I have a real appointment with a proctologist next month and was wondering what to expect. It will be my first visit to him.
I saw three proctologists.
The first one was an old Russian lady. She did a rectal exam on my side and said that she wanted to do a scope exam (with rigid scope) in another day. I asked the nurse for details when I was about to schedule the exam: arrive 2PM, wait for my turn to have an enema, doctor arrives at 3PM, exam in knee-chest position (I had to play the super-naive patient to get this piece of info).
The knee-chest was too much for me, so I did not make appointment.
The second proctologist was a middle-aged lady. The nurse asked me to remove my shoes and pull down my pants, underpants, then lay down on my side. No enema. The doctor was very professional and friendly. First she did digital exam very gently, then she used the anoscope (she always told me what she was doing) then the rectoscope.
I moved to the West Coast and realized that I have a preference for female doctors.
The third proctologist is also female. There was no nurse in the room. I didn't get enema either, just a paper towel to cover myself. There was a very long digital exam (she also checked my prostate), then a rigid sigmoidoscopy on my left side. That was a little bit uncomfortable because she pumped me up like a balloon, then asked me to expel it.
Now, my apologies for all the ladies here for the way I express myself, but I was asked to fart on her while the scope was in. Which I actually did because I'm a good patient. It was silent...
So, don't worry.
Went to several proctologists in my lifetime and they all had different routines:
1. My first rectal exam. Just the doctor and me in the room. After an initial talk, he told me to go behind a partition, take off pants and underwear and put on a gown. Then he told me lie on my back at first, then lie on my the side and bring one leg to my chest for the rectal exam. That was my first time and I was really surprised that it didn't hurt at all and it was quick. I was quite young and in fact I thought the doctor had some special powers for being able to do that with no pain. I remember he made a point to tell me to lie on the table normally as I'm sure many people assume they'll be on their stomachs or on all fours. I had no idea what to expect so it was nice that he guided me through it.
2. Just the doctor and me in the room. It was a different setup, with no partition. His desk and exam table were in the same room. After the initial conversation, he told me stand up and take off pants and underwear right in front of him (since there was nowhere else to go). Then he told me to lie on my side and did the rectal exam. After that for some strange reason, he told me to get on my hands and knees on the table and did another rectal exam that way. I don't think that is usual at all and it never happened to me again. Being naked from the waist down and on all fours was very disturbing and a bit humiliating, made worse by the fact that he kept talking to me the whole time. I remember at one time he touched a particular spot and asked for confirmation: "oh, is this what's bothering you?" And kept rubbing that spot as I mumbled an answer. It was very different from the first one, seemed unprofessional and kinda surreal. I only had a light t-shirt on and I was naked and and on all fours on the exam table while a doctor poked my butt.
3. Was led to the exam room by a nurse. Before she left the room, she told me to take off pants and underwear, have a seat on the table, use a drape to cover myself and wait for the doctor. When the doctor came, he sat down right in front of me and we talked while I was already naked, just covered by the unfolded drape. For the rectal exam, he had the kind of table where you kneel at the end and rest your upper body on the table. He positioned himself behind me and did a rectal exam.
4. This one didn't start well. I had been instructed to do two fleet enema the day of the exam and when I arrived, the receptionist asked me if "I was all set with my preparations." I was mortified and upset that everyone in that office knew my business! For the actual exam, it was just me and the doctor in the room. He came in, told me to drop pants and underwear and bend over the table. It was again a new position and similar to the prostate checks I get now. He turned on a lamp directed at me and told me to spread my cheeks for the rectal exam. That was the only time I was asked to do that, also a bit humiliating.
5. The best proctologist I had was unfortunately the one with an ever-present female assistant. I prefer male doctors and dislike anyone else joining, especially women. He had two separate rooms. First we discussed my issues in a regular office setup (desk, computer, etc). Then he told me to go to the actual exam room to get ready. When I got there, I met Trudy, the female assistant, who told me to lower my pants and underwear and lie on my side, with both knees to my chest. Again this was different because I got to keep pants on and just had to lower them. It was a bit weird to lclimb on the table with pants on and also to be exposed to a woman for what seemed an eternity. She draped both sides and basically just left my butt exposed. The doctor came a bit later and did the rectal exam with Trudy in the room. This doctor had a thick accent and made a point to say how "tight" I was and that's why I had problems. Again, a surreal experience to have someone with a finger up your butt discuss your tightness with another person in the room as if we were all in a cocktail party...
So my five rectal exams by proctologists were far from consistent. They each had some unique aspect to them that was never replicated.
I have only been to a proctologist once, and that was a long time ago, when I was 21 and in the Army. I had a painful internal hemorrhoid (I didn't know that at the time). When I got to the proctology dept. of the Army hospital, I was shown into a small room, which was divided in half by a curtained divider. The table and equipment were hidden behind the divider.
