THE PROCTOLOGICAL EXAMINATION

Often, many patients with serious conditions such as prolapsed haemorrhoids, constipation or anal fissure delay their medical examination as much as possible, for fear of ‘feeling pain’.

Sometimes, the fear of pain is compounded by that of shame for anatomical positions that are considered embarrassing, other times for an embarrassment for the doctor's sex, and so on.

Would you like to contact dr. troyer quickly?
fill the form and she will call you right back!

I have read and accept the privacy policy*

In reality, many disabling pathologies, such as prolapsed haemorrhoids, could be cured more easily and more quickly if the patient went to the doctor in time,without waiting for complicated and borderline unbearable situations.

The proctological examination and its usefulness in the health field are still, especially in Italy, culpably underestimated, also because of the often incorrect information and communicationcoming from the health personnel themselves.

Yet, the proctological examination is of fundamental importance for diagnosing (and then resolving) not only benign pathologies, such as pathological haemorrhoids, but also cancerous diseases, such as cancer of the anus or rectum.

Read this page written by Dr Luisella Troyer, Proctologist Surgeon, who aims to explain to you what a proctological examination really is, how it is performed and when it is necessary to perform it.

WHAT IS THE PROCTOLOGICAL EXAMINATION?

A proctological examination is a specialised medical examination of the anus and rectum performed by a proctologist.

The objective of the proctological examination is the analysis of the anus and rectum, in order to diagnose or exclude pathological conditions that are hyper-localised only in that area, such as haemorrhoidal disease, anal fissure and anorectal condylomas.

The proctological examination, contrary to what many still think, is not painful, it is not embarrassing, and there is therefore no reason to postpone it, with the risk of worsening chronic pathologies that, if left untreated, will certainly not go away on their own.

BY WHOM IS THE PROCTOLOGICAL EXAMINATION PERFORMED?

The proctological examination is performed by a proctologist, i.e. a doctor who has experience in anorectal and intestinal pathologies.

In Italy, there is still no specialisation school dedicated to proctology, which is therefore considered an ultra-specialisation of surgery or gastroenterology.

This means that Proctologists are mostly Vascular Surgeons, General Surgeons or even Gastric Surgeons, with a strong experience in the field, gained after many years of practice.

The learning curve of proctological problems is particularly long and difficult, so Proctologists are generally mature Surgeons with decades of practice.

In some Countries, due to the lack of a specific School of Specialisation in Proctology, any doctor (even non-specialists) can perform proctological examinations.

Unfortunately, such examinations are often rather cursory, unjustifiably brief, and the accompanying and complete examination of Videoproscopy is not performed.

On the other hand, a quality and high-level proctological examination is a particularly long examination, divided into four main and indispensable parts (rigorous anamnesis, abdominal examination, proctological examination and digital inspection and videoproctoscopy).

This is the only way to have a complete clinical picture, correctly diagnose the patient's condition and then direct him/her towards the appropriate therapeutic course.

HOW DOES THE PROCTOLOGICAL EXAMINATION TAKE PLACE?

The complete proctological examination is carried out (or at least, should be carried out) in four distinct phases:

1. The anamnesis, where the physician collects all the information on the patient's clinical history, with particular regard to his previous proctological history;

2. The abdominal examination, where the doctor, both with the phonendoscope and with specific abdominal palpation, ascertains the treatability of the bowel and its peristalsis (the natural bowel movement)

3. The proctological examination, where the doctor assesses the condition of the anus and perianal area, and also performs a gentle digital exploration of the anal canal, aided by an anaesthetic gel;

4. The Electronic Endoscopic Videoproscopy examination, where the Doctor investigates the entire anorectal canal with the help of a high-resolution video camera connected to a disposable proctological inspection tube.

Above all, the videoproctoscopy examination is a delicate phase of the entire examination, as it is the part that completes theexamination and provides the Doctor with confirmation or otherwise of his clinical suspicions, identified during the anamnesis phase or during the proctological examination.

IS THERE A NEED FOR SPECIFIC PREPARATION BEFORE THE PROCTOLOGICAL EXAMINATION?

Contrary to what one commonly reads on the Internet (and also, unfortunately, to the misinformation of health professionals not trained in proctology), the proctological examination does not require any preparation.

No preparatory enema is therefore necessary before the examination, and no invasive colon cleansing is required, as is the case with a colonoscopy examination.

In the proctology examination and the related Electronic Endoscopic Videoproscopy examination, the possible presence of faeces in the rectal cavity or faecal residues in the anal canal are not a problem, but rather a valuable diagnostic tool for the proctologist.

It is precisely the analysis of faecal residues, their consistency, smell and colour that allow the experienced Proctologist to understand possible intestinal problems of the patient, in which the root of the proctological problem may be present.

For example, traces of unformed faeces, yellowish in colour and with a pungent odour, present in the anorectal canal, may indicate to the doctor the suspicion of poor nutrition, with inflammation of the colon and consequent acidification of the bowel, which in turn may cause proctitis (inflammation of the anorectal mucosa), with redness and anal itching.

Conversely, particularly hard and so-called ‘goat-shaped’ faecal residues may indicate to the doctor a problem of constipation, and slowed transit of faeces in the colon, which in turn may cause injury to the delicate anal canal, and the onset of anal fissures or the extrusion of pathological haemorrhoids.

This is why the patient does not have to worry about any preparation before the proctological examination, and can present himself to the doctor even if he has not yet defecated.

WHAT IS VIDEOPROCTOSCOPY?

The Electronic Endoscopic Videoproctoscopy examination is a modern video examination, capable of inspecting the entire anorectal canal with thoroughness and extreme precision.

