Proctologist FAQ: the most common questions about exams, surgery and recovery

Appointments take place at a time agreed in advance. Message +994 55 757 34 47 on WhatsApp or call, and we'll choose the day and time together. Dr. Ellada Manafova sees patients in Baku at Qafqaz Hospital (formerly Yasamal Hospital). The address and a map are on the contact page.

You can ask general questions on WhatsApp: we answer them and tell you how urgent your complaint is. But a diagnosis is not made from messages or photos. The same complaint can be caused by hemorrhoids, an anal fissure, a polyp or another condition. They can only be told apart by an examination.

Pain in the anal area, bleeding, itching, swelling or discharge of pus, a lump that comes out after a bowel movement, long-lasting constipation or diarrhea, and a feeling that the bowel hasn't emptied completely are all a proctologist's field. After age 45–50, especially if bowel cancer runs in your family, an exam is recommended even without symptoms. We have gathered the full list of warning signs in our article what is a proctologist.

First we talk about your complaints, your diet, your toilet habits and the medications you take. Then you lie on your side on the exam table with your knees drawn toward your stomach. The rest of your body stays covered. The doctor looks at the anal area, examines it gently with a gloved finger and gel, and, if needed, performs anoscopy (a look into the anal canal with a small, lighted tube). Including the conversation, the whole appointment usually takes 20–30 minutes.

A routine proctological exam usually needs no special preparation, and daily hygiene is enough. If a rectoscopy or colonoscopy is planned, the bowel must be cleared beforehand. In that case, we explain separately what you need to do.

Bring earlier lab results, ultrasound, MRI or colonoscopy results, and the discharge summary from any previous operations, if you have one. Also write down a list of the medications you take, especially blood thinners. Note your questions on your phone beforehand so you don't forget them when you're nervous.

Yes, don't delay. Hemorrhoids and anal fissure are common in pregnancy: hormones, pressure from the growing uterus on the blood vessels and constipation all play a part. The exam can be done during pregnancy, and treatment is chosen with the stage of pregnancy in mind, often without surgery. If a planned operation is needed, it is usually postponed until after the birth.

The exam usually doesn't cause pain, though there may be brief discomfort or a feeling of pressure. If you have severe pain, for example with an acute anal fissure, the exam is done with a numbing gel. We explain every step in advance, and you can ask for a pause at any moment.

No. The operation is done under anesthesia: either you are asleep under medication, or the surgical area is numbed. In some operations the patient stays awake, feels no pain and can talk with the doctor if they wish. One of our patients' first words right after surgery were: “I was so scared, but I didn't feel a thing.”

Local, spinal (numbing the lower body with an injection in the back) or general anesthesia is chosen according to the type of operation and the patient's condition. For minor procedures, local or spinal anesthesia is often enough, and for larger or combined operations, general anesthesia may be chosen. The final decision is made by the anesthesiologist after talking with you and reviewing your tests.

This fear is very natural. Before surgery, your tests and general condition are checked, and the anesthesiologist chooses the type of anesthesia taking your chronic conditions and medications into account. Throughout the operation, the anesthesiologist stays with you and constantly monitors your breathing, blood pressure and pulse. The risk of serious complications with modern anesthesia is low, and we discuss the risks that apply to your situation openly with you before the operation.

Some pain and discomfort in the first days is expected, especially during the first bowel movements. This pain is kept under control with the painkillers your doctor prescribes, warm sitz baths and a diet that keeps stools soft. After less traumatic methods, such as laser treatment, pain is usually milder. The pain should decrease day by day. If it gets worse, let us know.

The tests and examinations you need before surgery are ordered. Tell us about all the medications you take, especially blood thinners and diabetes medications, but don't stop any of them on your own. Before some operations, the bowel needs to be cleared. We tell you exactly when to stop eating and drinking well in advance.

You come to the hospital at the agreed time. Planned operations often start early in the morning. Before surgery, the doctor and the anesthesiologist meet with you again to answer your questions, and then you sign the consent form. After the operation, you stay under observation until your condition is stable. The doctor tells you when you can go home.

The length depends on the type of operation and the stage of the disease. Laser treatment of hemorrhoids usually takes 15–20 minutes, and an operation for a chronic anal fissure about 15 minutes. Combined (“bouquet”) operations that treat several problems together can last 1–2.5 hours. The exact time is given after the examination.

