Proctology

Proctology (pronounced prok-tol-uh-jee)

(1) The branch of medicine dealing with the pathology of the colon, rectum and anus.

(2) Historically, the branch of medicine dealing with the surgery of the colon, rectum, and anus.

(3) In modern use, colorectal surgery as a specialty inside (as it were) proctology.

(4) A department or building so named in a hospital, university or clinic etc.

1896: The construct was procto- +‎ -logy or proct- + -ology.  Procto was from a Latinized form of the Greek prōktos (anus), from the primitive Indo-European prokto-, the source also of Armenian erastan-k' (buttocks).  The suffix -ology was formed from -o- (as an interconsonantal vowel) +‎ -logy.  The origin in English of the -logy suffix lies with loanwords from the Ancient Greek, usually via Latin and French, where the suffix (-λογία) is an integral part of the word loaned (eg astrology from astrologia) since the sixteenth century.  French picked up -logie from the Latin -logia, from the Ancient Greek -λογία (-logía).  Within Greek, the suffix is an -ία (-ía) abstract from λόγος (lógos) (account, explanation, narrative), and that a verbal noun from λέγω (légō) (I say, speak, converse, tell a story).  In English the suffix became extraordinarily productive, used notably to form names of sciences or disciplines of study, analogous to the names traditionally borrowed from the Latin (eg astrology from astrologia; geology from geologia) and by the late eighteenth century, the practice (despite the disapproval of the pedants) extended to terms with no connection to Greek or Latin such as those building on French or German bases (eg insectology (1766) after the French insectologie; terminology (1801) after the German Terminologie).  Within a few decades of the intrusion of modern languages, combinations emerged using English terms (eg undergroundology (1820); hatology (1837)).  In this evolution, the development may be though similar to the latter-day proliferation of “-isms” (fascism; feminism et al).  A physician specializing in proctology is a proctologist although some may prefer the punchier construction Bart Simpson (from the cartoon TV series The Simpsons), used: “butt doctor”.  The noun proctalgia (pain in the anus or rectum) existed in the medical literature as early as 1811 while the first known use of “proctologist” dates from 1897.  Proctology & proctologist are nouns and proctologic & proctological are adjectives; the noun plural is protologists.

In 1974, The British Medical Journal (BMJ) used the term “guitar nipple” to describe “the irritation to the breast that can occur from the pressure of the guitar against the body.”  In the same spirit, two years later a contributor to the Journal of the American Medical Association (JAMA) was more imaginative still, coining “hot pants syndrome” when documenting cases in which a burn to the skin had been induced by a patient carrying a battery-powered transistor radio in the pocket of their trousers.  There was also in 1978 the New England Journal of Medicine's (NEJM) “disco digit” which referred to “a sore or infected finger caused by too much finger snapping while dancing.”  These terms were indicative of the trend in the English-speaking world for newly-identified (and in some cases novel conditions) to be constructed with English elements, rather than the Latin historically used.  In the fields of proctology, the historic terms (of discomfort in the region) were:

Rectalgia (pain in the rectum), the construct being rect- (a clipping of the New Latin rectum, itself a clipping of the Latin rectum intestinum (literally “the straight intestine”), neuter of rectus (straight) +‎ -algia (from the New Latin -algia (pain), from the Ancient Greek ἄλγος (álgos) (pain).

Proctalgia (pain in the anal or rectal region), the construct being proct- (a New Latin combining form, from Ancient Greek πρωκτός (prōktós) (anus).+‎ -algia.

Anodynia (anal pain; anorectal pain), the construct being ano- (from the Latin anus) + -dynia (an alternative (used when the preceding morpheme has a terminal vowel) form of -odynia (a New Latin combining form, from the Ancient Greek ὀδύνη (odúnē) (sorrow, grief, anguish, unhappiness).

