The professional figure of the proctologist
A proctologist is the surgeon in charge of the prevention, diagnosis and treatment of all disorders and diseases related to the colorectal system. Through careful expert assessments, they aim to identify and implement the appropriate therapeutic pathways necessary for the patient’s improvement and healing. In Italy there is currently no specialised academic training in coloproctology, but instead intensive courses and master courses thanks to which doctors specialised in general surgery have the opportunity to develop their training. During their academic years, the specialists train in different types of approaches, surgical and non-surgical techniques and treatments, and subsequently remain updated through courses, congresses and masterclasses that take place annually across the entire national territory, but also through trade shows and events of worldwide importance.
Pathologies treated by the proctologist
A proctologist treats colon, rectum and anus diseases. A proctological examination is necessary for patients with a known proctological disease, but also to ascertain the nature of symptoms affecting the rectum and anus in the presence of pain, bleeding, itching, purulent secretions and swelling. The pathologies treated by this specialist are indeed numerous:
- constipation and faecal incontinence;
- haemorrhoids, fissures, marisca and anal fistulas;
- rectal abscesses;
- ulcerative colitis;
- anal condyloma;
- rectal prolapse;
- diverticulitis and diverticulosis;
- Crohn’s disease;
- irritable bowel syndrome;
- colorectal polyps;
- colorectal cancer.
In order to better understand the patient’s clinical picture and to find concrete responses to the disease, the specialist must perform a proctological examination. What is it?
Proctological examination: it is important not to be afraid
A proctological examination certainly creates a lot of fear and embarrassment: is this attitude justified? Not really! Discomfort and fear at the idea of a proctological examination are emotions that are entirely natural: embarrassment and the fear of feeling pain can lead to a postponing of the appointment with the proctologist. For this reason, the examination usually takes place a long time after the onset of the symptoms experienced. Giving the right weight to fear, overcoming it and contacting a medical specialist is however fundamental; it allows to detect and treat proctological pathologies that would be of minimum magnitude if taken in time and/or to avoid the onset of much more critical diseases (such as cancer pathologies). This is why it is advisable to undergo this type of examination when the first symptoms appear.
How a proctological examination is carried out
A proctological examination allows the doctor to carry out accurate assessments that are useful to identify and implement the appropriate therapeutic paths necessary for the patient’s healing. The first step of the proctological visit is the medical history: through a series of questions, the doctor can collect as much information as possible about the patient’s symptoms, clinical history and lifestyle, such as nutrition, smoking, alcohol consumption, level of physical activity and sedentariness, possible pathologies, family cases of proctological pathologies and intake of medication.
The visit continues with an inspection of the anal canal, at first external, by observation and palpation, and then internal, by digital exploration. This exploration, which the specialist carries out with a lubricated glove (in order to avoid any pain), is carried out on the patient lying on their left side in foetal position. Although there are many preconceived notions about the proctological visit, it actually causes only slight discomfort. Pain is rare and is related to significant inflammation of the anal canal mucosa.
If it is deemed appropriate, the physician may, for more accurate internal rectal examination, subject the patient to an anoscopy and a proctoscopy, which are carried out by the introduction into the anal canal of instruments that allow a direct view of the canal. The proctological evaluation may end with the prescription of a therapy or by the request of further specialised investigations, such as blood tests, X-ray and colonoscopy. The latter, in particular, is fundamental for the early diagnosis of diseases such as colorectal cancer or inflammatory bowel diseases.