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The main difference is actually the Medicare fees – say you are referred to a specialist because you have been screened for faecal occult blood and the test has been positive. For the initial consult, the Medicare benefits(100%) for the gastroenterologist is $139.45 while for surgeons it is $79.05.  This difference is because different specialities are allowed to claim different rates for the consults and in the past, not many physicians do procedures such as endoscopy.

Also in general, surgeons tend to treat the haemorrhoids at the same time while most gastroenterologist would refer the haemorrhoids to a surgeon for treatment(eg banding of haemorrhoids)

Not all general surgeons do colonoscopies as they concentrate on their specialized fields.  But there are general surgeons too who specializes in colonoscopy.

The most important thing is to check if the endoscopist is allocating enough time to do the scope in order to have a good thorough gentle look for polyps. One can easily miss a polyp in a mucosal fold or under a pool of faeculent fluid if one does a colonoscope too quickly(eg if there are time or economic pressures)

You should always speak to the endoscopist about this. It is best for the endoscopist to allocate on average about 30minutes to do a colonoscopy.

Bowel cancer is so common (About 1 in 20 Australians will develop bowel cancer in their lifetime) and so are haemorrhoids. It is not safe to assume once symptoms is due to haemorrhoids alone. It is best that this is discussed with your general practitioner. And if there are any concerns, you should be referred to a surgeon or endoscopist.

There has certainly the cases where patients present with clear symptoms of bleeding from haemorrhoids but on colonoscopy, a bowel polyp or even bowel cancer has been found!

Haemorrhoids can present in a variety of ways.

Presentations:

1. Bleeding – either blood on the toilet paper or blood dripping on the toilet bowl. The latter can be quite alarming for the patients

2. Palpable lump – usually comes out after one opens the bowels and can either go back in spontaneously or needs to be pushed back in

3. Pain – uncommon. This is caused by a thrombosed haemorrhoid (the blood in the dilated blood vessel within the haemorrhoid becomes clotted)  The pain can be severe especially in the first 3 days.  After that, as the swelling subsides, the pain reduces.  On examination, one can find a large swollen tender lump in the perianal area