Colorectal surgery: what the specialty covers, conditions treated and what to expect

Colorectal surgery is the part of general surgery that focuses on the lower digestive tract: the colon (large bowel), the rectum and the anal canal. A colorectal surgeon is a consultant surgeon who has trained in general surgery and then specialised in this area, and in the NHS typically works within a team that includes specialist nurses, radiologists, pathologists, gastroenterologists and oncologists.

The caseload falls into two broad groups. The first is cancer: surgery to remove bowel cancer is a core part of treatment, and the NHS notes that part or all of the bowel around a cancer may need to be removed, sometimes with a temporary or permanent stoma. The second is benign disease, which is far more common and includes piles, fissures, fistulas, diverticular disease, pilonidal disease, rectal prolapse and the surgical side of inflammatory bowel disease.

Many benign problems are managed in clinic with simple measures and procedures, so a first appointment with a colorectal surgeon does not mean an operation is planned.

Several problems around the back passage cause similar symptoms, particularly bleeding and pain, which is why an examination matters more than guessing from symptoms alone.

• Piles (haemorrhoids): swollen blood vessels in and around the anus. The NHS lists bright red blood after a bowel movement, itching, lumps and a feeling of incomplete emptying among the symptoms.

• Anal fissure: a small tear that the NHS describes as causing sharp pain during a bowel movement and burning afterwards; many heal without surgery.

• Anal fistula and perianal abscess: an infected collection near the anus, sometimes leaving a channel behind that needs surgical management.

• Bowel cancer (colon and rectal): symptoms the NHS lists include a lasting change in bowel habit, blood in the stool, abdominal pain, unexplained weight loss and tiredness from anaemia.

• Ulcerative colitis and Crohn's disease: the NHS says surgery may be offered when symptoms are severe, keep returning or medicines are not working, and emergency surgery may be needed in a severe flare-up.

• Diverticular disease, rectal prolapse, pilonidal sinus and faecal incontinence, each with their own clinic pathway.

The NHS says a GP appointment about bowel symptoms may include questions about family history, an abdominal examination, a rectal examination and a request for a stool sample or a faecal immunochemical test (FIT) kit, which checks for bleeding from the bowel. A blood test may also be requested.

At specialist level, the NHS describes colonoscopy as the main test for bowel cancer: a thin flexible camera is passed into the bowel, and a small sample of the lining may be taken. Some results can be available the same day, and others take days or weeks. CT, MRI and PET scans, blood tests and genetic testing may follow if cancer is found, to show how far it has spread and guide the treatment plan.

For fissures, piles and fistulas, the key assessment is usually a clinical examination, occasionally under anaesthetic. The NHS notes a specialist may examine under general anaesthetic if the diagnosis is uncertain or if examination is too painful. Anorectal physiology tests and scans of the anal sphincter can help in incontinence and complex fistulas.

The range runs from short day-case procedures to major operations. The NHS describes non-surgical hospital treatments for piles, including rubber band ligation, sclerotherapy injections, electrotherapy and infrared coagulation, done while awake and usually with same-day discharge. If those do not work or the piles are large, it lists haemorrhoidectomy, stapled haemorrhoidopexy and haemorrhoidal artery ligation, usually under general anaesthetic. It adds that treatment does not always stop piles returning.

For fissures that do not heal, the NHS lists an injection to relax the muscle or a small cut in the muscle to reduce tension, both under general anaesthetic. For cancer, surgery may be combined with chemotherapy before or after the operation, and radiotherapy is used in rectal cancer. In inflammatory bowel disease the NHS describes colectomy for ulcerative colitis, either with an ileostomy or an internal ileo-anal pouch, and bowel resection or stoma formation for Crohn's disease, with the caution that symptoms can return in another part of the gut.

Many hospitals use enhanced recovery programmes after major bowel surgery, which aim to get people eating, moving and home sooner. Ask the unit how it applies them.

Colorectal surgeons increasingly specialise further: some focus on cancer and rectal surgery, others on pelvic floor and anal conditions, and others on inflammatory bowel disease surgery. Gastroenterologists run colonoscopy lists and medical treatment of colitis and Crohn's disease, and they often work with surgeons in joint clinics. Stoma care nurses teach people how to live with a stoma, and the NHS notes that bowel cancer patients are given a clinical nurse specialist as their main point of contact. If cancer is suspected, the cancer care department describes the oncology side of the pathway.

On the NHS, most people are referred by their GP. Where bowel cancer is suspected, the referral is urgent: the national suspected-cancer standard is a first specialist appointment within two weeks. For other problems the standard is that treatment should start within 18 weeks of referral, although actual waits depend on the area and the procedure. In England, Right to Choose can allow a patient to ask for referral to any eligible provider; ask your GP whether it applies to your condition.

Privately, people can often self-refer or be referred by a GP letter. Check insurance terms first: policies usually need pre-authorisation, and some limit cover for certain benign procedures or for anything related to a pre-existing condition. Cost drivers are the type of anaesthetic, the length of stay, the implant or device used (if any), and whether pathology and follow-up are included. Ask for an itemised quote that says what happens if a complication needs further treatment.

A short symptom diary helps: when bleeding or pain happens, stool pattern, weight change and anything that makes it better or worse. Bring a list of medicines, including blood thinners and anti-inflammatory painkillers, and any previous bowel test reports.

• Ask what the working diagnosis is and what else is being excluded.

• Ask whether non-surgical options have been tried or are suitable.

• Ask how many of this operation the surgeon performs and what the unit's recovery pathway looks like.

• If a stoma is possible, ask to meet a stoma nurse before surgery.

• Ask what to expect in the first weeks: eating, bowel function, return to work, driving and lifting.

The NHS advises an urgent GP appointment or NHS 111 for black or dark red stools or bloody diarrhoea. It advises calling 999 or going to A&E for non-stop bleeding, large amounts of blood or clots, or severe pain, and not driving yourself. After bowel surgery, fever, spreading redness, a swollen painful abdomen, persistent vomiting or a wound that opens should prompt a call to the surgical team or NHS 111.