A colorectal surgeon is the doctor who removes hemorrhoids surgically. Sometimes called a proctologist, this specialist completes a general surgery residency followed by additional training focused entirely on the colon, rectum, and anus. While your primary care doctor can diagnose hemorrhoids and a gastroenterologist can perform certain in-office procedures, a colorectal surgeon is the specialist qualified to perform a full surgical removal.
Start With Your Primary Care Doctor
Most people begin with their regular doctor. A primary care physician can diagnose hemorrhoids through a physical exam and, if needed, use a small viewing instrument to check the lower rectum. They’ll ask about your symptoms, bowel habits, and how much fiber you eat. For mild hemorrhoids, your doctor may recommend dietary changes, over-the-counter creams, or stool softeners without referring you to anyone else.
Your primary care doctor will refer you to a specialist if your symptoms don’t improve after a week of home treatment, if you have significant rectal bleeding, or if they suspect something else is going on. They may also recommend a colonoscopy if you’re middle-aged and haven’t had one recently, or if you have risk factors for colorectal cancer.
What a Gastroenterologist Can Do
A gastroenterologist focuses on the entire digestive tract. For hemorrhoids, they can prescribe medications, recommend lifestyle changes, and perform certain office-based procedures. The most common one is rubber band ligation, where a small band is placed around the base of an internal hemorrhoid to cut off its blood supply. The hemorrhoid shrinks and falls off within a few days. This procedure doesn’t require anesthesia and is done during a regular office visit.
What a gastroenterologist generally won’t do is operate. If your hemorrhoids are large, prolapsing (bulging outside the anus), or not responding to banding or other in-office treatments, you’ll need a colorectal surgeon.
Colorectal Surgeons Handle Surgical Removal
A colorectal surgeon, formerly known as a proctologist, is the specialist trained to surgically remove hemorrhoids. To earn board certification from the American Board of Colon and Rectal Surgery, a surgeon must first complete a general surgery residency and pass the American Board of Surgery qualifying exam, then finish an additional accredited residency in colon and rectal surgery. Hemorrhoid surgery is a required part of their training.
These surgeons perform several types of procedures depending on the severity:
- Hemorrhoidectomy: The surgeon cuts out large external hemorrhoids or internal hemorrhoids that have prolapsed. This is the most thorough option, and hemorrhoids removed this way generally don’t come back.
- Hemorrhoid stapling: A stapling device removes internal hemorrhoid tissue and pulls any prolapsed tissue back into position inside the anus.
- Transanal hemorrhoidal dearterialization: The surgeon uses sutures to tie off the blood vessels feeding internal hemorrhoids, then stitches prolapsed tissue back into place.
Recovery After Surgical Removal
The surgery itself is relatively quick, but recovery takes longer than most people expect. The average healing time is two to four weeks, though some people need up to eight weeks before returning to strenuous exercise or physical labor. Most patients report that pain resolves within about two weeks. The main advantage of surgical removal over office procedures is durability: hemorrhoids treated with a full hemorrhoidectomy typically don’t return.
How to Choose the Right Doctor
The right specialist depends on where you are in the process. If you haven’t been evaluated yet, start with your primary care doctor. They can confirm the diagnosis and rule out other conditions. If your hemorrhoids are internal and moderate in size, a gastroenterologist may be able to treat them with banding or another in-office procedure, saving you a surgical recovery.
If you’re dealing with large external hemorrhoids, hemorrhoids that protrude and won’t stay inside, severe pain, or persistent bleeding, a colorectal surgeon is the doctor you need. You can ask your primary care doctor for a referral, or many colorectal surgery practices accept self-referrals depending on your insurance. When choosing a surgeon, look for board certification through the American Board of Colon and Rectal Surgery, which confirms they’ve completed the specialized training required for these procedures.
Preparing for Your Appointment
Before your first visit with a specialist, keep track of your symptoms: how long you’ve had them, whether they’ve changed, and what you’ve already tried at home. Your doctor will want to know about your bowel habits, diet, and any family history of digestive problems. The exam typically involves a visual inspection and possibly a digital rectal exam. If internal hemorrhoids are suspected, the doctor may use a small scope to look inside the lower rectum. This is brief and done in the office without sedation.
Seek care promptly if you experience rectal bleeding along with abdominal pain, fever, chills, nausea, or vomiting. These symptoms can signal something beyond hemorrhoids that needs immediate evaluation.