A proctologist is a doctor who specializes in diagnosing and treating conditions of the colon, rectum, and anus. The term “proctologist” is still widely used in everyday language, but the modern medical title is colorectal surgeon. These specialists handle everything from hemorrhoids and anal fissures to colorectal cancer and inflammatory bowel disease.
Why the Name Changed
“Proctologist” comes from the Greek word “proktos,” meaning anus or rectum. As the specialty expanded to include the entire colon and more complex surgical procedures, the profession adopted the broader title of colon and rectal surgeon. The American Board of Colon and Rectal Surgery is the governing body that certifies these specialists in the United States. If you search for a proctologist today, you’ll almost always find listings under “colorectal surgeon” instead.
What a Colorectal Surgeon Treats
The range of conditions is broader than most people expect. Many patients are referred for common, non-life-threatening problems like hemorrhoids, anal fissures (small tears in the lining of the anus), anal fistulas (abnormal tunnels between the anal canal and surrounding skin), rectal prolapse, and chronic constipation. These are the bread-and-butter cases that make up a large portion of the specialty.
On the more serious end, colorectal surgeons treat colon cancer, rectal cancer, anal cancer, and precancerous polyps that are too large to be removed during a standard colonoscopy. They also manage inflammatory bowel diseases like Crohn’s disease and ulcerative colitis when medication alone isn’t enough and surgery becomes necessary. Other conditions include diverticulitis, fecal incontinence, pelvic floor dysfunction, and inherited syndromes like familial adenomatous polyposis and Lynch syndrome that significantly raise cancer risk.
How They Differ From Gastroenterologists
This is one of the most common points of confusion. Gastroenterologists are medical specialists who manage diseases of the entire digestive tract, from the esophagus to the stomach, liver, pancreas, and intestines. They perform colonoscopies and endoscopies, and they handle conditions like irritable bowel syndrome (IBS), acid reflux, and liver disease. What they generally don’t do is operate.
Colorectal surgeons pick up where gastroenterologists leave off. If a gastroenterologist finds a polyp during a colonoscopy that’s too large to remove with the scope, or discovers a colon cancer, the patient gets referred to a colorectal surgeon. Similarly, when Crohn’s disease or ulcerative colitis becomes severe enough to require surgery, the colorectal surgeon takes over that aspect of care. Gastroenterologists focus on the upper digestive tract and medical management of gut diseases. Colorectal surgeons focus specifically on the colon, rectum, and anus, with an emphasis on surgical solutions.
That said, colorectal surgeons don’t only operate. For problems like hemorrhoids and anal fissures, they often start with non-surgical treatments and escalate to surgery only when conservative approaches fail.
Training and Certification
Becoming a colorectal surgeon requires at least ten years of education after college. That includes four years of medical school, a minimum of five years of general surgery residency, and then one additional year of specialized fellowship training in colon and rectal surgery. The fellowship must be accredited by the Accreditation Council for Graduate Medical Education (ACGME).
To become board certified, a colorectal surgeon must pass a two-part examination administered by the American Board of Colon and Rectal Surgery: a written exam followed by an oral exam. This certification confirms the surgeon has met the highest standards of training and competency in the specialty.
Common Procedures
Colorectal surgeons perform a wide variety of procedures, ranging from quick in-office exams to major abdominal operations. On the diagnostic side, they use tools like anoscopy, a short examination of the anal canal that takes 15 to 30 minutes, requires no sedation, and can help identify hemorrhoids, fissures, polyps, and tumors. It’s much less involved than a colonoscopy.
Surgical procedures include hemorrhoidectomy (removal of severe hemorrhoids), colectomy (removal of part or all of the colon, also called a bowel resection), and repair of fistulas, hernias, and prolapse. Many of these surgeries can now be done using minimally invasive techniques, including laparoscopic and robotic-assisted approaches, which typically mean smaller incisions and shorter recovery times compared to traditional open surgery.
What to Expect at Your First Visit
A first appointment with a colorectal surgeon typically lasts about 45 minutes. You’ll meet with a team that may include a nurse practitioner, the attending surgeon, and possibly a surgical resident or fellow. The visit starts much like any other doctor’s appointment: a thorough review of your medical history, your current medications and dosages, and any family history of cancer or digestive disease.
Bring any lab results, imaging studies, or colonoscopy reports you already have. After reviewing your history and performing a physical exam, the surgeon will discuss your options with you. For many patients, that first visit is purely a consultation, not a commitment to surgery. Depending on your condition, the plan might be as simple as dietary changes and topical treatments, or it might involve scheduling a procedure.
Symptoms That Lead to a Referral
Most people end up seeing a colorectal surgeon after a referral from their primary care doctor or gastroenterologist. The symptoms that typically prompt a referral include rectal bleeding, persistent changes in bowel habits, chronic constipation that hasn’t responded to standard treatments, unexplained anal pain, fecal incontinence, or a mass or lump near the anus. A colonoscopy that reveals large polyps, cancer, or signs of inflammatory bowel disease is another common reason for referral.
Rectal bleeding in particular is worth paying attention to. While it’s frequently caused by something benign like hemorrhoids, it can also be an early sign of colorectal cancer. A colorectal surgeon can determine the cause quickly and accurately, often during a single office visit.