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.
Many conditions 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 examining, diagnosing, and treating 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 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:
Proctology is not a medical specialty in itself but belongs to gastroenterology; a proctologist, also known as a colon and rectal surgeon or coloproctologist, is a surgical specialist who guides their skills to diagnose and treat diseases of the colon, rectum, or anus.
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 stool with blood or mucous secretion in the anus is observed, which possibly is a sexually transmitted disease.
- The presence of a room with a painful and reddened swelling on the buttocks may be an abscess or accumulation of pus.
- The presence of rectal bleeding, itching, and 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.
- I have turned 50 and need a screening colonoscopy.
- I have presented polyps in the past and need 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.
- 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.
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 include a stool test to detect microscopic blood.
- A physical examination 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 tiny endoscope called an anoscope, which has a range in the lower rectum.
- You can perform a rectoscope 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 essential to know that most proctological diseases are abnormalities. The treatments are relatively simple, and if they are treated on time, they culminate in a complete recovery.
Particular emphasis should be placed on malignant and cancerous disorders whose treatment can not be delayed, requiring a timely and complex therapy with surgery and complementary medicine.
Many people know a lot about these symptoms and minimal about diseases that can affect the digestive tract.
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 caused by various conditions.
Diseases that are detected through a proctological examination
The most common conditions that a proctologist can treat include:
- The presence of anal and rectovaginal fissures.
- Crohn’s disease .
- Colon polyps
- Colon cancer
- The gallstones.
- The hernias
- 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 the removal of parts of organs or whole organs, such as the gallbladder.
Some types of treatments include:
- Conservative and ambulatory treatment, with the help of creams, suppositories, diet, and a lifestyle change.
- Removal of external hemorrhoid lumps.
- The elimination of the skid marks (the elongated sheaths of the previous hemorrhoid lumps).
- Treatment of fistulas and abscesses.
- Ligation treatment of the nodes of internal hemorrhoids using a rubber ring.
- A particular Doppler test measures the artery that supplies the chunk and suture painlessly in more severe cases.
- Surgical interventions.
Proctological disorders and proposed treatments:
The most common disorders of the anal canal are hemorrhoids and anal fissures.
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, and people who maintain a sedentary lifestyle.
The hemorrhoidal disease includes all those clinical manifestations of pathological changes of hemorrhoids such as bleeding, prolapsed hemorrhoidal nodules, and thrombosis of internal and 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 combined hemorrhoids.
Acute hemorrhoids are known as thrombosis, 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 thrombosis of the hemorrhoids without 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 is characterized by thrombosis with the 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 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.
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.
In the beginning, the patient can quickly 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 the appearance or not of hemorrhages.
- Grade III: Presence of prolapsed hemorrhoids with the 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 the 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 is based on the prescription of a diet, limitation of physical activities, and medication of drugs to reduce edema and achieve the normalization of the microcirculation in the hemorrhoidal plexus with pain relief.
- Minimally invasive treatment: Using 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, and the excision of the entire thrombosed node.
An 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 forming 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 aperture and the presence of rough scar tissue. 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 treating 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, and 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, and rectal cancer, among others, to make a correct differential diagnosis.
The proctologist will indicate a particular treatment method for these and other proctological conditions found in the investigations, depending on the patient’s needs.
This examination includes a digital rectal 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 of the back, in some cases, knees and elbows.
Complete intestine preparation is necessary to perform the test, with the application in a 30-minute interval of two cleaning enemas or laxative suppositories four hours before the examination.
Suppose the patient presents severe pain and other severe symptoms. In that case, an urgent examination will be necessary to avoid early complications and the development of severe diseases in this area, including oncological diseases.
Preparation procedure for surgery
Within 34 days before surgery, the skin found in the perineum region, buttocks, and thighs should be cleaned daily with a Betadine solution.
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 cleansing enema is performed.