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Not many of you may have heard of a proctologist until you were referred to one. Proctologists are highly specialized medical doctors who are mostly called colorectal surgeons nowadays. These experts diagnose and treat conditions of the entire gastrointestinal tract, but specifically issues involving the rectum and anus. Although the terms proctologist and colorectal surgeons are used indistinctly, a proctologist mainly focuses on the branch of medicine concerning the anus and rectum (proctology).

A large spectrum of diseases is included under proctology including benign conditions such as haemorrhoids, anal fissure, anal fistula, rectal prolapse, anorectal polyps etc., as well as malignant conditions like rectal and anal cancer. If you experience anal or rectal pain, bumps or bleeding from the region, your general physician or gastroenterologist will refer you to see a proctology doctor for further evaluation.

Understanding Proctology

Proctology is a subspeciality of colorectal surgery that deals with conditions affecting the anal, perianal area and rectum. As proctology is a highly specialized area of medicine, an expert proctologist is a colorectal surgeon who has received many years of training to treat diseases and conditions pertaining to the large bowel and anus. This medical speciality requires four years of college for a bachelor’s degree followed by four years of medical school in the American system. The medical graduates have to then complete a 5-year training program in general surgery with additional training in colon and rectal surgery to become colorectal surgeons and therefore proctologists as well. As expert surgeons, they must complete a fellowship in colon and rectal surgery and must be fellows of colon and rectal societies.

Apart from this, proctologists also complete board certifications as required by their country of practice, before practising in clinics and hospitals. Colorectal surgeons and proctologists in Dubai also regularly participate in the continuing education of proctology.

Proctologist: What conditions do they treat?

A proctologist can manage and treat a variety of conditions affecting the rectum, anus and perianal area. These include:

• Bumps of skin around the anus, commonly known as anal skin tags
• Infections near the anus and rectum termed abscesses and fistulae
• Tears in the anal lining or fissures
• Swollen veins that are found in or around the anus, called haemorrhoids
• Rectal prolapse, which is a condition in which the rectum falls out from its position and moves out of the anal opening
• Pilonidal sinus & Pilonidal cyst are acute or chronic skin infections occurring in the skin and subcutaneous of the natal cleft
• Precancerous growths or polyps, that could potentially lead to malignancy
• Rectal or anal cancer
• Inflammatory bowel disease ( Crohn’s disease and Ulcerative colitis)
• Sexually transmitted infections (STIs) such as genital herpes, gonorrhoea, chlamydia and syphilis, etc.

Diagnosing proctology issues

Generally, diseases affecting the rectum and anus present with symptoms such as itching, burning of the anus, constipation, diarrhoea, infrequent bowel movements, rectal bleeding or blood in the stool, abdominal bloating, cramps or discomfort and rectal or anal pain. If you notice any of these symptoms, it is best to get the opinion of an expert proctologist to get the right treatment and rule out the chance of malignancy. Also, remember that it is important for the doctor to understand the full extent of your symptoms in order to reach a proper diagnosis. Therefore, you must disclose all information without feeling embarrassed.

To make a sound diagnosis, proctology doctors perform a variety of diagnostic tests or surgical procedures. Some of them are:

• Physical examination where the proctologist examines the anus, the lower rectum and prostate using gloved fingers
• Proctoscopy, where the doctor examines the rectum and may take biopsies or remove polyps.
• Anoscopy allows the proctologist to identify abnormalities of the anus
• Colonoscopy allows the doctor to examine the colon, remove polyps and screen for colorectal cancer
• Endorectal ultrasound is an imaging procedure to examine the wall of the bowel and the lymph nodes around it 
• Sigmoidoscopy allows the doctor to examine the lower third of your colon, also called the sigmoid colon

The proctologist mostly relies on an anoscopy and rigid proctoscopy during a clinical examination. The anoscope helps visualise the inside of the anus and the lower part of the rectum. The rigid proctoscope is a unique piece of equipment that has a hand-bulb insufflator and a light source and allows one to examine the length of the rectum until its transition with a sigmoid colon.

After the diagnosis, the proctologist will recommend a suitable surgical procedure including minimally invasive procedures like laparoscopy or robotic surgery. If the patient does not require surgical intervention, the doctor will recommend other nonsurgical treatment options. If a patient is diagnosed with colorectal cancer, the proctologist will work with an oncologist to deliver the best possible treatment that offers higher chances of cure and complete recovery.

When to see a proctologist?

Many people feel embarrassed to discuss symptoms like itching, burning, warts or bumps in and around their anus. While these symptoms may seem of little importance to you, they must be investigated on an urgent basis to avoid delays. Therefore, if you experience any unusual symptoms concerning your digestion, bowel movements and anal opening, it is strongly advised that you see a proctologist at the earliest.

Recent studies show that people above the age of 50 are highly prone to lower digestive tract issues requiring intervention from a proctologist. Experts have noted that even if patients have no risk factors or family history of colon or rectal cancer, they must present themselves for a colonoscopy after the age of 50. This will not only help detect malignancy at an early stage but also remove those polyps that may eventually progress and become cancer.

Another very common issue that people suffer from is haemorrhoids. While haemorrhoids are rare among the younger population, people who experience regular bouts of constipation and straining during bowel movements may develop them from a young age. Factors like pregnancy, obesity or standing/ sitting for long periods put you at greater risk of developing haemorrhoids. By consulting with a proctologist on time, you can not only confirm the diagnosis but also get treated right away. Treatments such as rubber band ligation and injection sclerotherapy for haemorrhoids can be carried out in the clinic without the need for sedation, giving you immediate relief. In short, discussing your issues with a proctology doctor at the earliest will help get a proper diagnosis, and in some cases, resolving the issue with non-invasive treatment without the need for multiple visits.

During your consultation, speak openly with the doctor about your concerns. This will allow you to get a faster diagnosis and treatment. Remember that your proctology doctor is an expert who can help you, however big or small your issue is without any judgement.

If you are unable to directly reach a proctologist in Dubai, ask your primary care doctor or general physician to refer you to one.

Next steps

If you are diagnosed with a condition that requires the expertise of a proctologist, you must consult with a specialist who has a full understanding of the anorectal anatomy and pathology and has mastery of minimally invasive techniques. With over 20 years of experience and expertise in the field, Dr Antonio Privitera is an internationally renowned proctology surgeon, currently practising in the NMC Royal Hospital Dubai Investment Park. Book your appointment today for a comprehensive consultation.