What is a proctologist, and when should you see one?

Proctology (coloproctology) is the branch of surgery that deals with the colon, rectum, anal canal and the tissues around it. A proctologist is a surgeon specialized in this field: they make the diagnosis, treat with medication and lifestyle measures, and perform surgery when needed.

People most often see a proctologist for these complaints and conditions:

• hemorrhoids (piles): bleeding, itching, lumps that come out after a bowel movement;
• anal fissure, a tear in the anal lining: sharp, burning pain during and after a bowel movement;
• anal abscess (paraproctitis) and anal fistula: painful swelling, fever, discharge of pus;
• colon polyps and early detection of bowel tumors;
• constipation and long-lasting changes in bowel habits;
• rectocele and other pelvic floor problems after childbirth;
• anal itching, anal skin tags, papillomas and pilonidal cyst (ingrown hair).

Dr. Ellada Manafova is both a proctologist and a general surgeon. That is why she also treats general surgery problems such as gallstones, hernias and lumps under the skin. All areas of care are listed on our services page.

Which tests does a proctologist use?

The basis of diagnosis is the doctor's visual inspection and a digital (finger) examination. When needed for your complaint, these are added:

• anoscopy and rectoscopy: looking inside the anal canal and the rectum;
• colonoscopy: examination of the whole colon with a camera; if a polyp is found, it can be removed during the same examination;
• ultrasound and MRI: to see the condition of an abscess, a fistula tract and the pelvic floor;
• defecography (an X-ray or MRI examination of the rectum during a bowel movement): to find the cause of a rectocele and of toilet difficulties;
• biopsy: testing suspicious tissue in a laboratory.

Not every patient needs all of these tests. The doctor chooses which ones are needed based on your complaints and the result of the first examination.

If you have any of these signs, don't wait for it to go away on its own. Often the cause is simple and the treatment is easy, but only an examination can show that.

1. Anal bleeding. Blood on toilet paper, in the stool or in the toilet bowl is never normal. It most often comes from hemorrhoids and an anal fissure, but polyps, inflammation and a bowel tumor can also cause bleeding. More: blood on toilet paper.
2. Pain in the anal area. A burning pain during and for hours after a bowel movement is often a sign of an anal fissure. Pain that gets worse when sitting and keeps growing may come from a thrombosed hemorrhoid (one with a blood clot inside) or from an abscess.
3. Swelling, a lump or a protrusion. A lump that comes out after a bowel movement or that you can feel with your hand may be a hemorrhoid. But a polyp, a papilloma and, rarely, a tumor look similar, so not every lump is a hemorrhoid.
4. Itching, moisture and discharge. Constant itching or a mucus-like or pus-like discharge can come from a fistula, a fissure, a fungal infection, intestinal worms or a skin condition. A cream rubbed on without an examination hides the cause.
5. A change in bowel habits. Constipation or diarrhea lasting more than a few weeks, the two alternating, and a change in the shape of the stool (for example, pencil-thin stool) need an examination.
6. A feeling of incomplete emptying or needing to help with your hand. A feeling that the bowel hasn't emptied completely after a bowel movement, or needing to help with your hand in order to go, is not normal. It is often a sign of a rectocele and other pelvic floor problems.
7. Age 45–50, or bowel cancer in the family. Even without complaints, a preventive examination and colonoscopy are recommended after age 45–50. If colon cancer or polyps run in your family, you should start earlier.

Urgent cases. If you have a painful swelling near the anus that keeps growing with a fever, heavy or non-stop bleeding, or sharp abdominal pain along with being unable to pass gas or stool, don't wait; seek urgent care. Any bowel complaint together with unexplained weight loss, weakness and anemia should not be delayed either.

The main reason people fear a proctological examination is not knowing how it goes. Knowing in advance what awaits you at the appointment reduces anxiety a great deal.

