The proctological consultation represents an important tool for preventing colorectal diseases. The Colo-proctology is an ultra-specialized branch of Surgery and Gastroenterology. In some European countries and in the United States, it is recognized as an independent speciality.
When should we undergo a proctological consultation?
For preventive purposes, it is recommended after the age of 40. If there is a family history of colorectal cancer, the examination should be done at age 30, even in the absence of symptoms.
About this, some symptoms are indicative for anorectal disorders, in the presence of which the patient should request a proctological examination. Let's consider the main ones:
Bleeding
Bleeding may manifest as small traces of blood on the toilet paper or underwear, or it can be most abundant during or after the defecation. The blood may be bright or dark red, mixed with clots. In most cases, it is due to benign conditions such as hemorrhoids or anal fissures. However, more serious conditions can cause bleeding with similar characteristics. Therefore, a colo-proctological examination is recommended whenever a rectal bleeding occurs.
Pain
The most common causes are anal fissures, perianal abscess, and acute hemorrhoidal thrombosis. Its intensity can vary. It may be mild, even described as a burning sensation, but it also may be described as acute and highly intolerant. It can also be associated with other symptoms such as bleeding and fever. If the pain is also extended to the abdominal region, very often associated with other symptoms as diarrhea, constipation, or mucus and feces discharging, the causes can be extremely varied. In these cases, it is advisable to request a colo-proctological consultation.
Anal Itching
It is a common symptom associated to many conditions, including perianal dermatitis, anal fissures, hemorrhoids and anal warts. But it may be the initial symptom of less common conditions such as parasitic infections, psoriasis, condylomas or other more complex pathologies. Itching is not a disease, but a common symptom. A colo-proctological consultation should be requested from the patient.
Alterations in Bowel Habits
When some variations occur in the frequency of bowel movements, and in the quality or quantity of stools with periods of constipation alternating with diarrhea, sometimes mixed with blood, it is important to promptly request a colo-proctological examination. These symptoms can be due to simple viral infections, or dietary intolerances to certain foods. However, they can also be the initial manifestation of more serious conditions. Repeated episodes of diarrhea mixed with mucus and blood, accompanied by abdominal pain, especially in young people, may be the first symptom of chronic inflammatory bowel disease such as Crohn's disease or Ulcerative Colitis (UC).
Soiling
Soiling is the slight loss of mucous secretion from the anus, sometimes associated with minimal amounts of feces, often noticed by the patient on the underwear. It is responsible for the annoying sensation of a "wet anus" and the constant need to "wipe" the anus multiple times a day. This symptom is commonly reported in cases of mucosal prolapse of the rectum and associated hemorrhoids, but can also be due to other more complex and serious anorectal pathologies.
Symptoms of Obstructed Defecation Syndrome (ODS)
More common in women, these are characterized by difficulty in evacuating due to the sensation of a "blockage" in the last segment of the rectum during the efforts to defecate. Stools are partially expelled or not expelled at all, and patients feel that they haven't completely emptied their rectum, and still have stools to expel. Evacuation, therefore, becomes fragmented, and patients frequently change their position on the toilet. In more severe cases, manual maneuvers are used: the patient is obliged to put its fingers into the rectum or into the vagina to facilitate the feces expulsion . These symptoms are common in rectal prolapse and rectocele (recto-anal intussusception and anterior rectocele), associated with other intestinal pathologies or not. They can also be due to alterations in the muscular functionality of the perineum, and are often associated with symptoms such as stress urinary incontinence. They result from a wider prolapse that affects not only the rectum but all the organs in the pelvic area (descending perineum syndrome). But some neoplastic pathologies can also manifest with these symptoms, so a colon proctological examination is always necessary.
Rectal Tenesmus
It is the sensation of rectal fullness with a continuous desire to defecate, without being able to do so. This bothersome and important symptom, if associated with fever and diarrhea, can be an expression of an acute viral disease. In the elderly, especially those confined to bed, rectal tenesmus is often associated with severe anal pain. It frequently is expression of the so-called "fecaloma", which is a very hard mass of feces that completely fills the rectum, making it lose its expulsive capacity. However, tenesmus can also be an expression of a rectal neoplasm. As the tumor grows in size, tenesmus becomes more frequent. Therefore, this is an important symptom that should never be underestimated, and requires a prompt proctological consultation.
Anorectal or Perineal Heaviness
This symptom can force the patient to lie down in order to reduce its intensity. It is a common symptom in women with significant prolaps of the rectum, uterus (colpocele) and bladder (cystocele). This syndrome is known as "Descending Perineum Syndrome". It is also a common symptom in the Obstructed Defecation Syndrome (ODS) or in other functional pelvic floor pathologies. It can be an expression of an enterocele or a stable sigmoidocele (descent of the small intestine or sigmoid colon into the space between the rectum and the uterus). Sometimes this symptom is so severe to determine significant problems of a psychological nature, affecting not little the patient's quality of life.
Associated Symptoms
Very often, symtoms related to proctological diseases are associated with other symptoms related to uro-gynecological disfunctions. An example is the stress urinary incontinence. When the bladder is full of urine and the patient coughs or makes a physical effort, a few drops of urine can involuntarily leak out. The combination of this symptom with the difficulty to defecate is typically related to the Descending Perineum Syndrome and Obstructed Defecation Syndrome. Other symptoms can include urinary burning (due to recurrent cystitis), the presence of a swelling inside the vagina which can even exceed the vulvar cleft (rectocele, cystocele, or colpocele), and perianal dermatitis due to bacterial or fungal infections.