After many proctological operations, the patient goes home the same day or the next day. After larger or combined operations done under general anesthesia, a stay of 1–3 days under observation is usually needed. The exact time is given after the examination.

Yes, if your health allows it. For example, hemorrhoids and an anal fissure, rectocele and urinary incontinence, or gallstones and an umbilical hernia can be operated on in the same session under one anesthesia. We call this combined (“bouquet”) surgery: you have anesthesia once, stay in the hospital once and go through one recovery period. We explain who it suits on the surgical and conservative treatment page.

This is the fear we hear most often, and it is very understandable. The first bowel movement can be somewhat uncomfortable, so we prepare for it in advance: diet and, if needed, a stool softener prescribed by your doctor keep the stool soft, and we explain how to take your painkiller. A warm sitz bath after using the toilet greatly reduces pain and spasm. Compared with pain endured for years, this is a few days of passing discomfort.

The first bowel movement usually happens within 1–3 days after the operation. When you feel the urge, don't hold it, but don't strain and don't sit on the toilet for long. If you follow your diet and fluid plan and still can't go for more than 3 days, or if your abdomen feels tense, message us.

After an operation in the anal area, a small amount of blood may show on the toilet paper or in the stool in the first days, sometimes for a few weeks. It is part of the wound's healing process. If the bleeding is heavy, comes with clots or doesn't stop, don't wait: seek help urgently.

Pour warm, not hot, water into a basin or bathtub and sit so that the anal area stays in the water. Usually 10–15 minutes, 2–3 times a day and after every bowel movement is recommended. Unless your doctor says otherwise, don't add anything to the water. After the bath, dry the area by patting gently with a soft towel, without rubbing. Your doctor tells you the routine that suits you.

After each bowel movement, it is enough to wash the area with warm water, pat it dry with a soft towel and not rub. Scented wet wipes and harsh soap irritate the skin, so avoid them. A little discharge may come from the wound. To protect your underwear, you can use gauze or a thin hygiene pad. If stitches were placed, self-dissolving suture material is usually used, and the stitches don't need to be removed.

If you have any of these signs, don't wait: seek help urgently. A fever above 38°C (100.4°F), heavy or non-stop bleeding, being unable to urinate for several hours, pain that gets worse instead of better, and severe swelling or pus around the wound. Even at night or on a holiday, call us or go to the nearest emergency service.

After anesthesia, or after an operation in the anal area or vagina, urinating can be difficult in the first hours. This is usually related to swelling and muscle spasm and is temporary. In the first days, try to empty your bladder every 2–3 hours. If your bladder is full and you can't urinate, tell us right away: if needed, a catheter is placed for a short time.

No. After surgery, the doctor prescribes which painkiller, ointment or suppository you need and how and how much to use. Remedies bought at the pharmacy on your own can hinder wound healing or mask a problem. If you can't take a prescribed medication or you notice side effects, message us.

The first follow-up is usually about a week after the operation. The number of later visits depends on how the wound heals: sometimes one exam is needed, sometimes several. We set the follow-up dates with you at discharge.

Recurrence is possible, but it is not inevitable. The chance depends on the stage of the disease, the method chosen and, most of all, whether the causes have been removed: constipation, straining, sitting on the toilet for long periods, lifting heavy loads. When you follow the recommendations on diet and toilet habits, the risk drops considerably. We explain the differences between methods on the hemorrhoid treatment page.

After general anesthesia, light, liquid, easily digested food is given on the first day, and then the diet is gradually widened. The main aim is to keep the stool soft and regular: cooked vegetables, fruit, oatmeal and buckwheat porridge, yogurt and kefir, and enough water. Increase fiber gradually rather than all at once, because a sudden increase in fiber can cause bloating.

During healing, limit hot, very salty and spicy, fried, smoked and pickled foods, fast food and alcohol. White flour products, lots of sweets and semolina porridge make constipation worse in some people. Watch which foods cause constipation in you, and build your diet accordingly.

Unless your doctor has set a limit because of a heart or kidney condition, try to drink 1.5–2 liters of fluid a day on average, with most of it plain water. Tea, coffee and sugary sodas don't fully replace water. Fiber works together with water: when there is too little water, fiber-rich food can harden the stool instead of softening it.