Confusingly though, because terminology evolved often independently an in parallel, medicine contrived to use anodynia also to mean “the absence of pain in a previously painful region” and in that case the construct differed, being an- (from the Ancient Greek ἀν- (an-); a doublet of un- and in- (used her in the sense of a negation) +‎ odynia (a New Latin combining form, from the Ancient Greek ὀδύνη (odúnē) (sorrow, grief, anguish, unhappiness).  So for the non-medically trained, confusion could arise given anodynia can mean either “pain in the butt” or “pain has gone away” although because it’s a word unlikely much to be seen by other than the medically trained, instances of this have presumably been rare.  But in the context of “butt pain” there would seem to be some overlap in meaning between rectalgia, proctalgia & anodynia but while all are used to refer to “pain in or around the rectal area”, in the profession there are distinctions in use, particularly in clinical and diagnostic work 

Rectalgia is used to describe pain localized in the rectum and tends to be used as general term for the condition and often without specifying a cause.  Conditions associated with rectalgia include anorectal abscesses and fissures.  Proctalgia encompasses pain in the anorectal region (both anus and rectum) and is commonly used of proctalgia fugax, a specific condition characterized by sudden, severe, and brief rectal pain with no obvious underlying cause.  As the etymology suggests, proctalgia’s remit is broader than that of rectalgia because it includes both anus and rectum.  Whether or not related to the duality of meaning, anodynia is now not in general clinical use but historically it referred to pain in the vicinity of the anus.  The modern terms for that are “anal pain” & “anorectal pain”.  So, although lay-readers might be forgiven for thinking they could be used interchangeably, clinicians applied them based on anatomical location: rectalgia (rectum), anodynia (anus) &, proctalgia (anorectal region).

In the thoughts of Kellyanne Conway: A protologist's ultrasonic rectal probe (available in 140 & 200 mm (5½ & 8 inch) length versions) by the Electro Surgical Instrument Company (ESI (1896)).

Protology and pains in the butt do feature in idiomatic use in English.  Kellyanne Conway (b 1967; senior counselor to the US president, 2017-2020) when discussing the “Muller probe” (an investigation by special counsel Robert Mueller (1944) into Donald Trump (b 1946; US president 2017-2021; president elect 2024) and the matter of alleged Russian interference in the 2016 US presidential election told a press conference the whole project was “a political proctology exam.”  She clearly liked the imagery because later, when Mr Muller handed down his report, she told the assembled press pack it was the “best day” since Mr Trump’s (2016) election, repeated the phrase and stuck with the medical analogy, saying the verdict delivered “a clean bill of health.”

PITB (and its variations) is widely used.

So like Mr Trump, Ms Conway would have found the Muller probe a (metaphorical) pain in the butt but “political proctology exam” was both a more polite and elegant way of saying it.  The saying “pain in the butt” belongs to a class of such expressions (all meaning “a nuisance; a source of trouble or annoyance”) which variously are used according to the need for politeness, the hierarchy of rudeness (in ascending order) being: “pain in the neck”, “pain in the brain”, “pain in the back” (all about equal), “pain in the rear”, “pain in the bum”, “pain in the ass” & “pain in the arse” (the choice between “ass” & “arse” dictated by linguistic tradition).  All are often used as initializms (PITN PITB, PITR, PITA) and PITA seems the most popular while in oral use “pain in the neck” and “pain in the ass (arse)” vie for popularity although some do like “pain in the brain” for the rhyme.

First edition (hardcover, 1956) of Soranus' Gynecology, published by Johns Hopkins University Press, translated and with an introduction by Owsei Temkin MD (1902-2002).

Quite when the idea of “specialists” in the modern sense of the word came to the practice of medicine isn’t certain but long before such things were formalized by the creation of colleges or specialist qualifications, it’s likely the early physicians did tend to develop particular areas of expertise and would have had certain patients referred to them, much as is the modern practice.  Probably, this emergence of specialties would have happened organically, based on geography: a physician in a fishing community on the sunny Aegean coast would have encountered a different patient profile than one who worked in the cold of the mountains.  Thus, while it’s not known who can be though the “first proctologist”, medical students everywhere will probably nominate Soranus of Ephesus, a Greek physician who practiced in both Alexandria and Rome during the first & second century AD.  His four-volume treatise on gynecology still exists so he probably deserves to be remembered as an early gynecologist but, as all those medical students learn, his name is pronounced sawr-ey-nuhs so a proto-proctologist he is.  Such things do happen: Winston Churchill’s (1875-1965; UK prime-minister 1940-1945 & 1951-1955) neurologist was Russell Brain (1895–1966).