There are many handheld and self-retaining anal retractors on the market. All vary in price, availability and utility. Sims' vaginal speculum is standard in most hospitals' instrument inventory, in both developed and developing countries. A simple modification by transecting the stem and rotating one blade through 180° creates the perfect anal speculum (Fig 1). This modification can be achieved by any local tradesman or instrument maker at a modest cost compared to the purchase of a dedicated instrument. We use this modified Sims' speculum for a variety of anal procedures including haemorrhoidal ligation in the office, where the patient can attend to handheld retraction!
Figure 1.
Sims' speculum (left) and modification (right)