A specialist qualified by the Japan Society of Coloproctology, whether in the field of proctology or colorectal surgery, is a physician who has completed a specialized training course, and thus it is recommended to visit a clinic or hospital where such a specialist is available. If there is no specialist available at a nearby clinic or hospital, it is recommended to first consult with your family doctor to be referred to a specialist. In recent years, an increasing number of people have been collecting information on such specialists using the Internet. However, you must keep in mind that not all of the information on the Internet is reliable, so you must collect information with much caution. If you have an acquaintance, especially a healthcare professional who has some knowledge of or experience in your problem, his or her advice may be helpful.
In the initial stage of anal fistula, pus accumulates around the anus. Such condition is called "anal abscess," which is very painful. If anal abscess feels hot or becomes swollen, visit a hospital as soon as possible. Special caution should be exercised for an abscess which has developed deep inside the anal canal. Such abscess may not be found by an internist or a physician not experienced in proctology treatment, and such a physician may prescribe antibiotics for anal pain of unknown cause, during which time the disease progresses rapidly. If the correctness of the physician’s diagnosis is doubted, consider seeking a second opinion at another proctology hospital. Patients may delay visiting a physician due to hesitation or embarrassment, but finally they will visit a proctology clinic/hospital. Therefore, proctologists should provide specialist procedures for such patients, and it is important for patients to choose a clinic/hospital where they can expect specialist procedures from proctologists.
It is recommended that patients consult a proctologist who belongs to the Japan Society of Coloproctology, the Japanese Association for Clinical Proctology, or other related associations. Although there are various hospitals (including university hospitals) and clinics where the “department of proctology” is included at the end of the list of departments, physicians at some proctology departments of such hospitals and clinics may keep prescribing drugs for patients, and not offer other treatment options. If cancer is not detected early, it may be too late for treatment. If bleeding continues, intestinal examination should be performed. If pain persists, conservative therapy may be ineffective. Therefore, it is recommended for patients to choose a hospital or clinic where a proctologist offers various treatment options including surgery. Hospitals or clinics, where proctologists suggest appropriate treatment courses, giving patients a satisfactory explanation, are recommended. There is an option to switch hospitals or clinics if no alleviation of symptoms is achieved by long-term drug therapy. It is also recommended to choose a hospital or clinic which has a record of many cases of anal surgery.
It is recommended to choose a hospital where a doctor experienced in gastrointestinal surgery is available. Surgeons experience clinical practice at a proctology department as a trainee; they can treat patients based on knowledge of the general course of treatment. It is not recommended to receive treatment from a doctor who rejects patients complaining of pain or bleeding as soon as symptoms seem to be alleviated. For example, even if no abnormalities are apparent by the doctor’s routine physical examination, rectal prolapse may be found at the inner portion of the anal canal on detailed examination. From my experience, I have learned much from patients’ comments. Patients who are not convinced by their doctors’ explanation must seek a second opinion at another hospital.
In an era when expertise is required, it is becoming more common for patients to choose to receive treatment at a proctology clinic (proctological surgery/proctology). A diagnosis of anal fistula is established by digital examination in which a finger is inserted into the anal canal to palpate the primary opening located approximately 2 cm inside the anus. Some proctologists do not perform digital examination, but a correct diagnosis cannot be established by such physicians. If a patient knows that "digital examination is to be performed for anal fistula to palpate its internal opening," the patient can judge whether the proctologist is reliable based on the presence or absence of digital examination. Some proctologists prescribe drugs for patients without telling patients the name of their disorders (such proctologists may not have established a diagnosis of an anal disorder). Appropriate drugs cannot be prescribed for patients with unknown disorders. In such a case, it is recommended that the patients confirm the name of the established disorder and feel free to ask the doctor a few questions about any concerns they may have. Proctologists who give patients knowledeable answers and propose various treatment options are reliable.
