A colorectal surgeon is a doctor who specializes in treating conditions of the large intestine, specifically the colon, rectum, and anus. They complete full training as general surgeons first, then pursue additional specialized fellowship training focused on this part of the body. If you’ve been referred to one or are wondering whether you need one, understanding their scope can help you know what to expect.
What Colorectal Surgeons Actually Do
The title includes “surgeon,” but these specialists do far more than operate. They diagnose conditions, perform in-office procedures like colonoscopies and ultrasounds, manage chronic diseases, and monitor patients long-term. Surgery is one tool in their practice, not the only one.
Their primary focus is the large intestine, but because organs in the pelvis and abdomen are closely connected, colorectal surgeons frequently treat problems involving the small intestine, pelvic floor muscles, urinary system, and female reproductive organs. A rectal prolapse, for example, often involves weakened pelvic floor muscles. A fistula between the rectum and vagina falls squarely in their domain.
Training and Certification
Becoming a colorectal surgeon requires roughly 14 years of education and training after high school. That includes four years of college, four years of medical school, a five-year general surgery residency, and a one-year fellowship specifically in colon and rectal surgery. Some programs have discussed extending the fellowship to two years.
After completing training, surgeons must pass both the American Board of Surgery qualifying exam and a two-part exam from the American Board of Colon and Rectal Surgery. Certification requires demonstrating proficiency across key procedure types, including pouch surgery, prolapse repair, fistula surgery, hemorrhoid surgery, incontinence surgery, and removal of the rectum for cancer. Candidates must also commit to limiting the majority of their practice to colon and rectal surgery.
Conditions They Treat
The range is broad, spanning everyday problems and life-threatening diseases. On the common end, colorectal surgeons treat hemorrhoids, anal fissures, and diverticulitis. These are conditions that a primary care doctor or gastroenterologist may initially manage, but that sometimes need surgical expertise when they don’t respond to conservative treatment.
For cancer, colorectal surgeons handle colon cancer, rectal cancer, anal cancer, and appendix cancer at all stages, including metastatic disease. They also manage inherited conditions that raise cancer risk, such as familial adenomatous polyposis, Lynch syndrome, and other polyposis syndromes.
Inflammatory bowel disease is another major part of their work. Many people with Crohn’s disease or ulcerative colitis are managed with medication, but surgery becomes necessary when medical therapy fails or complications arise, such as abscesses, strictures, or toxic colitis. These procedures can involve removing diseased segments of bowel, creating temporary or permanent stomas, or constructing internal pouches to restore normal bowel function.
Less commonly known conditions in their scope include pelvic floor dysfunction (difficulty with bowel movements due to muscle coordination problems), fecal incontinence, rectal prolapse, and hidradenitis suppurativa, a painful skin condition that can affect the area around the anus.
Surgical Approaches
Most colorectal operations today use minimally invasive techniques rather than large open incisions. Laparoscopic surgery, which uses small incisions and a camera, became the standard approach after research showed it was equally safe and effective as open surgery while offering faster recovery. Robotic surgery using systems like the da Vinci platform has also become increasingly common, giving surgeons enhanced precision and visualization in tight spaces like the pelvis.
Common procedures include removing part or all of the colon (colectomy), low anterior resection for rectal cancer, and creating or reversing ostomies. For benign conditions, many procedures are much simpler: draining an abscess, repairing a fistula, or removing hemorrhoids can sometimes be done in an outpatient setting with a relatively quick recovery.
How They Differ From Gastroenterologists
People sometimes confuse these two specialties. Gastroenterologists are internal medicine doctors who specialize in the entire digestive tract, from the esophagus to the anus. They perform diagnostic colonoscopies and manage conditions medically but do not perform surgery. Colorectal surgeons focus specifically on the lower digestive tract and can both operate and manage conditions non-surgically. In many cases, the two work together: a gastroenterologist might find a complex problem during a colonoscopy and refer the patient to a colorectal surgeon for treatment.
You may also hear the older term “proctologist.” This was the previous name for the specialty when it focused more narrowly on the rectum and anus. As the field expanded to include the full colon, the name shifted to colorectal surgery. The terms refer to the same type of specialist today.
Diagnostic Tools in Their Office
A visit to a colorectal surgeon doesn’t necessarily mean you’ll have surgery. These specialists use several diagnostic tools to evaluate your condition before recommending a treatment plan. High-resolution anoscopy lets them examine the anal canal closely for cancer or precancerous changes. Endorectal ultrasound provides detailed images of the rectal wall and surrounding tissue, which is particularly useful for staging rectal cancers. They also perform flexible sigmoidoscopy and full colonoscopies, and can use anorectal manometry to measure how well the muscles controlling bowel movements are functioning.
Signs That May Lead to a Referral
Your primary care doctor or gastroenterologist typically refers you to a colorectal surgeon when a condition needs surgical evaluation or has not improved with standard treatment. Certain symptoms deserve prompt attention. Rectal bleeding carries the strongest association with colorectal cancer, with research showing it increases risk roughly fivefold compared to people without that symptom. Persistent abdominal pain, ongoing diarrhea, and iron deficiency anemia (which can signal hidden blood loss in the digestive tract) are also red flags, particularly in people under 50, where rates of colorectal cancer have been rising.
Screening colonoscopies are now recommended starting at age 45 for people at average risk, with repeat exams every 10 years if results are normal. If polyps are found during screening, or if results suggest something more serious, a colorectal surgeon is often the next step. Adults aged 45 to 75 fall within the recommended screening window, while screening between 76 and 85 is an individual decision based on overall health.