A colorectal surgeon (also called a colorectal and general surgeon) is a doctor who has completed medical school, at least five years of surgical training, and additional specialist training focused specifically on the colon, rectum, and anus. In Australia, this training leads to Fellowship of the Royal Australasian College of Surgeons (FRACS) — the highest surgical qualification in this country.
The important thing to know is that colorectal surgeons do not only operate. They manage a wide range of conditions — many of which can be treated without surgery at all. Their work covers:
- Colorectal (bowel) cancer — including diagnosis, surgery, and coordinating chemotherapy and radiotherapy with the wider team
- Haemorrhoids (piles) — from dietary advice and rubber band ligation (a quick outpatient procedure) through to formal haemorrhoidectomy
- Anal fissure (a painful tear at the anal opening) — Botox injections and, if needed, lateral internal sphincterotomy
- Inflammatory bowel disease (IBD) — the surgical side of managing Crohn's disease and ulcerative colitis
- Diverticular disease — including acute diverticulitis and planned bowel resection
- Hernia repair — inguinal (groin), umbilical (belly button), incisional, and hiatus hernias
- Pilonidal disease — cysts and sinuses at the base of the spine
- Perianal abscess and fistula (an abnormal tunnel between the bowel and skin)
- Colonoscopy and polypectomy — bowel camera examinations and removal of polyps
- Rectal prolapse and pelvic floor problems
This is one of the questions we hear most often. Both specialists look after the gastrointestinal tract, but they trained differently and their focus is different.
Colorectal surgeon
- A surgical specialist — trained to operate as well as manage conditions non-surgically
- Operates on the colon, rectum, anus, and abdominal wall
- Performs colonoscopy
- Manages haemorrhoids, fissures, hernias, pilonidal disease, and more
- The right choice when surgery might be needed, or for most conditions of the lower bowel and anus
Gastroenterologist
- A medical (non-surgical) specialist — does not perform operations
- Manages inflammatory bowel disease with medications, liver conditions, and upper digestive problems
- Performs colonoscopy and gastroscopy (camera of the stomach)
- The right choice for complex ongoing medication management of bowel conditions
In practice, these two specialists often work side by side. If you have Crohn's disease or ulcerative colitis, you will typically see a gastroenterologist for your medications and a colorectal surgeon if you need an operation or develop perianal complications. For bowel cancer, a whole team including both specialists works together — this is standard of care in Australia.
For most conditions affecting the lower bowel and the anal area — haemorrhoids, anal fissures, pilonidal disease, perianal abscess, anal fistula — a colorectal surgeon is the most appropriate first specialist to see.
Your GP can refer you to a colorectal surgeon for any of the following. You do not need a confirmed diagnosis first — a referral is appropriate as soon as any of these symptoms appear.
- Any rectal bleeding — whether it is bright red blood on the paper or in the toilet, or darker altered blood mixed through the stool
- A change in your usual bowel habit that has lasted more than three to four weeks — looser stools, constipation, or going back and forth between the two
- Losing weight without trying, or losing your appetite
- Persistent or recurring pain around the anus or in the perianal area
- A lump or swelling near the anus
- Anal itch that is not improving with simple treatments
- Faecal leakage or difficulty controlling your bowels
- A personal or family history of bowel polyps or bowel cancer
- A hernia you have noticed or been told about
- Known or suspected pilonidal disease, perianal abscess, or anal fistula
- Haemorrhoids that have not improved with dietary changes and over-the-counter treatments
These symptoms need an urgent referral — ideally seen within days, not weeks: any rectal bleeding in someone over 50, a change in bowel habit lasting more than three to four weeks in an over-50, unexplained weight loss along with bowel symptoms, unexplained low iron or anaemia with bowel symptoms, or a perianal abscess. Please do not wait for these to settle on their own.
In Australia, you need a referral from your GP (or another specialist) to see a colorectal surgeon and claim a Medicare rebate. Here is how the process works from start to finish:
See your GP first. Be as specific as you can about your symptoms — including any bleeding, pain, changes in bowel habit, and how long things have been going on. Your GP will examine you, arrange any initial tests (blood tests, stool tests, or imaging), and decide whether a specialist referral is the right next step. Do not downplay your symptoms to seem less like a bother.
Your GP writes a referral. This referral is what allows you to claim a Medicare rebate on your specialist appointment. A referral from a GP is valid for 12 months; from another specialist, for 3 months. If your symptoms are concerning, ask your GP specifically to mark the referral as urgent.
You come to your appointment. Your surgeon will go through your history in detail, perform an examination (which may include a gentle internal examination of the rectum), and look at any test results you have brought. Further investigations — such as a colonoscopy, CT scan, or MRI — may be arranged to get a clearer picture. We aim to see most patients within one to two weeks of receiving a referral.
You receive a clear explanation and a plan. After the assessment, your surgeon will talk you through what was found, explain what it means, and discuss your options. These might range from simple lifestyle changes, to an outpatient procedure, to planned surgery — depending on what is going on.
Treatment happens at the right setting for you. Some procedures can be done right in the rooms (such as rubber band ligation for haemorrhoids). Others require day surgery or a short hospital stay at one of our partner hospitals, depending on how involved the procedure is.
