Hemorrhoids, the swollen veins in the rectum and anus, are a common condition affecting a significant portion of the adult population. Because symptoms can be uncomfortable, many people are unsure of the appropriate specialist to consult. Proctologists are the medical experts specifically trained to manage this condition. This article clarifies the role of this specialist and details the different approaches they use, from non-surgical options to advanced procedures.
The Role and Scope of a Colorectal Specialist
The term “proctologist” is the traditional name for a medical specialist who focuses on the lower gastrointestinal tract. Today, this physician is more accurately referred to as a colorectal surgeon or colorectal specialist. Their training involves a general surgery residency followed by a specialized fellowship focusing on the colon, rectum, and anus. This expertise means they are qualified to diagnose and treat all diseases affecting this area of the body.
Hemorrhoids are central to a colorectal specialist’s practice, but their scope extends beyond this single condition. They manage conditions such as anal fissures, fistulas, rectal prolapse, and diverticulitis. They are also the primary surgeons for malignant conditions, including colorectal and anal cancer. Consulting this specialist ensures the patient receives care from a surgeon with the highest level of specific training for lower digestive tract issues.
Diagnosis and Initial Treatment Approaches for Hemorrhoids
A colorectal specialist begins with a thorough physical examination and medical history to assess the severity of the hemorrhoids. Diagnosis involves a visual inspection of the anal area, a digital rectal exam, and potentially an anoscopy. An anoscopy uses a short, lighted tube to view internal hemorrhoids above the dentate line, allowing the specialist to grade the condition for treatment planning.
For mild cases, the first line of treatment involves conservative, non-operative management. This includes increasing dietary fiber intake to 25 to 35 grams per day to soften stools and reduce straining. Specialists also recommend sitz baths and the use of over-the-counter topical creams or ointments to manage pain and inflammation. These steps aim to alleviate symptoms by addressing the underlying cause of pressure and irritation.
If conservative measures are not sufficient, the specialist moves to minimally invasive, office-based procedures. Rubber band ligation (RBL) is a common method for internal hemorrhoids graded I through III. During RBL, a small elastic band is placed at the base of the hemorrhoid to restrict its blood supply. The tissue shrinks and falls off within a week.
Another in-office procedure is sclerotherapy, where a chemical solution is injected into the hemorrhoidal tissue. This injection causes the tissue to scar and shrink. These procedures are effective because they are performed without general anesthesia and allow the patient to return to normal activities quickly.
Advanced and Surgical Interventions
When hemorrhoids are advanced (Grade III or IV) or recurrent despite in-office procedures, a colorectal specialist may recommend a definitive surgical intervention. These procedures are performed in a hospital or surgical center under anesthesia. The goal of surgery is to offer the lowest risk of recurrence for severe cases.
The traditional surgical option is a hemorrhoidectomy, which involves the complete excision of the hemorrhoidal tissue. While highly successful, a conventional hemorrhoidectomy is associated with significant post-operative pain and a longer recovery period. It remains the gold standard for large external or prolapsed internal hemorrhoids.
More specialized techniques include stapled hemorrhoidopexy (PPH), which uses a circular stapling device to remove a ring of tissue above the hemorrhoid. This action pulls the hemorrhoidal cushions back into their normal position, reducing prolapse. Another technique is Doppler-guided hemorrhoidal artery ligation (DG-HAL), which uses an ultrasound probe to locate and tie off the arteries supplying blood to the hemorrhoid. By reducing the blood flow, the hemorrhoidal tissue gradually shrinks.