A first colorectal surgery appointment is primarily a consultation, not an immediate surgical procedure, designed to establish a diagnosis and create a treatment plan. The goal of the visit is to allow a highly trained specialist to review your history and symptoms to determine the most appropriate next steps for care. Understanding the process and preparing thoroughly can help reduce apprehension and ensure you make the most of the time with the surgeon.
Understanding the Scope of Colorectal Surgery
A colorectal surgeon, sometimes referred to as a proctologist, is a medical doctor who has completed specialized fellowship training focused on the disorders of the lower digestive tract. This specialty includes the colon, rectum, anus, and parts of the small intestine and pelvic floor. They are experts in managing both non-surgical and surgical treatments for a wide array of conditions affecting these organs.
The conditions managed by these specialists are diverse, ranging from common benign issues to complex malignancies. Colorectal surgeons frequently treat anorectal diseases like hemorrhoids, anal fissures, and abscesses. They also manage chronic inflammatory conditions such as Crohn’s disease and ulcerative colitis, collectively known as Inflammatory Bowel Disease (IBD).
Other serious conditions falling under their care include diverticulitis, fecal incontinence, and complex pelvic floor disorders. Colorectal surgeons play a central role in the diagnosis and surgical treatment of colon and rectal cancer. While they are surgeons, their expertise ensures that surgery is only recommended when other less invasive medical or lifestyle treatments are not effective or appropriate.
Preparing for Your First Visit
The more organized you are before your appointment, the more effectively the surgeon can assess your situation. You should gather all relevant medical records, especially those pertaining to your current complaint, such as previous colonoscopy or endoscopy reports and pathology results. If you have had any recent imaging, like CT scans or MRIs, it is helpful to bring the written reports and a disc containing the images themselves.
A detailed list of all medications, including dosages, is important for the physician to review. This list must also include any over-the-counter drugs, vitamins, and herbal supplements, as these can interact with prescribed medications or impact symptoms. Insurance information and any necessary referral forms should also be prepared ahead of time.
Creating a specific timeline of your symptoms is highly useful preparation. Note when the symptoms first began, whether they have worsened or improved, and what factors seem to trigger or relieve them. Finally, write down a list of specific questions focusing on your potential diagnosis, the need for further testing, and whether surgery is a likely possibility.
What to Expect During the Appointment
The consultation will begin with a comprehensive discussion of your medical history, which includes a detailed review of the symptom timeline you prepared. The surgeon will ask specific questions about your bowel habits, diet, family history of gastrointestinal diseases, and any prior surgeries. This history intake is crucial because many colorectal conditions present with similar, non-specific symptoms like bleeding or changes in bowel frequency.
Following the history, the surgeon will perform a physical examination. This typically involves a general abdominal examination to check for any tenderness, masses, or organ enlargement. The next part of the physical exam is often a digital rectal exam (DRE), which is a quick procedure necessary for evaluating the health of the anus and rectum.
During the DRE, the surgeon inserts a gloved, lubricated finger a short distance into the rectum to check for abnormalities, such as masses, internal hemorrhoids, or tenderness. This exam also allows the assessment of sphincter muscle tone, which is important for diagnosing conditions like fecal incontinence. The DRE is a standard, minimally invasive tool that provides immediate diagnostic information.
Discussing Diagnostic Procedures
Based on the information gathered during the history and physical examination, the surgeon will discuss preliminary findings and propose a path forward. This initial appointment usually serves as the first step in a diagnostic process, which often involves scheduling specific tests to confirm a diagnosis or accurately stage a condition.
One of the most common diagnostic procedures ordered is a colonoscopy, which allows the surgeon to visually inspect the entire colon and take tissue samples (biopsies) if needed. For some complaints, a flexible sigmoidoscopy, which examines only the lower part of the colon and rectum, might be recommended instead. These endoscopic procedures are often necessary to rule out or diagnose cancer, polyps, or inflammatory bowel disease.
Imaging studies may also be ordered, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI). A CT scan helps determine if a disease, such as cancer or diverticulitis, has spread or caused complications like abscesses. MRI provides detailed soft tissue images, which is particularly helpful for staging rectal cancer or evaluating complex anal fistulas.