I was told to have a seat on a folding chair. I wasn't aware at first that there was a patient already on the table behind the curtain. Then I glanced to my right, and realized that the far wall was made up of mirror tiles, and that I was actually looking at the back end of the table. I then realized that there was a guy on the table. It was tilted with his head down and rear end up, and I couldn't believe how little privacy was actually provided to the patient.
When the guy was finally lowered down off the table, he pulled his pants up, took a prescription slip the doctor handed, and then he had to walk past me in the waiting area. I think he knew I sort of witnessed his embarassing exam, and he totally avoided looking at me.
Of course, then it was my turn. I was told to come around the screen by a fairly young assistant. I was really nervous because the guy was really feminine. When I got beside the table, he told me to drop my pants and underpants (underpants???) to my ankles. After I did this, he told me to kneel on the ledge at the end of the table. Then he raised the whole table, and then lowered my head and elevated my legs and butt. I could just feel him staring at my naked rear end, but what could I do?
Then the doctor walked around the curtain, told me to take a deep breath, and roughly jammed his finger into me. Talk about jump! He pulled his finger out, and then said "Now it's time for the "rocket"." I had no idea what he was referring to, but it didn't take me too long to figure it out. I could see out of the corner of my eye that he had picked up a rigid sigmoidoscope (found out what it was years later). When he started to insert the thing into me, I could have sworn I was going to move my bowels right there on the table. In fact, I DID mention to him that I really felt a strong urge to poop. He just laughed and said that it was a normal sensation, and to just "grin and bear it".
When it was all done, and I was lowered back to the floor, he advised me that I had an internal hemorroid, and he gave me a prescription for some sort of salve. That was the first and last time I ever had that kind of exam. I must admit, the scariest part of the exam was the table. You feel completely helpless when you are put into that heads down, rear end up position.
Every practice is different and the exact routine is something that may be unique to that particular doctor. Generally you will only need to be exposed from the waist down, and they may provide you a gown or sheet as well. The exam will likely be done in either the Sims position (on your left side), in the knee-chest position, or on a proctological exam table similar to the knee-chest position. Most specialists, regardless of their field, will have an assistant during examinations and treatment.
Since you have been instructed to have a Fleet enema prior to your appointment it is unlikely they will do any further prep in the office. The first part of the exam will involve an external inspection followed by a digital rectal exam. Most anal and lower rectal conditions are seen with an anoscope or proctoscope 4 to 6 inches in length. The doctor may also perform a flexible sigmoidoscopy as the internal hemorrhoid zone is easily inspected by 180 degree retroflexion of the scope inside the rectum. The doctor may perform a rigid sigmoidoscopy, however that would likely be as a routine measure "while we are here anyways". Possibly the doctor may perform a rigid sigmoidoscopy rather than anoscopy, simply as it provides more potential for diagnostic yield and doesn't cause much more discomfort to the patient.
Once the doctor has made a full diagnosis there will be a question of treatment. In a very conservative manner, diet changes and topical treatment with hydro-cortisone ointments or suppositories may be the first suggestion. In-office therapies the doctor may perform include rubber band ligature, injection therapy, and infra-red coagulation. If your condition is extreme with protruding or bleeding hemorrhoids you may require a hemorroidectomy to surgically remove them.
Here is a link to some photos of what you might expect in terms of equipment, and also photos of a proctological exam table.
He is a colorectal surgeon. I was referred to him by my GI after finding internal hemorrhoids. The prep is one fleet enema. I am curious if I will wear a gown, get naked or just pull pants down. What types of positions? Is a nurse usually present? I am trying to get an idea what will happen once i get there. Thanks.
The term "proctologist" has been replaced by the name "Colon and Rectal Surgeon." (These are not gastroenterologists, who are internal medicine specialists with additional training in GI medicine, but are general surgeons with additional specialty training in colon and rectal surgery.) I would imagine for a first visit, you should expect an anal inspection and digital rectal exam at the least. You will most likely be on a specialized table on which you kneel and the doctor elevates and tilts you to make anal exposure easier for him. I would suggest a Fleet enema for anal cleansing so his finger comes out clean.
It is unusual to hear the term Proctologist nowadays as most Colo-rectal surgeons are certified as Gastroenterologists. As you have not said what the reason for your referral is, may we assume that you are seeing a "proctologist" since it is anal or rectal specific. Based on that assumption, your pre-exam prep instructions may provide a hint of what to expect. If you have not been instructed to follow any type of bowel prep prior to your first visit, it will likely be more of a consultation to determine which diagnostic route to follow.
There is a virtual certainty that you will receive a digital rectal exam, and ultimately some type of endoscopic exam to take a look inside. What type and how far depends on what your condition is. If you have hemorrhoids they may only use an anoscope, possibly a sigmoidoscope, and probably are not likely to schedule you for a full colonoscopy. If you have a suspected bowel condition such as Colitis, the diagnostics will be much more extensive and may also include referral for x-rays.
Good luck with your appointment, hoping it goes well.
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