It hasn't been proven that spicy food alone causes hemorrhoids. The main causes are constipation, straining, sitting for long periods, pregnancy and heredity. But in some people, hot, heavily spiced food and alcohol increase burning and irritation after using the toilet, especially with an anal fissure and after surgery. So it is better to limit these foods during flare-ups and while healing. We explain the topic in detail in our article on common misconceptions.

Every day, eat vegetables and fruit (apples, pears, oranges, carrots, leafy greens), whole grains (oats, buckwheat, rye bread), legumes and fermented dairy products. Keep mealtimes regular, drink enough water through the day and stay active. If constipation continues even after you change your diet, its cause should be investigated: we have written about this on the constipation page.

It depends on the type of operation and the nature of your job. After less traumatic procedures, such as laser treatment or anal fissure surgery, people can often return to a desk job after a few days. After larger or combined operations, 1–2 weeks are usually needed, and a return to heavy physical work comes later. The exact time is given after the examination.

Walking is useful from the first days: it improves circulation and bowel function. You can usually return to light activity after 1–2 weeks. Lifting weights, strength training in the gym, cycling and horseback riding are usually postponed for 2–4 weeks, until the wound has fully healed. After pelvic floor operations (rectocele, cystocele, vaginoplasty), you need to avoid heavy loads for about 4–6 weeks. We give permission at the follow-up exam.

You must not drive on the day you have anesthesia, so plan ahead to go home with a relative or by taxi. After that, you can return to the wheel when you can sit comfortably, press the brake without hesitation and are not taking painkillers that cause drowsiness. This usually takes a few days, and can be longer after larger operations.

When planning your trip, keep in mind that it is best to stay in Baku until the first follow-up exam. That time depends on the type of operation. On a long journey, stop and walk around a bit every 1–2 hours, and keep water and light food with you. Before you come, message us on WhatsApp and send the test results you already have so that your trip takes as few days as possible.

After operations in the anal area, it is advisable to wait until the wound has healed and the pain has gone, usually a few weeks. Any contact that puts pressure on the anal area is possible only after full healing. After rectocele and cystocele operations, this period is usually 4–6 weeks, and after vaginoplasty about 6 weeks. We give permission at the follow-up exam.

Be sure to tell the doctor, because the decision depends on the type of problem. Hemorrhoids or an anal fissure that cause symptoms usually get worse in pregnancy, so it may be easier to treat them before pregnancy. Pelvic floor operations such as rectocele repair and vaginoplasty, on the other hand, are often better done after your plans for childbirth are complete, because a new birth can affect the result.

This feeling is very common and completely natural. For a proctologist, your complaint is part of everyday work, and there are no embarrassing questions here. If it's hard to talk, you can write your complaint to us on WhatsApp beforehand, or note it on paper and show it at your appointment. Time lost to embarrassment often makes the problem bigger and treatment harder.

Yes. The examination takes place in private, and your diagnosis and medical information are not shared with anyone without your consent. When booking, you don't have to name the condition in your message: writing “Hello, I'd like to book an appointment” is enough.

Not without your wish and consent. No photos or videos that could identify a patient are taken or shared. The patient stories on the site are also published anonymously, with identifying details removed and with the patient's consent.

No. Operations are performed by a female surgeon and an all-female anesthesia team. When a female patient is on the operating table, no men enter the operating room. We are asked this question often, and we understand your concern well.

Treatment doesn't depend on the doctor's gender, but comfort changes a lot. Many women delay seeing a doctor for years because they feel embarrassed in front of a male doctor, and they tell no one about changes after childbirth, urinary leakage or difficulty on the toilet. With a female doctor and a female team, it is easier to talk openly about these topics, and seeing a doctor early means simpler treatment. We talk about this in more detail in our female proctologist page.

Yes. Dr. Ellada Manafova sees both women and men. Hemorrhoids, anal fissure and constipation are very common in men too, and an anal abscess is actually more common in men. The exam is done with the same privacy and respect for everyone.

A proctological exam can be done during your period too. If you feel uncomfortable, you can move the appointment a few days later. But if you have severe pain, fever or heavy anal bleeding, don't postpone the exam.

