedure. Parents receive detailed information in the appointment letter.

While rectoscopy is more commonly performed in adults, children sometimes require this examination to investigate symptoms such as rectal bleeding, chronic constipation, or suspected inflammatory bowel disease. The procedure is essentially the same as in adults but with additional considerations for the child's age, size, and ability to cooperate.

Younger children or those who are particularly anxious may be offered sedation—either oral medication to help them relax, or in some cases, general anesthesia (being completely asleep during the procedure). This ensures the child remains comfortable and still, allowing the doctor to perform a thorough examination safely.

The decision about whether to use sedation or anesthesia is made on an individual basis, considering the child's age, medical history, temperament, and the specific examination required. Parents will receive detailed instructions about preparation, including any fasting requirements if anesthesia will be used.

Parents are usually welcome to stay with their child before and after the procedure, and in some facilities, may be present during the examination (depending on the use of anesthesia and facility policies). Ask your healthcare provider about what to expect so you can best prepare your child for the experience.

How Will You Feel After a Rectoscopy?

After rectoscopy, most people feel normal and can leave immediately. You may experience some flatulence and, if biopsies were taken, minor bleeding. Contact your healthcare provider if bleeding continues beyond your first bowel movement after the procedure.

One of the advantages of rectoscopy is the quick recovery time. Because the procedure is brief, does not require deep sedation, and does not involve significant intervention, most patients can get up from the examination table and leave the clinic within minutes of the procedure ending.

In the hours following rectoscopy, you may notice increased flatulence (passing gas). This is completely normal and results from the air that was pumped into the rectum during the examination to help the doctor see the mucosal lining. The discomfort is usually mild and resolves within a few hours as the air naturally passes.

Bleeding after biopsy

If tissue samples were taken during the procedure, it is normal to see a small amount of blood afterward—you might notice it on toilet paper, in the toilet bowl, or in your stool. This bleeding is typically minor and stops on its own.

The first bowel movement after a rectoscopy with biopsy may contain some blood, which is expected. However, if bleeding continues with subsequent bowel movements, is heavy (filling the toilet bowl with blood), or you feel lightheaded or unwell, contact your healthcare provider promptly.

If you received sedation

If you received sedative medication before the procedure, your reaction time and judgment may be impaired for the rest of the day, even if you feel alert. For your safety, do not drive a car, ride a bicycle, operate machinery, or make important decisions until the following day.

Arrange for someone to accompany you home after the procedure if you have received sedation. Avoid alcohol for the rest of the day, as it can intensify the effects of sedative medications.

When Will You Get Your Rectoscopy Results?

The doctor can tell you immediately what they observed during the examination. If tissue samples were taken, biopsy results typically take 1-2 weeks. The results will be sent to the doctor who ordered the test, who will then discuss them with you.

One benefit of rectoscopy is that you receive immediate feedback about what the doctor observed. Right after the procedure, the doctor will explain what the rectal lining looked like, whether they saw any abnormalities such as hemorrhoids, fissures, polyps, or areas of inflammation, and what this might mean for your diagnosis and treatment.

If you wish, you can usually request a written summary of the findings. You can also call the clinic later if you have questions or need the information repeated—sometimes it is difficult to absorb details immediately after a medical procedure.

Waiting for biopsy results

If tissue samples were collected during the rectoscopy, these need to be processed and examined in a pathology laboratory. This involves preserving the tissue, cutting it into thin sections, staining it with special dyes, and having a pathologist examine it under a microscope.

Biopsy results typically take one to two weeks, though timing can vary depending on the laboratory and the complexity of the analysis required. Some specialized tests may take longer.

The biopsy results are sent to the physician who ordered the rectoscopy (often your general practitioner or a specialist). That doctor will then contact you to discuss the results and any next steps. Different healthcare facilities have different systems for delivering results—some phone patients, some send letters, and some use online patient portals. Ask at the time of your procedure how and when you should expect to receive your biopsy results so you know what to expect.

What Are the Risks and Complications of Rectoscopy?

Rectoscopy is a safe procedure with a very low complication rate. Serious complications such as bowel perforation or heavy bleeding are extremely rare. Minor complications like temporary discomfort or light bleeding after biopsy are more common but typically resolve quickly.

Rectoscopy is considered a safe diagnostic procedure with a low risk of complications. Because it is a shorter, simpler examination than colonoscopy, the risks are correspondingly lower. However, like any medical procedure, there are potential complications that patients should be aware of.

The most serious potential complication is perforation—a tear in the wall of the rectum or colon. This is extremely rare with rectoscopy, occurring in fewer than 1 in 10,000 procedures. If perforation occurs, it typically requires hospitalization and may require surgery to repair.

Bleeding is another potential complication, particularly if biopsies are taken. Minor bleeding is common and expected after biopsy, but significant bleeding requiring medical intervention is rare. Patients taking blood-thinning medications have a slightly higher bleeding risk, which is why it is important to discuss medications with your doctor before the procedure.

Some patients experience temporary symptoms after rectoscopy such as abdominal cramping, bloating, or discomfort. These are usually mild and resolve within hours. Infection is theoretically possible but extremely rare because the scope only enters areas that normally contain bacteria.

What Happens to Tissue Samples?

Tissue samples taken during rectoscopy are examined in a laboratory to help diagnose your condition. After analysis, samples may be stored in a biobank for potential future medical research or to support your ongoing care.

When tissue samples (biopsies) are collected during medical procedures, they are sent to a pathology laboratory where they undergo processing and analysis. This is essential for diagnosing conditions such as inflammatory bowel disease, pre-cancerous changes, or cancer.

After the initial diagnostic analysis is complete, the tissue samples may be preserved and stored in what is known as a biobank. Biobanking serves several important purposes: the samples may be needed for additional tests if your condition changes or if new diagnostic methods become available; they can support quality assurance in healthcare; and with appropriate consent and ethical oversight, they may contribute to medical research that benefits future patients.

If you have questions or concerns about how your tissue samples will be used or stored, discuss this with your healthcare provider. You have the right to know how your biological material is handled and, in many healthcare systems, you have options regarding its use for research purposes.

Your Rights as a Patient

You have the right to understand and participate in your healthcare decisions. Ask questions, request explanations in plain language, and let staff know if you need interpretation services or have hearing difficulties.

Being an active participant in your healthcare leads to better outcomes. To participate effectively, you need to understand the information provided by your healthcare team. If something is unclear, ask for clarification—healthcare professionals want you to understand and are happy to explain things in different ways.

Before any procedure, you should understand why it is being recommended, what will happen during the procedure, what the alternatives are, and what risks are involved. Do not hesitate to ask questions or express concerns. If you feel rushed or pressured, it is appropriate to ask for more time to make your decision.

If you do not speak the local language fluently, you have the right to interpreter services in most healthcare systems. Similarly, if you have hearing difficulties or other communication needs, let the staff know so appropriate accommodations can be made.

Children also have the right to participate in their healthcare in age-appropriate ways. Parents and guardians should help children understand what will happen during medical procedures and advocate for their needs and comfort.