Proctology is the medical specialty dedicated to pathologies of the anus and rectum. It is a subspecialty of the gastroenterology or visceral surgery. It is estimated that the management of diseases of the anus accounts for about 20% of the activities of gastroenterologists (3).

Most often, the proctologist is consulted for:

• rectal bleeding (rectal bleeding);
• pain in the anus;
• swelling or prolapse (“Externalization” of the rectum);
• itches ;
• transit disorders;
• continence disorders;
• the presence of oozing or pus.

The most common condition encountered in proctology is hemorrhoidal disease, more often called “Hemorrhoids”. It is estimated that about 10 to 15% of adults may be affected by this problem, which causes severe pain, itching and bleeding in the anus. The cause: the abnormal dilation of veins called hemorrhoids, in the anus and rectum.

Hemorrhoidal disease is particularly common:

• after 50 years (up to one in two people);
• in chronic constipation;
• in women who are pregnant or have just given birth.

In addition to hemorrhoids, several pathologies can cause disorders or pain in the anus and rectum, in particular:

• tumors (benign or malignant) of the anus and rectum;
• inflammation of the rectum (proctitis);
• anal fissure or other anoperineal lesions;
• a rectal prolapsus;
• dermatoses (diseases of the skin and mucous membranes);
• a Crohn’s disease (chronic inflammatory bowel disease);
• sexually transmitted infections.

Although anorectal pathologies can affect anyone, there are certain recognized risk factors, including:

• pregnancy and childbirth;
• chronic constipation;
• sexually transmitted anorectal diseases.

To arrive at a diagnosis and identify the origin of the disorders, the proctologist:

• questions his patient;
• performs an anorectal examination (rectal examination, anoscopy, rectoscopy);
• may have recourse to examinations: endoscopy, biopsy, Hemoccult to detect a cancer colorectal…).

Depending on the problem and the treatment to be provided, the proctologist may have recourse to various additional examinations, such as:

• visual examination with an anoscope or rectoscope;
• touch and palpation;
• functional rectal examinations (anorectal manometry, electromyography, defecography, etc.);
• imaging examinations (CT scan, endoscopy, colonoscopy, etc.);
• blood or local samples (especially to diagnose a sexually transmitted infection).

The consultation with a proctologist does not involve any particular risks for the patient. However, the examination of this region is often badly lived, since it is uncomfortable and concerns an intimate area, even taboo. It is important to establish a relationship of trust with your doctor and to ask him the necessary questions to fully understand the progress of the examination.

The training of the proctologist in France

To become a proctologist, the student must obtain a diploma of specialized studies (DES) in hepato-gastroenterology:

• he must first follow, after his baccalaureate, a common first year in health studies. Note that an average of less than 20% of students manage to cross this milestone;
• at the end of the 6th year, students take the national classifying tests to enter the boarding school. Depending on their classification, they will be able to choose their specialty and their place of practice. The internship in hepato-gastroenterology lasts 4 years.

Finally, to be able to practice as a pediatrician and hold the title of doctor, the student must also defend a research thesis.

The training of proctologists in Quebec

After college studies, the student must pursue a doctorate in medicine. This first stage lasts 1 or 4 years (with or without a preparatory year for medicine for students admitted with college or university training deemed insufficient in basic biological sciences). Then, the student will have to specialize by following a residency in gastroenterology, for 5 years.

Before going to the appointment with a proctologist, it is important to take any imaging or biology exams already carried out, and to bring the various prescriptions.

To find a proctologist:

• in Quebec, you can consult the website of the Association des gastroentérologues du Quebec (4), which offers a directory of their members;
• in France, via the website of the Ordre des médecins (â ?? µ) or the Société nationale française de colo-proctologie (6).

The consultation with the proctologist is covered by the Health Insurance (France) or the Régie de l’assurance maladie du Québec.