No. Enlarged hemorrhoidal lumps don't return to their previous state on their own: even if the symptoms settle for a while, the disease can progress over time. In the early stages (I–II), treatment is often without surgery: diet, toilet habits and remedies prescribed by your doctor. Read about the stages and methods on the hemorrhoid treatment page.

A fresh (acute) anal fissure (commonly called an anal tear) often heals in a few weeks with proper treatment. Treatment consists of softening the stool, warm sitz baths and creams prescribed by your doctor that reduce the spasm of the sphincter (the circular muscle that closes the anal canal). If a fissure lasts longer than 6–8 weeks, its edges harden and it becomes a chronic fissure. Even with a chronic fissure, medication is tried first, and when it doesn't work, a short, less traumatic operation is performed. You'll find more on the anal fissure treatment page.

No. Anal bleeding can be a sign of hemorrhoids, an anal fissure, a polyp, inflammation of the rectum and, sometimes, a bowel tumor. You can't tell the cause at home from the color or amount of blood. We have written about this in detail in our article on blood on toilet paper. Bleeding that appears after age 45–50, or comes with weight loss, anemia or a change in bowel habits, always needs an examination and often a colonoscopy.

No. Laser treatment of hemorrhoids (LHP, laser hemorrhoidoplasty) often gives good results in stages II–III. In stage IV and with very large lumps that come out, other methods such as removal of the lumps may be more suitable. We tell you which method suits you after the examination: laser treatment.

No. An anal fistula does not heal on its own, and antibiotics can only reduce the inflammation temporarily. As long as the fistula tract remains, the inflammation comes back, and the longer you wait, the more the tract branches and the harder treatment becomes. Treatment is surgical and is planned with a method that protects the sphincter as far as possible: anal abscess and anal fistula.

This may be a sign of paraproctitis (an anal abscess, a collection of pus in the anal area). Don't wait, seek help urgently: an abscess doesn't clear up with antibiotics and must be opened and drained surgically. If you delay, the pus can spread and damage the sphincter, and the abscess can turn into a fistula. More here: treatment of an anal abscess.

It isn't normal, and you shouldn't have to live with it for years. Pressing on the back wall of the vagina to have a bowel movement, and a feeling of incomplete emptying, are often signs of a rectocele (the front wall of the rectum bulging toward the vagina). It is especially common in women after childbirth and is treatable: rectocele.

Although urinary incontinence is very common, it isn't something you simply have to put up with, and it can be treated at any age. In mild cases, pelvic floor muscle exercises can help, and in more advanced stress incontinence (leaking when coughing or laughing), short operations such as TOT (sling, placing a thin tape under the urethra) are used. Incontinence that comes with a sudden, irresistible urge is treated in a different way. More here: cystocele and urinary incontinence.

Most polyps are benign, but some types can turn into cancer over the years. That is why polyps that are found are usually removed during the colonoscopy itself and sent for histological examination, meaning they are checked in a laboratory. The timing of the next exam is set according to the result: colon polyps.

The standard treatment for gallstones that cause symptoms is removing the gallbladder laparoscopically, through small incisions (cholecystectomy). Dissolving stones with medication is tried only in rare, selected cases, and stones often form again. For stones that cause no symptoms, the decision is made individually: gallbladder surgery.

Yes, chronic constipation is one of the most common causes of hemorrhoids and anal fissure. Hard stools and straining increase the pressure on the blood vessels of the anal area and damage the mucous lining. Finding and removing the cause of constipation is the basis of both treatment and prevention: constipation treatment.

The price depends on the diagnosis and the treatment chosen: the type and scope of the operation, the anesthesia, the tests needed and the length of the hospital stay all affect the cost. That is why the exact amount is determined after the examination. Along with the treatment plan, we discuss the costs openly with you in advance.

It wouldn't be right to give an exact price without an examination, because the same complaint can be caused by different conditions. For example, the cause of bleeding is sometimes treated with diet and medication alone, and sometimes with surgery. We answer your general questions about appointments on WhatsApp, and we give the exact cost of treatment after the examination.

It depends on your insurance company's contract with Qafqaz Hospital and the terms of your policy. When you book, tell us the name of your insurance company, and also ask your company whether this service is covered.

Message us on WhatsApp or call as far in advance as possible. That way we can offer you a new time and give the freed-up slot to another patient.