What Is a Colorectal Surgeon (Proctologist)?

A proctologist (now called a colon and rectal surgeon or a colorectal surgeon) is a medical doctor who specializes in diseases and conditions of the lower digestive tract, which includes the anus, rectum, and colon. These physicians have general surgical training but also have more specialized education in the types of complex surgery that are used to treat diseases and conditions of the lower digestive tract.

Disorders that a colorectal surgeon may treat include hemorrhoids, abscesses, anal fissures, pelvic floor conditions, and colon cancer. They may perform tests such as colonoscopy or sigmoidoscopy, which are done to screen for colon and rectal cancer. A colorectal surgeon may work together with others on a healthcare team, such as a gastroenterologist, a primary care physician, or an oncologist to manage conditions in the lower digestive tract.

Concentrations

A colorectal surgeon treats conditions that affect the lower digestive tract and also may be specialized in procedures such as colonoscopy or sigmoidoscopy, which are used to screen for colon cancer or diagnose other conditions. As a surgeon, they are different from a gastroenterologist, which is a medical doctor that treats diseases and conditions medically and does not perform surgery.

The parts of the body in which a colorectal surgeon has particular training are located in the last part of the digestive tract. This includes the large intestine, the anus, and the rectum. These parts (along with the cecum, which is the connection point between the large and small intestines) are collectively referred to as the colon. 

There are four parts to the colon: ascending colon, transverse colon, descending colon, and sigmoid colon. The ascending colon is on the right side of the abdomen and is the first section after the cecum. The colon then has a turn into the transverse colon which goes across the abdomen from right to left. Next is another turn into the descending colon which goes down the left side of the abdomen. The last part is the sigmoid colon, which curves down to the rectum.

The rectum is located between the large intestine and the anus and is the last part of the colon. It is a tube-shaped structure that’s where stool is held until it is ready to leave the body. The rectum can stretch, to a degree, thanks to the elastic muscles that line it. The muscles are what helps the rectum to hold differing amounts of stool prior to a bowel movement.

The anus is a group of muscles that form a sphincter (a circle). The anal sphincter muscles hold stool in until it’s time to have a bowel movement. At that time, the muscles release their tension and open up to allow stool to pass out of the body.

There are a wide range of disorders for which a colorectal surgeon is trained in managing and treating.

Anal fissures. An anal fissure is a tear in the anal canal that may be painful and cause symptoms such as itching and bright red blood in the stool. Some of the conditions that are associated with anal fissures are constipation, hypothyroidism, and obesity. Many fissures may heal with medical treatment that can be done at home and supportive care but others may need surgery to treat them.

Anal warts. Anal warts are growths that occur on an inside the anal canal. They are caused by the human papillomavirus (HPV), which is often transmitted via sexual intercourse but infection can occur in other ways, as well. Anal warts may start small and grow larger over time. Removal can be done with a variety of methods, including cryotherapy, electrocautery, or laser treatments.

Blood in the stool. Blood in or on the stool or black, tarry stool is never normal; they are signs that there is a problem that needs to be addressed. A colorectal surgeon can help determine what is causing the bleeding. While hemorrhoids are common and they do bleed, they should still be looked at by a physician on the chance that there is another cause for rectal bleeding. It is not safe to assume the bleeding is from hemorrhoids, even if they have been a problem in the past.

Colon polyps. Polyps are growths that occur in the lining of the rectum and the colon. Polyps may grow larger over time and lead to the development of colon cancer. They may cause bleeding and when they become large there could be symptoms such as constipation, diarrhea, or abdominal pain, but in most cases, they cause no symptoms at all. Removing polyps, which can be done during a colonoscopy, prevents them from growing and from becoming cancerous.

Colorectal cancer. Cancer in the colon and rectum starts as a polyp. Risk factors for colorectal cancer include age (over 50 years), a family history of the disease, or having an inflammatory bowel disease (IBD). Colon and rectal surgeons are trained in conducting colorectal cancer screening (such as colonoscopy and sigmoidoscopy) as well as the different types of surgery that may be used to treat this disease.

Constipation. Passing hard stools or only going to the bathroom infrequently has a variety of causes. In most cases, it can be treated with changes in diet and lifestyle but a colorectal surgeon can help evaluate constipation and determine if there is a more serious cause.

Diarrhea. There are many causes of loose stools and it often goes away on its own. But for chronic, persistent diarrhea, it might be necessary to look in the colon to see if there is something there that is causing diarrhea. 

Diverticular disease. About half of people over the age of 60 have outpouchings in their colon which are called diverticula. In most cases, they do not cause any symptoms but in some people they can become inflamed and cause symptoms such as abdominal pain, constipation or diarrhea, nausea, fever, or vomiting.

Fistulas. A fistula is an abnormal connection (somewhat like a tunnel) between two body structures. If a fistula occurs in the lower digestive tract (such as between the colon and the vagina), a colorectal surgeon may be consulted for treatment.

Hemorrhoids. A swollen vein in the anal canal or the rectum can cause pain, itching, and bleeding. Often, hemorrhoids can be treated with at-home measures but at times there’s a need for a colorectal surgeon to evaluate them and prescribe other treatment measures, including surgery.

