Proctologist & Proctology Expertise
who is a Proctologist?
A proctologist is a surgical specialist of the anus and rectum. Proctologists are surgeons that have completed successfully a fellowship in colon and rectal surgery and are fellows of colon and rectal societies. Therefore, a colon and rectal surgeon is also proctologist, but the two terms are commonly used interchangeably. A full understanding of the anorectal anatomy and pathology together with a mastery of the old and the new minimally invasive techniques are essential. A possible complication of anal surgery is fecal incontinence, and this should be minimised as it greatly impairs the quality of life. Studies show that best results are in the hands of colon and rectal surgeons with large experience in high-volume centres.
What Is Proctology?
Proctology is the branch of colon and rectal surgery that studies the rectum and the anus. The rectum represents the last portion of the large intestine and it is divided into three portions: lower rectum 0-5 cm, mid rectum 5-10 cm and upper rectum 10-15 cm. This distance is assumed from the anal verge, and it also comprises the anatomical part of the anus. However, this is the most practical subdivision as measured with a rigid proctoscope. As regards indications to give radiotherapy in rectal cancer, the upper limit of distance from the anal verge is 12 cm.
The upper rectum is almost completely intraperitoneal, while the mid and lower rectum are extraperitoneal. This is a very important point as perforations occurring in the lower rectum do not extend into the abdomen with less aggressive treatment needed. Also, excisions of lesions in the lower rectum are safer to perform as there is no risk of entering the peritoneum. Anteriorly the peritoneum reflects over the bladder in males and uterus in females to form the pouch of Douglas. The point of reflection is about 8-9 cm in males and slightly lower in females. The rectum is extraperitoneal posteriorly to about 12 cm from the anal verge. Therefore, particular attention is to be paid when excising anterior lesions through a transanal route not to breach the peritoneum.
The rectum is surrounded by the mesorectum, a fat containing envelope that also bears the lymph nodes that are possible sites of cancer deposits. The mesorectum is separated by the other pelvic organs and structures by a fascia. During rectal cancer surgery, it is important to avoid opening this fascia as this may cause tumor spread. Also, the plane of dissection between the mesorectum and the surrounding structures is very close to the pelvic nerves. Injury to these nerves may cause retrograde ejaculation, bladder dysfunction and impotence.
02. Rigid Proctoscope
What Instruments does the proctologist use?
The proctologist will use mainly two types of instruments in the clinic during the examination: an anoscope and a rigid proctoscope. The anoscope allows to visualise the inside of the anus and the lower part of the rectum. The rigid proctoscope is equipped with a hand-bulb insufflator and a light source. The full length of the rectum can be examined until its transition with the sigmoid colon. Other procedures that can be carried out without the need of sedation in the clinic are: rubber band ligation and injection sclerotherapy for haemorrhoids.
In the operating theatre special probes are used to identify anal fistula tracts that form a communication between the perianal skin and the inside of the anal canal.
What Are The Top Reasons To Visit A Proctologist?
- Pain or burning in the anal region.
- Bleeding from the anus, especially during defecation.
- Presence of a lump that can be felt around the anus or comes out during defecation.
- Urgency to pass stool.
- Change in bowel habits with diarrhea or constipation.
- Incomplete evacuation or feeling something obstructing the passage of stool.
- Fluid discharge that can be pus-like or blood-stained.
What Common Problems Does A Proctologist Treat?
Looking for A Proctologist?
A proctology service in Dubai and Abu Dhabi for all colorectal diseases is currently operating in Dubai London Hospital, Aster Hospital, American Hospital. Currently, Dr. Antonio Privitera is offering a free consultation for nonhealing anal fissure in the same hospital in Dubai.