Colorectal Surgeon, also known as a proctologist, completes 5 years of general surgical residency after medical school and then undergoes an additional 2 years of specialty training for surgery of the colon, anus and rectal area treating everything from hemorrhoids and anal fistulas to inflammatory bowel disease and cancer.
Hemorrhoids are swollen veins in the anal canal and are common. They develop from increased pressure on the anus from sitting for long periods of time, pregnancy, childbirth and constipation. This pressure causes the normal anal tissue to swell and can lead to bleeding during bowel movements. Hemorrhoids are categorized as external or internal and grades from 1 to 4. The more swollen and painful a hemorrhoid is, the higher the grade. Hemorrhoids do not increase the risk of colorectal cancer or cause it, but rectal bleeding may be a symptom of more serious conditions.
Several treatments for hemorrhoids are available. A cream or ointment applied directly to the area can reduce pain and itching. However, these treatments do not cure the hemorrhoids and they can recur. Some patients can get relief from a warm, moist bath (sitz bath) with potassium permanganate or from taking nonsteroidal anti-inflammatory medications such as ibuprofen.
When over-the-counter treatments do not help, the colon and rectal surgeon can recommend more invasive tests. A sigmoidoscopy or colonoscopy can collect more information on the source of the bleeding. A blood test, including a complete blood count and a red blood cell count, may also be ordered to check for any blood-thinning medications you may be taking.
The most effective treatment for hemorrhoids is a surgical procedure called hemorrhoidectomy. During this procedure, the physician removes the swollen tissue with various tools that include a scalpel, scissors and cautery or a more modern device called LigasureTM which uses an internal vessel sealer to eliminate the need for cutting or stitching.
Hemorrhoidectomy is performed in the hospital with sedation, general anesthesia or a spinal block similar to an epidural injection during labor and delivery. Patients who undergo this procedure usually stay in the hospital for one to a few days.
After a patient recovers from hemorrhoid surgery, he or she must follow simple diet and lifestyle modifications to prevent the condition from returning. Regular exercise, a well-balanced diet and avoidance of constipation can help prevent the recurrence of hemorrhoids.
Diverticulitis
Diverticulitis is a condition where pouches (diverticula) develop in your colon. It often causes pain in the lower abdomen. It can be mild or severe, and the pain usually gets worse with bowel movements. It also may cause back pain, fever or vomiting. Diverticulitis can lead to an infection that needs treatment with antibiotics. It can be a serious problem if the pouch ruptures and causes a pocket of pus to form (abscess). It can also cause blood in your stool or belly pain that spreads to the rest of your body (peritonitis).
Most people have one episode of uncomplicated diverticulitis. This type of inflammation comes on suddenly and goes away quickly with treatment. However, some people have recurring (repeat) episodes of diverticulitis or develop chronic inflammation. This may happen because the first episode didn’t heal all the way, or it might be related to another condition in the colon.
If you have a flare-up of diverticulitis that doesn’t respond to medicine or a change in your diet, surgery may be needed. This is especially true if you have a high risk of repeated attacks or a complication such as a hole in the colon wall (perforation) or narrowing (stricture).
When doctors recommend surgery for diverticulitis, they’re trying to prevent recurrent symptoms or complications. They’ll usually recommend surgery if you have two or more severe episodes of diverticulitis or if you’re at a higher risk for them, such as being younger or having a history of previous colon infections.
Your doctor will use a needle to insert a tube in your belly, then they’ll remove the unhealthy part of your sigmoid colon. This can be done with a large incision (open colectomy) or with several small cuts across your belly (laparoscopic surgery). They’ll use a small video camera and tiny surgical tools to perform the procedure. Then they’ll connect the healthy parts of your colon, which is called anastomosis. If anastomosis isn’t possible, your surgeon will create a hole (stoma) in your belly. Your poop then passes through this opening and collects in a bag on the outside of your belly (colostomy). They’ll close the incisions (cuts) in your belly.
Small Intestine Disorders
While many medical professionals treat conditions affecting the lower digestive tract, colorectal surgeons specialize in treating disorders of the colon and rectum. They have a broad range of knowledge to treat conditions from hemorrhoids to inflammatory diseases and cancer. Our surgeons are also active researchers, advancing the field of colorectal surgery and training future specialists in patient-focused care.
Depending on your condition, a colorectal surgeon can use open or minimally invasive surgeries. During your procedure, you will receive general anesthesia to ensure you do not feel pain or discomfort.
Some disorders require the removal of part or all of your colon and rectum. A surgeon may also need to change the way your body processes waste, a process called bowel adaptation.
In some cases, your doctor will remove the diseased portion of the colon while leaving part or all of your rectum intact. This is called segmental colectomy or a small bowel resection. During this procedure, your doctor makes an incision over the area with disease and removes only that part of the colon. Your surgeon then reconnects the ends of the bowel, which is known as anastomosis.
For some patients, such as those with familial polyposis or ulcerative colitis, a total colon and rectum removal is necessary. A surgeon can restore bowel function in these patients by fashioning a pouch from the remaining parts of the small intestine, which is called a J-pouch.
Another option is a temporary procedure, called an ileostomy. In this type of procedure, your surgeon creates a hole in the abdominal wall and pulls the end of your small intestine through the opening, which is called a stoma. Your surgeon then attaches a pouch to the stoma, which collects your waste.
After surgery, it is normal to experience some pain as your body heals. Your doctor can prescribe medications to manage this pain. You may also need to visit your doctor more often for a few weeks as you adjust to your new bowel habits. In addition, you may develop hernias around your stoma, which can occur over time and cause pain or a bulge in your abdomen. Our doctors can repair these hernias using different methods, including mesh and removing the stoma.
Cancer
Cancer of the colon is a serious illness that can often spread to other parts of the body. When this occurs, additional surgery or treatment may be necessary to protect the remaining organs of the body. The first step in treating colon cancer is usually surgery to remove the primary tumour. This can be done through a large incision or using a minimally invasive technique called laparoscopy. In addition, chemotherapy and radiation therapy may also be used to help shrink the tumour.
During surgical removal of a tumor, your surgeon may need to take a sample of the surrounding tissue (called a biopsy) for testing in a lab. This will show if the cells are cancerous and give doctors more information about the type of tumour. This helps them create an appropriate treatment plan.
If a tumour has not spread to nearby lymph nodes, your doctor can perform a bowel resection, in which the surgeon removes the affected section of the rectum and connects the end of the rectum to the anus. In some cases, the surgeon may need to remove other sections of the rectum as well. If the cancer has spread to lymph nodes that are near your colon, a surgeon can perform a pelvic exenteration, in which they remove the rectum and other parts of the abdomen.
Sometimes, neoadjuvant chemotherapy and/or radiation can be used to shrink a tumour enough that it does not require surgery. If this is the case, your colorectal surgeon may recommend that you watch and wait. Your doctor will check you via physical exam and colonoscopy or sigmoidoscopy on a regular basis to make sure the tumour does not grow or return.
If your colourectal tumour is at an early stage, your doctor can do a minimally invasive procedure called laparoscopic total mesorectal excision to remove the cancer and a margin of healthy tissue around it. This can be done with general anesthesia or sedation. If your colon cancer is at a later stage, your surgeon may need to do a colostomy, in which the bowel is removed completely and connected to an opening made in the abdominal wall. Poop then goes through this opening into a bag.