1. Who Is a Colorectal Surgeon?

A proctologist or colon and rectal surgeon (colorectal surgeon) is a doctor who specializes in the surgical management of the diseases of the colon, rectum, and anus. To become a colorectal surgeon, after graduating from medical school, a doctor completes a residency program in general surgery, followed by a fellowship in colon and rectal surgery.
Conditions commonly managed by colorectal surgeons include colorectal cancer, diverticulitis, ulcerative colitis, Crohn’s disease, irritable bowel syndrome, fecal incontinence, colorectal malformations, rectal prolapse, anal fissures and fistulas, anal abscesses, and hemorrhoids. Gastroenterologists and colorectal surgeons often address the same colon and rectal diseases and both may perform diagnostic and therapeutic endoscopic procedures. However, gastroenterologists provide medical treatment, while colorectal surgeons provide surgical treatment for these diseases.

2. When Should I See a Colorectal Surgeon?
Your primary care provider will usually refer you to a colorectal surgeon for symptoms that may indicate a problem with your colorectal health, including :
• Persistent abdominal pain or tenderness in lower abdomen
• Gas or bloating
• Fatigue
• Poor appetite
• Unexplained weight loss
• Nausea and vomiting
• Changes in bowel habits
• Persistent constipation or diarrhea
• Rectal bleeding or blood in the stools
• Pain during bowel movements
• Itching or pain in the anus, especially while sitting
• One or more hard tender lumps near the anus
• Anorectal malformations
Additionally, if you are over 50 or if you have family history of colorectal cancer, you may be referred for a screening colonoscopy.

3. What Tests Does a Colorectal Surgeon Perform or Recommend?

A colorectal surgeon may request several tests, including:

• Blood, urine and stool tests
• Stool DNA test for colon cancer or colon polyps
• Stool test for hidden (occult) blood
• Imaging tests including ultrasound, computed tomography (CT) scan, MRI, x-ray, virtual colonoscopy, and others

Colorectal surgeons perform several types of endoscopy for diagnosis and certain treatments of digestive diseases. Endoscopic procedures include:
• Colonoscopy to examine the colon
• Sigmoidoscopy to examine the rectum and sigmoid colon
• Rectoscopy to examine anal cavity, rectum, and sigmoid colon
• Anoscopy to examine anus and rectum

During endoscopy, colorectal surgeons may take small samples of tissues (biopsy), stop any bleeding, and perform other types of treatments such as excising polyps, opening strictures, and removing foreign objects.

4. What Procedures Does a Colorectal Surgeon Perform or Recommend?

Colorectal surgeons may perform any open or laparoscopic abdominal surgical procedure for colorectal diseases, commonly including:

• Colectomy or proctocolectomy (resection surgery of colon or colon and rectum)
• Stricturoplasty (for narrowed bowel segments)
• Polypectomy
• Colostomy (creation of opening in the abdominal wall for one end of the colon)
• Ileal pouch-anal anastomosis
• Rectopexy
• Surgery for hemorrhoids - hemorrhoid banding, hemorrhoidectomy, sclerotherapy, hemorrhoid artery ligation
• Lateral-internal sphincterotomy for anal fissures
• Fistulectomy (removal of fistula) and fistulotomy (opening of fistula) for anal fistulas
• Transanal endoscopic microsurgery
• Endoscopic mucosal resection
• Neurostimulation therapy for fecal incontinence

5. What Questions Should I Ask a Colorectal Surgeon?

You may want to ask these kinds of questions:

• What condition do I have? What caused my condition? What complications can I expect?
• What are my treatment options? Are there any alternatives to this treatment?
• Do I need an endoscopy, surgery, or any other procedure? Can this procedure be performed as an outpatient?
• Can you describe in detail what will be done during this procedure?
• How do I prepare for my surgery?
• What kind of anesthesia will I receive? What are the risks for this anesthesia?
• What can I expect during and after my surgery? How long will the surgery take?
• What are the success rates of this treatment? What are the risks involved?
• Should I continue taking my other medicines?
• Will I be able to resume normal activities and daily routine post recovery?
• Will it affect my digestion process or bowel habits?
• How long will recovery take? Are there any restrictions on diet and physical activity during this period?
• Can my condition occur again? What lifestyle modifications can I make to improve my outlook and prevent the recurrence of the disease?
• Are there any dietary guidelines I need to follow?
• What are the emergency signs and symptoms I need to watch out for?
• How often should I have another endoscopy or follow-up examination?