Australian Optimal Care Pathway guidance recommends that suspected-cancer and other urgent referrals are seen promptly — typically within a few weeks of the referral. These are not situations to put off for a routine appointment:
- Rectal bleeding and a change in bowel habit at the same time in anyone over 50
- Looser or more frequent stools lasting more than six weeks in someone over 60
- Unexplained low iron or anaemia in a man, or in a woman who has gone through menopause
- A lump that can be felt inside the rectum or in the abdomen
- Unexplained weight loss along with any bowel symptoms
- A strong family history of bowel cancer, plus new symptoms
- A perianal abscess — especially with severe pain, fever, or if you feel unwell overall
If your GP is unsure whether to refer you, it is always better to be seen and reassured than to wait on something that turns out to need prompt attention. Reassurance from a specialist is not a waste of anyone's time — it gives you peace of mind that is grounded in a proper examination.
Bowel cancer is the second most common cancer in Australia. Most cases appear without any family pattern, but around 20–25% have some familial clustering and about 5% are linked to a recognised hereditary syndrome. You should ask your GP for a colorectal surgeon referral to discuss your risk and set up appropriate monitoring if:
- A parent, sibling, or child was diagnosed with bowel cancer before age 55 (moderate risk)
- Two first-degree or second-degree relatives have had bowel cancer at any age (moderate risk)
- Three or more first-degree or second-degree relatives on the same side of the family have had bowel cancer (high risk)
- You have been told you carry a hereditary syndrome such as Lynch syndrome, familial adenomatous polyposis (FAP), or MUTYH-associated polyposis — conditions that carry a substantially higher lifetime risk of bowel cancer (high risk)
- You have previously had colorectal polyps removed
Under NHMRC guidelines, moderate-risk surveillance is colonoscopy every 5 years from age 50 (or 10 years before the youngest affected relative, whichever is earlier). High-risk surveillance starts from age 40 (or 10 years before the youngest affected relative). Earlier still for confirmed hereditary syndromes.
In Australia, you need a GP or specialist referral to access Medicare-rebated specialist appointments. Technically you can see a specialist without a referral (paying the full fee yourself), but it is not the best path — your GP plays an important role in ordering initial tests, providing context to the specialist, and coordinating your overall care.
If you already know you have a condition that needs attention — a hernia you have been aware of for a while, haemorrhoids that are not getting better, or recurrent pilonidal disease — you do not need to wait until things get worse. Just ask your GP for a referral. That is a routine and legitimate request.
What to bring to your first appointment
- Your GP referral letter
- Your Medicare card, and your private health insurance details if you have them
- A list of all your current medications, including anything you buy over the counter or take as supplements
- Any recent blood tests, scans, or endoscopy results
- A note of your main symptoms and roughly how long you have had them — even a rough timeline is helpful
- Any relevant family history of bowel cancer or polyps
Mr Ba Nguyen MBBS FRACS MS is a specialist colorectal and general surgeon consulting at 50 Mount Street, Heidelberg. He trained in Australia and holds a Master of Surgery (MS) degree — a research qualification that reflects further study in colorectal surgery specifically.
At your first appointment, you will have time to explain what has been going on. Mr Nguyen will take a thorough history and perform an examination — all in a private, relaxed environment. Many conditions can be fully assessed and a plan discussed at your very first visit. If a colonoscopy is needed, it is arranged at a partner endoscopy facility, usually without a long wait.
To make an appointment or ask a question, contact the rooms on (03) 9816 3951 or email admin@northeasternsurgical.com.au.
Your GP can absolutely manage mild haemorrhoids — dietary advice, fibre supplements, topical creams, and stool softeners are a reasonable starting point. But if your haemorrhoids are causing heavy bleeding, prolapse (a lump that comes out), or pain — or if they have not improved after several weeks of trying — a referral to a colorectal surgeon is the right next step.
At North Eastern Surgical, we aim to see routine referrals within one to two weeks and urgent referrals within days. If you have been waiting longer at another practice, it is worth calling our rooms directly — we may be able to see you sooner.
Not at all. Many of the conditions that bring people to a colorectal surgeon are treated without any operation at all — through dietary changes, medications, Botox injections, rubber band ligation (a quick in-rooms procedure), or sometimes just thorough reassurance that everything is fine. Surgery is only considered when simpler options have not worked, or when the situation specifically calls for it.
Yes — entirely normal. Bowel and perianal symptoms are among the most under-reported issues in medicine, mainly because people feel embarrassed. We understand that. These conditions are seen every single day at the practice. There is nothing you can say that will be surprising or awkward. What is more concerning is when embarrassment causes someone to delay care for months or years — because most of the conditions we see are very treatable when caught early.
Specialist consultations are covered by Medicare, not private health insurance. Bring your Medicare card to your appointment. Private health insurance helps with hospital and surgical costs if a procedure is needed down the track — that is where it becomes relevant. If you have extras cover, check with your insurer about any ancillary benefits.
Need a specialist opinion?
If something in this article matches what you're experiencing, the most useful next step is a proper assessment. A GP referral is required.