1. A conversation. First, we ask about your complaints, how long they have lasted, your diet, your toilet habits, the medications you take and any earlier operations. For women, the number and course of deliveries also matter.
2. A private setting. The examination is done in a closed room. You uncover only the lower part of your body, and the rest stays covered.
3. A comfortable position. Often it is enough to lie on your side on the examination couch with your knees drawn toward your abdomen. This position is both comfortable and the least embarrassing. If another position is needed, the doctor explains it beforehand.
4. Inspection. The doctor looks carefully at the anal area and assesses whether there is a lump, a fissure, redness, a fistula opening or a skin change.
5. A finger examination. It is done with a gloved finger and lubricating gel, gently, and takes only a few seconds. During it, the state of the sphincter (the ring-shaped muscle that closes the anal canal), painful areas and lumps are checked.
6. Anoscopy, if needed. An anoscope is a small, smooth tube lubricated with gel. With it, the anal canal and the lower part of the rectum are looked at from the inside. It usually takes a minute or two and causes a feeling of pressure, not pain.
7. Results and plan. After the examination, we explain the diagnosis in plain language, answer your questions and discuss the treatment plan together. If needed, additional tests such as rectoscopy, ultrasound or colonoscopy are ordered.

Together with the conversation, the whole appointment usually takes 20–30 minutes.

A proctological examination usually causes no pain, only a brief feeling of discomfort at most. In painful conditions such as an acute anal fissure, a numbing gel is used before the examination. If the pain is very strong, for example with an abscess, the finger examination is kept to a minimum and, when needed, completed with additional methods such as ultrasound. We tell you every step in advance, and you can ask for a pause at any moment.

As for embarrassment: for a proctologist, these complaints are everyday work, while for you it may be the most personal subject there is. We understand this well. Many patients wait for years, and then are surprised when they see that the examination took only a few minutes. In patient stories, you can read the experiences of people who put off coming for 15, even 25 years.

These thoughts most often delay a visit:

• "It will pass." Proctological conditions often don't go away on their own, and waiting makes the problem bigger and treatment harder.
• "I'll buy suppositories at the pharmacy." A product without a diagnosis lessens the complaint for a while but hides the cause.
• "If there's no bleeding, it's not worth going." Some conditions, such as polyps, give no signs for a long time.
• "It will hurt." The examination is short, and a numbing gel is used in painful cases.
• "I'm embarrassed." For the doctor, it is everyday work, and the examination is done confidentially.

We explain these thoughts in more detail in our article on common misconceptions.

If talking is hard, write your complaints on your phone beforehand and show them at the appointment. Every examination is completely confidential, and your medical information is not shared with anyone without your consent.

Proctological conditions are very common in women: pregnancy, childbirth, hormonal changes and constipation raise the risk of hemorrhoids, anal fissure and rectocele. But women are more reluctant to talk about these complaints with a male doctor and put off seeing a doctor for years.

The main advantage of a female proctologist is comfort. It is easier to talk to a female doctor about changes after childbirth, needing to help with your hand on the toilet, urinary leakage or intimate discomfort. And a patient who can speak comfortably comes sooner, which makes treatment simpler.

Dr. Ellada Manafova is a female proctologist and general surgeon who sees patients at Qafqaz Hospital in Baku. She has worked as a surgeon for more than 20 years. During operations, an anesthesia team made up of women works with her: when a female patient is on the operating table, no man enters the room. You can read more about problems after childbirth on our aesthetic proctology page.

• For an ordinary proctological examination, no special preparation, enema or fasting is usually needed; daily hygiene is enough.
• If a rectoscopy or colonoscopy is planned, the bowel must be cleaned beforehand. In that case, we explain the preparation separately.
• Bring earlier test, ultrasound and colonoscopy results and discharge summaries from operations.
• Write down a list of the medications you take, especially blood thinners.
• Note your questions beforehand, because it is easy to forget them when you are nervous.
• If you are pregnant or planning a pregnancy, be sure to say so.

To book an appointment, message +994 55 757 34 47 on WhatsApp or call. The address and map are on our contact page, and we have answered the most common questions on our FAQ page.

One of the reasons people avoid seeing a proctologist is the fear that "they will definitely operate on me." In fact, many problems, for example, an acute anal fissure, early-stage hemorrhoids and many cases of constipation, are treated with diet, toilet habits and medication. Surgery is offered only when conservative treatment doesn't help or the disease has progressed.

We always build the treatment plan together with you: we explain the advantages, recovery time and possible risks of each option in advance. If conservative treatment is chosen, we invite you to a follow-up examination to assess the result.

When surgery is needed, the least traumatic method possible is chosen, for example, laser, LigaSure or the Longo procedure for hemorrhoids. If you have several problems, and your health allows it, they can be treated in one session. More: surgical and conservative treatment.