It is performed with a special high-definition video camera connected to a handpiece equipped with an air insufflator and connection for a light source.

In turn, the handpiece is connected to a 130-mm disposable proctoscopic tube which, suitably lubricated, is inserted directly into the anorectal canal by the doctor.

Modern video cameras used for videoproctoscopy examinations can go beyond 1080p, projecting on the screen a film enlarged even beyond 20X, capable of allowing the physician to visualise every minute detail of the ano-rectal canal.

This is particularly useful when searching for anal or rectal polyps, minor internal haemorrhoids, condylomatous lesions or anal fissures.

In general, any abnormality or lesion of the anorectal canal can be detected with videoproscopy, with the advantage of being able to digitally record the examination, and thus review it as many times as desired.

This is a great diagnostic aid for the doctor, who can thus compare several examinations carried out in a given time frame, and monitor the progress of any treatment the patient is undergoing.

Videoproctoscopy is an examination of choice for ano-rectal investigations, and is usually used in excellent medical practices, for maximum diagnostic advantage.

BUT SO THE PROCTOLOGICAL EXAMINATION IS NOT PAINFUL?

Absolutely not.

The proctological examination is not painful, and therefore should not cause apprehension, fear or embarrassment.

Both digital inspection and videoproctoscopy are performed painlessly and require no preparation, and should therefore not be feared by the patient.

Even the awkwardness of the examination can be easily resolved by listening well to the doctor's instructions and trusting his experience, always remembering that the examination is imperative to begin the resolution of pathologies that may have been neglected over time .

It is therefore necessary to go to the proctological examination calm, relaxed and serene: it will not hurt and, finally, you will be able to have an idea and an accurate diagnosis of the proctological problems that, very often, have been deliberately ignored for many years.

Unfortunately, unlike the rest of the countries of the European Union, the United Kingdom and North America, Italy is lagging behind in proctological research and innovation.

Not only is there still no adequate School of Specialisation in our country, but also the proctological services offered in hospitals and local health authorities are, on average, of poor quality, often performed by doctors who are not highly trained.

Invasive examinations such as videocoloscopy are still prescribed even for anal fissures, haemorrhoids and anorectal condylomas, and the use of the videoproctoscope is the prerogative of very few private practices of excellence.

Proctological examinations in agreement with the National Health System are often hasty, with little attention to patients' discomfort and their history of suffering, and often not even accompanied by a simple anoscopy, but only digital inspection.

Doctors' preparation in proctology is in many cases insufficient, not for lack of talent and abnegation, but for simple incomplete training and lack of adequate experience in the field.

This backwardness has led, over the years, to a general mistrust of patients in proctological care, accompanied by long waiting lists even for the surgical resolution of common pathologies, such as anal fissures or anorectal condylomatosis.

The now chronic closed number in the faculties of Medicine and Surgery, the training funnel caused by the blocks of the Specialisation Schools and a chronic lack of adequate funds for the preparation of young proctologists complete the worrying picture, to the detriment of the suffering of millions of people, afflicted by serious and disabling proctological problems.

HOW LONG DOES A PROCTOLOGICAL EXAMINATION TAKE?

The proctological examination is one of the most demanding and delicate of all specialist examinations.

The four fundamental steps of the examination, i.e. the anamnesis, the abdominal examination, the proctological inspection and the Electronic Endoscopic Videoproscopy take time, also in relation to the fact that the proctologist has to acquire all the previous information on the patient's proctological and intestinal history.

Each patient has his own very precise proctological history, which is different from that of any other person: the doctor must therefore acquire a great deal of clinical information, and must then perform as many as three medical acts, among which Electronic Endoscopic Videoproctoscopy, to try to arrive at a correct diagnosis for problems that have often been in existence for a long time (and with much suffering on the part of the patient).

This is why the proctological examination, when well performed, is one of the most time-consuming specialist examinations, and can exceed one hour.

Dr. Luisella Troyer has strong deontological principles in her proctological examinations, and as long as the patient is not perfectly framed and a reliable diagnosis has not been hypothesised, or additional diagnostic examinations are proposed, the examination cannot be called finished.

This is why the proctology patient must be prepared for the fact that the proctological examination, although totally painless, may take some time.

DO YOU SUFFER FROM AN ANUS PROBLEM BUT ARE AFRAID OF A MEDICAL EXAMINATION?
WITH dr. troyer, YOU WILL HAVE NO PROBLEM

Dr Luisella Troyer is a Vascular Surgeon specialised in Proctology, with years of experience in anal and rectal pathologies.

In her clinic in Dubai, iDr. Troyer can help you understand the origin of your anus or rectum discomfort, with professionalism and delicacy, without making you feel any pain.

Thanks to the videoproctoscopy examination, the doctor can clearly see the condition of your anorectal canal, in a totally painless manner, thus diagnosing with extreme precision fissures, pathological haemorrhoids, condylomata or anorectal polyps.

No preparation will be required, and the examination will not be traumatic or aggressive, guaranteeing an immediate return to everyday life.

Dr Luisella Troyer is a Vascular Surgeon specialised in Proctology, with years of experience in anal and rectal pathologies.

In her clinic in Dubai, Dr. Troyer can help you understand the origin of your anus or rectum discomfort, with professionalism and delicacy, without making you feel any pain.

Thanks to the videoproctoscopy examination, the Doctor can clearly see the condition of your anorectal canal, in a totally painless way, thus diagnosing with extreme precision anal fissures, pathological haemorrhoids, anal warts or anorectal polyps.

No preparation will be required, and the examination will not be traumatic or aggressive, guaranteeing an immediate return to everyday life.