Do I need a Colorectal Surgeon or a Gastroenterologist?

What is the difference between a colorectal surgeon and a gastroenterologist? This is a very common question that we receive and often patients are unsure of which field is appropriate for their needs. Although these fields overlap in some areas, the specialties are actually very different in the conditions they treat and their method of training. In order to address this issue, we have added some useful information to decide which type of physician treats your condition.

A Colorectal Surgeon, formerly known as a proctologist, is a general surgeon who has undergone further training in the diagnosis and treatment of diseases of the colon, rectum and anus. Colon and rectal surgeons are experts in the surgical and non-surgical treatment of colon and rectal problems. Colon and rectal surgeons treat benign and malignant conditions, perform routine colon screening examinations and surgically treat problems when necessary.

A colorectal surgeon will evaluate, diagnose and treat the following symptoms and conditions:

Anal Abscess/Fistula Anal Cancer Anal Fissure
Anal Pain Anal Warts Bowel Incontinence
Colorectal Cancer Constipation Crohn’s Disease
Diverticular Disease Hemorrhoids Irritable Bowel Syndrome
Pelvic Floor Dysfunction Pilonidal Disease Pruritus Ani
Rectal Prolapse Rectocele Ulcerative Colitis

A gastroenterologist is a doctor who has completed initial training in internal medicine and further training in gastroenterology. Gastroenterologists do not operate on patients. A gastroenterologist specializes in diseases of the digestive system (gastrointestinal (GI) tract). Gastroenterologists diagnose and treat many conditions that affect the esophagus, stomach, small intestine, large intestine (colon), and biliary system (e.g., liver, pancreas, gallbladder, bile ducts).



Fixed Price Colonoscopy

Dr. Perryman participates with Parker Adventist Hospital in the fixed price colonoscopy program. Fixed price colonoscopies are for patients who do not have insurance coverage. There is a set fee of $1,000.00 which covers all expenses related to the procedure. Please call our office at 303-840-8822 if you need any further information or want to schedule.

What is a virtual colonoscopy

What is a virtual colonoscopy?

A virtual colonoscopy is different from a regular colonoscopy. The virtual colonoscopy is performed in the radiology department of a hospital or medical center. No sedatives are needed and no scope is used. You will lie on your left side on a narrow table that is connected to a CT scan machine.

  • A small, flexible tube will be inserted into your rectum. Air is pumped through the tube to make the colon bigger and easier to see. Pumping air into the colon can create cramping or gas pains.
  • After this is done, you’ll be asked to lie on your back as the table slides into a large tunnel through the machine, where x-rays create images of your colon.

A regular colonoscopy may also need to be done (on a different day) after a virtual colonoscopy if:

  • No cause for bleeding or other symptoms were found. Virtual colonoscopy can miss some smaller problems in the colon.
  • Biopsy or polyp removal is needed.

Your doctor will most likely recommend a conventional colonoscopy instead of a virtual colonoscopy for the majority of patients. The reason is that virtual colonoscopy does not allow the doctor to remove tissue samples or polyps. This is important because some polyps can be precancerous and must be removed to eliminate the possibility of turning into cancer. In addition to removing polyps, your doctor may want to take additional biopsies to rule out certain conditions in conjunction with symptoms you experience. This can only be done with a conventional colonoscopy.

How to prepare for either test

Everyone undergoing any type of colonoscopy, virtual or traditional, must completely empty their bowels before the exam. Both tests require a bowel prep and clear liquid diet, specified by your doctor.

Risks for a virtual colonoscopy

  • Radiation exposure. The risk of radiation exposure remains uncertain, although it is significantly lower radiation than one is exposed to during standard CT scans.
  • The medications to prepare for the test can cause nausea, vomiting, bloating, or rectal irritation.


Differences between virtual and conventional colonoscopy include:

  • Virtual colonoscopy uses no sedation, and patients are usually able to go back to their normal activities right away after the test. Conventional colonoscopy involves sedation, and usually the loss of a work day.
  • Conventional colonoscopy uses the same prep as a virtual and allows for biopsies at the time of the procedure, thus no need for patient to repeat prep and have a 2nd procedure if something abnormal is found on the virtual colonoscopy.
  • Conventional colonoscopy has a lesser margin for missing smaller problems in the colon.
  • Screening conventional colonoscopy generally covered by most insurance companies at 100%.
  • Virtual colonoscopies may not be covered by insurance and can be a very expensive out of pocket cost for a patient.
  • Not all medical facilities are currently performing virtual colonoscopies.

