Proctologist: What is it? Importance, Proctological Examination, Diseases and Treatments

There is evidence that proctology was practiced in antiquity, and even then it was seen as a specialty.

However, a proctologist is not an individual with empirical knowledge, the proctologist must first be a general practitioner and then a specialist.

There are many conditions, such as anal itching and hemorrhoids , that should not be treated locally until the causative factors are known.

There are many conditions that should not be treated systemically until the physical examination is complete and the information that a proctologic diagnosis can provide is complete.

Proctology deals with the examination, diagnosis and treatment of acute and chronic diseases of the anal canal , the perineum and the intestine.

Many patients avoid consulting a proctologist because of the embarrassment of the exam or the lack of information.

But a timely exam is vital, especially if you are in the risk category or if you notice some disturbing symptoms.

A proctologist is a medical professional who will diagnose diseases and disorders through the use of techniques and instruments that allow him to inspect the rectum and colon, in a wide range of pathologies such as:

Internal and external hemorrhoids, anal fissures, pararectal fistulas, acute paraproctitis, fecal incontinence, colorectal cancer, rectal polyps , among others.

Proctology, is not a medical specialty in itself, but belongs to the field of gastroenterology, a proctologist, is also known as a colon and rectal surgeon or coloproctologist, is a surgical specialist who guides their skills for the purpose of diagnosing and treat diseases of the colon , rectum or anus.

Importance

Some people may need to see a proctologist to treat a disease of the lower digestive tract, there are reasons to visit a proctologist such as:

  • When a lump is seen or felt in the external anus, a sensation of a foreign object in the rectum or inflammation in the skin in the anal area.
  • When the presence of stool with blood or mucous secretion in the anus is observed, which possibly is a sexually transmitted disease.
  • The presence of an area with a painful and reddened swelling on the buttocks, which may be an abscess or accumulation of pus.
  • The presence of rectal bleeding, itching, pain in the anal area.
  • The appearance of changes in bowel habits, or a change in bowel movements such as: changes in bowel habits with alternate periods of constipation and diarrhea, frequent urge to defecate.
  • Have turned 50 and need a screening colonoscopy .
  • Having presented polyps in the past and needing a follow-up colonoscopy.
  • Have a strong family history of polyps in the colon or colorectal cancer and need an evaluation before any possibility of a genetic disorder.
  • When an operation is necessary for diverticulitis (inflammation of the colon), colorectal cancer or inflammatory bowel diseases, also known as: Crohn’s disease and ulcerative colitis .
  • Possess irritable bowel syndrome .
  • Hemorrhoid problems during pregnancy or after delivery.
  • Long-term or unexplained abdominal swelling.

Diagnosis

There are a wide variety of procedures for the diagnosis of disorders of the anus and rectum, the diagnosis in proctology is made following the following steps:

In the first place, the proctologist will perform a thorough medical examination through:

  • The elaboration of a medical history where the symptoms and the information of hereditary type are reflected.
  • Laboratory tests, which include a stool test to detect microscopic blood.
  • A physical examination that includes a digital rectal exam, in which the proctologist uses a gloved finger to examine the inside of the anal canal smoothly. This is a painless test.
  • The anal area of ​​the patient will also be examined, with a small endoscope called an anoscope, which has a range in the lower rectum.
  • You can perform a rectoscopy, to have the scope of the entire rectum, if necessary.
  • A biopsy or sampling of the histological tissue.
  • Tests of images.

These procedures are minimally invasive. Once the examinations have been made and the tests have been obtained, the patient is presented with a diagnosis to begin the most recommendable treatment.

According to the results of these diagnoses, the doctor will guide the treatment, avoiding surgery, except in those cases whose severity or complexity make it necessary.

Most people are ashamed to expose their rectal symptoms and hide them.

In the case of presenting symptoms of hemorrhoids, they expect them to heal themselves, or they are afraid to undergo the tests that are likely to be necessary.

It is important to know that most proctological diseases are abnormalities, for which the treatments are relatively simple and if they are treated on time they culminate in a complete recovery.

Special emphasis should be placed on malignant and cancerous disorders whose treatment can not be delayed, which usually require a timely and complex therapy, with surgery and complementary treatment.

Many people know a lot about these symptoms, and very little about diseases that can affect the digestive tract.

That’s where the proctologist comes in, based on the signs and symptoms to make a correct differential diagnosis since pain, bleeding, itching, flow, swelling and prolapse are symptoms that can be caused by various conditions.

Diseases that are detected through a proctological examination

The most common conditions that can be treated by a proctologist include:

  • The presence of anal and rectovaginal fissures.
  • The Crohn ‘s disease .
  • Colon polyps
  • Colon cancer
  • The constipation.
  • Diverticulitis
  • The gallstones.
  • The hernias
  • Hemorrhoids
  • Inflammatory intestinal diseases.
  • Irritable bowel syndrome.
  • Perirectal abscess.
  • The anal itching

Proctologists perform corrective colorectal surgeries to repair the colon, rectum, or anus, and surgeries that may involve removal of parts of organs or removal of whole organs, such as the gallbladder.

Treatments

Some types of treatments include:

  • Conservative and ambulatory treatment, with the help of creams, suppositories, diet and a change in lifestyle.
  • Removal of external hemorrhoid lumps.
  • The elimination of the skin marks (the elongated sheaths of the previous hemorrhoid lumps).
  • Treatment of fistulas and abscesses.
  • Ligation treatment, of the lumps of internal hemorrhoids using a rubber ring.
  • In more severe cases, a special Doppler test is used to measure the artery that supplies the lump and suture painlessly.
  • Surgical interventions.

