Colorectal Surgeon

What is a colorectal surgeon (proctologist)?

A colorectal surgeon is a surgeon who specializes in conditions affecting your large intestine (your colon, rectum and anus.) Formerly, you may have gone to see a proctologist for these conditions. “Colorectal surgeon” is the more up-to-date term for what’s essentially the same specialty as a proctologist.

Is there a difference between a colorectal surgeon vs. proctologist?

One reason for the name change may be that the term, “proctologist,” literally refers to the rectum and anus, but doesn't include the colon. “Colorectal” refers to the colon and rectum, which make up the largest portion of your large intestine. In practice, a surgeon by either name treats all of these parts.

Why would you go to a colorectal surgeon?

If you have symptoms involving your lower gastrointestinal (GI) tract, you might begin by seeing a general physician or a gastroenterologist (a specialist in gastrointestinal diseases). This doctor might refer you to a colorectal surgeon if they believe your condition is likely going to require surgery to manage it.

Colorectal conditions that are likely to require surgery include:

• Cancer and polyposis.
• Inflammatory bowel disease (IBD).
• Ischemia (loss of blood supply).
• Structural defects, such as fistulas, hernias and prolapse.

Do colorectal surgeons only treat the large intestine?

Colorectal surgeons specialize in the large intestine, but they are also general surgeons. And, since organs in your body tend to affect each other, colorectal surgeons often end up treating other organs that directly interact with your large intestine or that share the same disease. These may include your:

• Small intestine.
• Pelvic floor muscles.
• Urinary system.
• Female reproductive system.

What qualifications does a colorectal surgeon have?

In the U.S., a colorectal surgeon spends at least five years training as a general surgeon and one additional year of residency specializing in colorectal conditions. After training, they pass a written exam and an oral exam to become certified as colorectal surgeons by the American Board of Colorectal Surgery.

What does a colorectal surgeon study that a general surgeon doesn’t?

Colorectal surgeons go deep into the study of intestinal and anorectal physiology in order to understand how all the parts work together. This makes them uniquely qualified to analyze complex physiological problems involving how everything works together and to treat them with the delicacy they require.

What does a colorectal surgeon do?

Colorectal surgeons practice the full range of endoscopic and surgical techniques for treating your GI tract. That means they have all the available tools at their disposal to treat complex conditions. They can treat you nonsurgically (by endoscopy), with minimally invasive surgery or with open surgery.

Techniques colorectal surgeons use include:

• Colonoscopy: Endoscopic examination of your large intestine that allows minor interventions.
• Enteroscopy: Endoscopic examination of your small intestine that allows minor interventions.
• Sigmoidoscopy: Endoscopic examination of your sigmoid colon, rectum and anus that allows for minor interventions.
• Laparoscopy: Exploratory examination of your abdominal organs, using a special endoscope (laparoscope) passed through a small cut in your abdomen.
• Laparoscopic surgery: Minimally invasive surgery technique that uses a laparoscope to operate through several small cuts in your abdomen.
• Robotic surgery: Laparoscopic surgery using a robotic arm that the surgeon controls from a console.

Procedures colorectal surgeons perform include:

• Polypectomy: Endoscopic removal of polyps from your intestines.
• Endoscopic mucosal resection (EMR) / endoscopic submucosal dissection (ESD): Advanced endoscopic techniques for removing difficult tumors.
• Transanal endoscopic microsurgery: Surgery through a proctoscope to remove large tumors or obstructions.
• Bowel resection surgery: Removal of part or all of your large intestine.
• Ostomy surgery: Colostomy or ileostomy to redirect your bowels to a stoma.
• Anastomosis surgery: Reversing an ostomy and reconnecting the bowels.
• Appendectomy: Removal of an inflamed appendix.
• Anoplasty: Surgery to repair or reconstruct the anus.
• Rectopexy: Repair of rectal prolapse.
• Sacrocolpopexy: Repair of pelvic organ prolapse.
• Hernia repair: Repairing intestinal hernia, including laparoscopic and robotic methods.
• Cecostomy / antegrade colonic enema (ACE) surgery: Implanting an enema tube.

They also conduct routine diagnostic tests of your colorectal and anal function, including:

• Digital rectal exam.
• Anoscopy.
• Proctoscopy.
• Defecography.
• Endorectal ultrasound.
• Anorectal manometry.

What conditions do colorectal surgeons treat?

You may see a colorectal surgeon to treat:

Colorectal cancer, including:

• Colon cancer.
• Rectal cancer.
• Anal cancer.
• Appendix cancer.
• Peritoneal carcinomatosis.
• Gastrointestinal stromal tumors.
• Neuroendocrine tumors.
• Hereditary nonpolyposis colorectal cancer (HNPCC).

Colorectal polyps and inherited polyposis syndromes, including:

• Familial adenomatous polyposis syndrome (FAP).
• Lynch syndrome.
• MUTYH-associated polyposis (MAP).
• Serrated polyposis syndrome / Hyperplastic polyposis syndrome.
• Desmoid tumors.
• Peutz-Jeghers syndrome.
• Juvenile polyposis syndrome.
• PTEN hamartoma syndrome.

Complicated colitis, including:

• Diverticulitis.
• Ulcerative colitis.
• Microscopic colitis.
• Pseudomembranous colitis.
• Crohn’s disease.
• Appendicitis.
• Necrotizing enterocolitis.
• Ischemic colitis.

Functional bowel disorders, including:

• Pelvic floor dysfunction.
• Fecal incontinence.
• Obstructed defecation.
• Anismus.

Structural defects including:

• Large bowel obstructions.
• Anal fistula.
• Rectovaginal fistula.
• Perineal hernia.
• Perianal abscess.
• Rectal prolapse.
• Pelvic organ prolapse.

Benign conditions of the large intestine, including:

• Gastrointestinal bleeding / rectal bleeding.
• Anal fissures.
• Anal warts.
• Hemorrhoids.
• Rectal ulcers.
• Constipation and fecal impaction.

A note from Cleveland Clinic

Your large intestine is also known as your lower gastrointestinal tract. That’s because it’s the last part of the journey food takes through your digestive system before exiting at the bottom. If you have symptoms in your lower GI tract, you might feel them in your lower abdomen or notice them when you poop.

This is the domain of a colorectal surgeon, who specializes in the colon, rectum and anus. Not all conditions need surgical treatment, but when they do, it’s helpful to see a specialist. A healthcare provider will refer you to a colorectal surgeon if they believe one may be able to treat your condition more effectively.