1st April 2022

A 67-year-old male present to his GP complaining of anal pain that is worse on defecation

A 67-year-old male present to his GP complaining of anal pain that is worse on defecation and rectal bleeding for 11 months. He says he has received treatment for anal fissures but has not seen any improvement. He also complains that the pain does not allow him to sit comfortably. He does not have any significant medical history, but he has a 20-pack year smoking history. He denies any anal intercourse and has tested negative for syphilis and HIV. Given this clinical picture, what is the most appropriate first-line investigation for this man?

Select the SINGLE most appropriate option from the list below. Select ONE option only.