Rectal Bleeding

The most common misconception about rectal bleeding is that it is coming from hemorrhoids.

Hemorrhoids can be the cause of rectal bleeding; however, there are many other conditions that can cause rectal bleeding. These conditions include but are not limited to, colon cancer/rectal cancer, anal fissures, constipation, polyp(s), and Inflammatory Bowel Disease, such as Crohn’s and Ulcerative colitis. Please visit this link to see all causes of rectal bleeding

To determine the source of rectal bleeding, an anorectal exam should be performed by a qualified provider as well as a colonoscopy. Doing both of these procedures will allow Dr. Perryman to diagnose the source of the bleeding and determine treatment. 


 Colorectal Cancer and Digestive Health Awareness Webcast  


Click here for more information 


Be sure to click the link above and join in on March 28th as The American Society of Colon & Rectal Surgeons answer your questions about the importance of early detection and provide information on treatment options.





March 2nd is Dress In Blue Day!

March is National Colorectal Cancer Awareness Month. 

Did you know that colon cancer is the 2nd leading cancer killer?   The good news is that screening tests, such as colonoscopies, can save 30,000 lives each year.  These tests not only detect colorectal cancer early, but can also prevent colorectal cancer.  When you turn 50 years old, or if you are younger and have a family or personal history of colorectal polyps, colorectal cancer, inflammatory bowel disease, or breast, uterine or endometrial cancer, you need to talk to your health care provider about colorectal cancer screening tests.

This Friday March 2nd is Dress In Blue Day. 

Get involved to increase colon cancer awareness and help patients in need.  Wear blue and encourage everyone you know to talk with their doctor about colon cancer screening.  You never know who’s life you may help save.

For more information, you can visit


What Causes Hemorrhoids?

Hemorrhoids are vascular cushions in the anal canal.  Hemorrhoids are normal.  However, if these vascular cushions become enlarged or inflamed, symptoms, such as bleeding, discomfort, swelling or protrusion, may result.  Hemorrhoids become enlarged from increased pressure in the lower rectum.  Factors causing increased pressure include:  constipation, straining, prolonged sitting on the toilet, pregnancy, obesity and anal intercourse.  Hemorrhoids can also enlarge as you get older because the surrounding tissues in your rectum weaken and stretch with age.

You can Prevent Colon Cancer

Colon Cancer is the Second Leading Cause of Cancer Death

However, the good news is that regular screening colonoscopies can prevent colon cancer from starting. Screening detects growths in your colon (called “polyps”) so they can be painlessly removed before they turn into cancer. Colon cancer can occur at any age, but your risk significantly increases at Age 50.

9 out of 10 People Diagnosed with Colon Cancer are Over the Age of 50

Other Risk Factors

Simply being over 50 increases your risk, but there other factors that also increase your risk. Be sure to talk to Dr. Perryman about them:

  • Personal history of polyps—certain types of polyps increase the risk of colon cancer
  • Personal history of colon cancerpeople who have had colon cancer are more likely to develop it again
  • Family history of colon polyps or cancer—individuals who have a first-degree relative (parent, sibling, child) who developed colon cancer before age 60, or two or more relatives with colon cancer at any age are at higher risk of developing colon cancer
  • Personal history of inflammatory bowel disease
  • Hereditary syndromesFamilial Adenomatous Polyposis (FAP) or Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
  • Race—African Americans are at greater risk of developing colon cancer and dying from it than any racial or ethnic group in the United States
  • Lifestyle—consuming a diet high in fat, smoking, and physical inactivity increase your risk of colon cancer. Your chance of developing colon cancer increases if you are overweight!

Check with Dr. Perryman about when you should begin your preventative screenings, and how frequently to repeat them if you have any of these risk factors.

Early colon cancer usually has no symptoms

Signs and symptoms of colon cancer often do not present until the cancer is more advanced.

Contact Dr. Perryman immediately if you begin experiencing:

  • Change in bowel habits
  • Rectal bleeding or blood in the stool
  • Abdominal discomfort
  • A feeling of needing to have a bowel movement or rectal pressure that doesn’t go away
  • Weakness and fatigue
  • Anemia
  • Decreased appetite
  • Unintentional weight loss

Treatments and outcomes continue to improve. There are more options available today than ever before. They vary and may include surgery, chemotherapy, radiation, or a combination depending on the stage and location of the cancer. Surgery can be performed laparoscopically. A permanent colostomy is rarely needed. But you must seek medical attention early to improve your odds of beating this deadly disease.” Lisa A. Perryman, MD, FACS, FASCRS