Proctological disorders and proposed treatments:

The most common disorders of the anal canal are hemorrhoids and anal fissures.

Hemorrhoids:

Although it is a common condition, it should not be neglected.

The disease mainly affects those who perform jobs that require intense physical efforts, people suffering from chronic constipation, pregnant women, people who maintain a sedentary lifestyle.

Hemorrhoidal disease includes all those clinical manifestations of pathological changes of hemorrhoids such as: bleeding, prolapsed hemorrhoidal nodules, thrombosis of internal, external nodules, among others.

Hemorrhoids are manifested by a hemorrhage of different intensity during the act of defecation and by the prolapse of internal hemorrhoids.

Hemorrhoids can present as an acute or chronic condition, internal and external hemorrhoids can be detected, depending on the dominant element, and there are combined hemorrhoids.

Acute hemorrhoids:

Acute hemorrhoids is known as thrombosis of hemorrhoids , which is manifested by the enlargement, swelling of hemorrhoids and pain in the anus, often very intense.

There are three degrees of severity in acute hemorrhoids :

  • Grade I: It is characterized by a thrombosis of the hemorrhoids, without the presence of inflammation of the mucous membrane and perianal skin.
  • Grade II: It is characterized by thrombosis of hemorrhoids with inflammation of the mucous membrane.
  • Grade III: It is characterized by thrombosis with transition to inflammation of the mucous membrane and perianal skin.

If the patient addresses a specialist on time and with appropriate treatment, this condition can be resolved in a period of 4 to 6 days.

Necrotic changes of the perianal tissue can develop in severe cases, with the appearance of an abscess in the perianal area.

Chronic hemorrhoids:

The main manifestations are the presence of episodic bleeding, especially when defecating.

Bleeding is usually the first sign of the disease, prolapse of hemorrhoids occurs in the next 5 to 8 years.

At the beginning, the patient can easily reduce it with a simple contraction of the anal muscles, subsequently, the muscle tone decreases and the nodules require a manual reduction.

The grades that are observed in chronic hemorrhoids are:

  • Grade I: Presence of anal bleeding without the prolapse of hemorrhoids.
  • Grade II: Presence of reduced prolapse of hemorrhoids in the anal canal with appearance or not of hemorrhages.
  • Grade III: Presence of prolapsed hemorrhoids with periodic need for manual reduction in the anal canal, with or without the appearance of hemorrhages.
  • Grade IV: Presence of permanent prolapse of hemorrhoids together with the mucous membranes of the rectum, with the inability to reposition them in the anal canal manually with appearance or not of hemorrhages.

Depending on the individual characteristics presented by the patient and the degree of the condition is I, II, III or IV, the proctologist will choose the most appropriate treatment method:

  • Conservative treatment: It is based on the prescription of a diet, limitation of physical activities and prescription of drugs to reduce edema, and achieve the normalization of the microcirculation in the hemorrhoidal plexus, with pain relief.
  • Minimally invasive treatment: Through the use of a ligature of internal hemorrhoids with latex rings. This procedure is performed on an outpatient basis, does not require the application of anesthesia and the costs are minimal.
  • Surgical treatment: This is an outpatient surgery, it is applied in cases of thrombosis of external hemorrhoids and is performed with local anesthesia. In this case, the isolated removal of the thrombotic masses is carried out, as well as the excision of the entire thrombosed node.
Anal fissure:

Anal fissure is a common disease, much more common in women, and it becomes a deterioration of the anal mucosa .

After 3 to 4 weeks of the formation of acute anal fissure and in the absence of appropriate treatment, it becomes chronic.

Visually, the chronic anal fissure differs from the acute one, due to the thickening of the margins of the fissure, the presence of rough scar tissue and in the distal portion a “guardian polyp” is formed.

Pain in patients with chronic anal fissures usually occurs after defecation, this pain is less intense than in acute or even absent anal fissures.

Anal fissure treatment:

In the treatment of chronic anal fissures both minimally invasive techniques and surgery are used.

Pharmacological treatment in these cases is ineffective, but dietary compliance is mandatory.

Enemas, sitz baths and suppositories are recommended with Belladona.

It is essential to visit a proctologist on time, since the treatment is minimally invasive, the non-surgical treatment of the fissures is very efficient.

When the symptoms of anal fissures appear, it is necessary to exclude secondary anal fissures in the case of tuberculosis, syphilis, rectal cancer, among others, to make a correct differential diagnosis.

For these and other proctological conditions found in the investigations, the proctologist will indicate a method of individual treatment, depending on the conditions of the patient.

Pathological examination:

This examination includes a digital rectal exam or rectal examination, an instrumental examination of the anal canal and the rectal mucosa through the proctoscope.

This examination is performed in a physiological position lying on the side or on the back, in some cases, knees and elbows.

To perform the test, a complete preparation of the intestine is necessary, with the application in a 30-minute interval, of two cleaning enemas or laxative suppositories, four hours before the examination.

In case the patient presents severe pain and other severe symptoms, an urgent examination will be necessary to avoid early complications and the development of serious diseases in this area, including the development of oncological diseases.

Preparation procedure for surgery

Within 34 days prior to surgery, the skin found in the region of the perineum, buttocks and thighs should be cleaned daily with a Betadine solution.

The day before surgery, you should remove pubic hair, perineal hair, buttock hair and thighs.

The day before surgery, the patient will be given a laxative.

Also on the eve of surgery, two cleaning enemas are performed and on the morning of the surgery, at least 1 to 1.5 hours before, a cleaning enema is performed.

The patient will keep fasting from the night of the day before surgery.