Incontinence. Losing control of bowel movements or stool leaking from the anus is a common problem that can negatively affect quality of life. A colorectal surgeon may order various tests in order to determine the cause of fecal incontinence in order to prescribe the right treatment.

Inflammatory bowel disease (IBD). Crohn’s disease, ulcerative colitis, and indeterminate colitis may affect various parts of the digestive tract. A gastroenterologist will manage these conditions medically, sometimes in conjunction with a colorectal surgeon who has special training in the surgeries that are done to treat these conditions.

Rectal prolapse. A rectal prolapse is when the rectum extends outside of the anus. This is more common in older people and in women after having a baby, and symptoms can include bleeding from the rectum and tissue that can be seen/felt outside of the anus.

Rectocele. A rectocele is a condition that occurs when the layer of tissue between the rectum and the vagina weakens. This causes the rectum to extend and push into the back wall of the vagina. A rectocele often causes no symptoms but may also be associated with constipation, pain in the rectum, incontinence, painful intercourse, and vaginal bleeding. In many cases, changes to diet and therapy such as biofeedback may help with symptoms but for others, surgery may be used.

Procedural Expertise

A colorectal surgeon also has specialized training in doing certain types of endoscopy procedures and surgeries. An endoscopy is a type of procedure that is done to look inside an internal organ such as the colon, the vagina, or the bladder. A colorectal surgeon may carry out a variety of procedures in order to diagnose or evaluate conditions that affect the lower digestive tract.

Colonoscopy

A colonoscopy, which is the test that is done to look inside the anus, rectum, and large intestine, is done for a variety of reasons. It may be used to screen for colon and rectal cancer, to look for the cause of symptoms such as bleeding from the rectum, or as part of the ongoing management of IBD.

Sigmoidoscopy

A sigmoidoscopy is used to look inside the last section of the large intestine, the sigmoid colon. This test may be used to screen for colon cancer or to evaluate hemorrhoids or other conditions that may affect that section of the colon.

Colon and rectal surgeons also perform several different types of specialized operations on the colon, rectum, and anus. There are a variety of surgeries in which these physicians are trained.

Hemorrhoid Surgery

In some cases, hemorrhoids don’t respond to care at home and require surgery. Hemorrhoids might be removed through rubber band ligation, laser coagulation, or hemorrhoidectomy.

Fistula Surgery

Fistulas might be opened up through specialized surgery, either a fistulotomy or fistulectomy, in order to promote healing. Laser coagulation might also be used to treat fistulas.

Ostomy Surgery

Colon and rectal surgeons will complete ileostomy and colostomy surgery, during which part or all of the colon is removed (a colectomy) and a stoma is created.

Polypectomy

Polyps are often removed during a colonoscopy or a sigmoidoscopy, in order to prevent them from growing into cancer.

Resection Surgery

Resection surgery to remove a part of the small or the large intestine may be done to treat colorectal cancer or Crohn’s disease.

Training and Certification

A colorectal surgeon is experienced in general surgery for all parts of the digestive tract but then goes on to receive further training for the lower digestive tract. Education for this specialty begins with four years in an undergraduate program and then four more years in an accredited medical program. The next step is a surgical residency, which can be five or six years long. After that, there are one or two more years of specialized training in colon and rectal surgery.

Colon and rectal surgery is already a sub-specialty but some surgeons may also learn to perform certain procedures that are done less commonly and therefore become more well-versed in those.

After about 14 years of higher education, a colon and rectal surgeon may apply for board certification. These physicians are certified by the American Board of Surgery and the American Board of Colon and Rectal Surgery and may be members of The American Society of Colon and Rectal Surgeons and The American College of Surgeons.

Appointment Tips

A colorectal surgeon is a specialist and therefore some insurance carriers may require a referral from an internist, primary care physician, or gastroenterologist prior to making an appointment. A call to your insurance company (the number will be on the back of your insurance card) can help in determining if a referral is necessary. In some cases, a referral from a physician at a prompt care or walk-in medical office may be acceptable as well.

In addition, some colorectal surgeons will ask for a referral before seeing new patients. They may also want the medical records from the primary care provider or other physician (such as a gynecologist or gastroenterologist) that is making the referral. It may take time and several phone calls to get referrals and to get records transferred, which can be frustrating. However, seeing a specialist for problems in the lower digestive tract is important in getting a diagnosis and then appropriate treatment.

Insurance carriers may also be helpful in finding a colorectal surgeon that is in-network. Physician finders at The American Society of Colon and Rectal Surgeons, the Crohn’s and Colitis Foundation, and the American College of Surgeons also provide physician locator services that may help in finding a surgeon 

A Word From Verywell

Having a need to see a colon and rectal surgeon may bring up many emotions. Some people may find it embarrassing to talk about the problems in the lower digestive system. It may help to remember that physicians who specialize in conditions that affect the colon, rectum, and anus have chosen to work in this field and are interested in helping their patients receive a diagnosis and treatment. They see patients every day with similar issues, whether it be bleeding, constipation, diarrhea, or incontinence. They are well aware that their patients may feel reticent to talk about bathroom problems and it may help in acknowledging during the appointment that it is a sensitive issue to discuss openly. Being open about and telling the surgeon all the symptoms that are occurring will help in getting to the source of the problem and receiving the care that’s needed.