Bleeding
Bleeding may manifest as small traces of blood on the toilet paper or underwear, or it can be most abundant during or after the defecation. The blood may be bright or dark red, mixed with clots. In most cases, it is due to benign conditions such as hemorrhoids or anal fissures. However, more serious conditions can cause bleeding with similar characteristics. Therefore, a colo-proctological examination is recommended whenever a rectal bleeding occurs.
Pain
The most common causes are anal fissures, perianal abscess, and acute hemorrhoidal thrombosis. Its intensity can vary. It may be mild, even described as a burning sensation, but it also may be described as acute and highly intolerant. It can also be associated with other symptoms such as bleeding and fever. If the pain is also extended to the abdominal region, very often associated with other symptoms as diarrhea, constipation, or mucus and feces discharging, the causes can be extremely varied. In these cases, it is advisable to request a colo-proctological consultation.
Anal Itching
It is a common symptom associated to many conditions, including perianal dermatitis, anal fissures, hemorrhoids and anal warts. But it may be the initial symptom of less common conditions such as parasitic infections, psoriasis, condylomas or other more complex pathologies. Itching is not a disease, but a common symptom. A colo-proctological consultation should be requested from the patient.
Alterations in Bowel Habits
When some variations occur in the frequency of bowel movements, and in the quality or quantity of stools with periods of constipation alternating with diarrhea, sometimes mixed with blood, it is important to promptly request a colo-proctological examination. These symptoms can be due to simple viral infections, or dietary intolerances to certain foods. However, they can also be the initial manifestation of more serious conditions. Repeated episodes of diarrhea mixed with mucus and blood, accompanied by abdominal pain, especially in young people, may be the first symptom of chronic inflammatory bowel disease such as Crohn's disease or Ulcerative Colitis (UC).
Soiling
Soiling is the slight loss of mucous secretion from the anus, sometimes associated with minimal amounts of feces, often noticed by the patient on the underwear. It is responsible for the annoying sensation of a "wet anus" and the constant need to "wipe" the anus multiple times a day. This symptom is commonly reported in cases of mucosal prolapse of the rectum and associated hemorrhoids, but can also be due to other more complex and serious anorectal pathologies.
Symptoms of Obstructed Defecation Syndrome (ODS)
More common in women, these are characterized by difficulty in evacuating due to the sensation of a "blockage" in the last segment of the rectum during the efforts to defecate. Stools are partially expelled or not expelled at all, and patients feel that they haven't completely emptied their rectum, and still have stools to expel. Evacuation, therefore, becomes fragmented, and patients frequently change their position on the toilet. In more severe cases, manual maneuvers are used: the patient is obliged to put its fingers into the rectum or into the vagina to facilitate the feces expulsion . These symptoms are common in rectal prolapse and rectocele (recto-anal intussusception and anterior rectocele), associated with other intestinal pathologies or not. They can also be due to alterations in the muscular functionality of the perineum, and are often associated with symptoms such as stress urinary incontinence. They result from a wider prolapse that affects not only the rectum but all the organs in the pelvic area (descending perineum syndrome). But some neoplastic pathologies can also manifest with these symptoms, so a colon proctological examination is always necessary.
Rectal Tenesmus
It is the sensation of rectal fullness with a continuous desire to defecate, without being able to do so. This bothersome and important symptom, if associated with fever and diarrhea, can be an expression of an acute viral disease. In the elderly, especially those confined to bed, rectal tenesmus is often associated with severe anal pain. It frequently is expression of the so-called "fecaloma", which is a very hard mass of feces that completely fills the rectum, making it lose its expulsive capacity. However, tenesmus can also be an expression of a rectal neoplasm. As the tumor grows in size, tenesmus becomes more frequent. Therefore, this is an important symptom that should never be underestimated, and requires a prompt proctological consultation.
Anorectal or Perineal Heaviness
This symptom can force the patient to lie down in order to reduce its intensity. It is a common symptom in women with significant prolaps of the rectum, uterus (colpocele) and bladder (cystocele). This syndrome is known as "Descending Perineum Syndrome". It is also a common symptom in the Obstructed Defecation Syndrome (ODS) or in other functional pelvic floor pathologies. It can be an expression of an enterocele or a stable sigmoidocele (descent of the small intestine or sigmoid colon into the space between the rectum and the uterus). Sometimes this symptom is so severe to determine significant problems of a psychological nature, affecting not little the patient's quality of life.
Associated Symptoms
Very often, symtoms related to proctological diseases are associated with other symptoms related to uro-gynecological disfunctions. An example is the stress urinary incontinence. When the bladder is full of urine and the patient coughs or makes a physical effort, a few drops of urine can involuntarily leak out. The combination of this symptom with the difficulty to defecate is typically related to the Descending Perineum Syndrome and Obstructed Defecation Syndrome. Other symptoms can include urinary burning (due to recurrent cystitis), the presence of a swelling inside the vagina which can even exceed the vulvar cleft (rectocele, cystocele, or colpocele), and perianal dermatitis due to bacterial or fungal infections.