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Haemorrhoidal disease is common during pregnancy. Most would resolve after delivery but some can remain persistent and refractory to medication.
If the haemorrhoids are symptomatic and distressful, surgical excision may be carried out with no compromise to the integrity of the episiotomy wound. If the hemorrhoids are prolapsed, then stapled hemorrhoidectomy is the ideal solution.
This can be done as a day procedure and patients are frequently relieved after the operation.
Anal fissures are classified into acute or chronic. Acute fissure (lasting 8-12 weeks) may be treated conservatively with stool softeners, sitz bath and analgesics. Chronic fissures (more than 3 months) are more stubborn and difficult to heal.
Treatment is surgical division of the anal muscles known as Lateral Anal Sphincterotomy. In experienced hands the results are very good with near instant relief of symptoms. Other options include creams and suppositories but these are associated with side effects like headaches.
Change in stool caliber and consistency can be due to a narrowing in the anus or rectum. Patients who had haemorrhoid surgery done may develop narrowing of the anus and pass narrow caliber stools.
The most sinister cause would be a narrowing of the rectum or descending colon due to an inflammatory or malignant process.
In older patients, these symptoms should never be taken lightly and a diagnostic colonoscopy would be the obvious next step.
At 25 and assuming no family history the odds of it being cancer is low, but not zero. You should see your family GP and have the doctor perform a rectal examination for you, and if necessary refer you on to a specialist for further evaluation.
Colon cancer surgery is complex and requires a team of specialists, nurses and specialised equipment. The average number of days in hospital is 7-10 days after the operation.
As the cost depends on the complexity of the case and the technique used, it is difficult to quote a number but it would roughly range from $40,000 to $70,000 all inclusive.
Colorectal cancer surgery is Medisave and insurance claimable. It would be best to contact your insurance provider as they are the best persons to answer your policy questions.
There are 2 types of colostomy : temporary and permanent.
During colorectal cancer surgery, the segment of bowel containing the cancer is removed and healthy bowels are joined back together to form a joint, or what surgeons call an anastomosis. For cancers that are near the anus muscles (so called low tumours), the chance of leakage after the anastomosis is formed is higher than cancers that are further away from the anus (high tumours).
Therefore, temporary colostomies are created after operation for low tumours to divert the fecal stream away from a fragile anastomosis to give it a better chance to heal. Colostomies are frequently not necessary after operation for a high tumour.
Temporary colostomies are closed at a later date once the anastomosis is deemed to have healed using special X rays. This varies from 1-3 months after the operation.
Permanent colostomies are created when the tumour is so low it involves the anal muscles. The anus is therefore sacrificed during the operation and the remaining colon is brought out on the abdomen as a "new anus". The bottom end is then closed permanently. The patient then lives with the stoma for the rest of his/her life.
A colostomy, whether temporary or permanent, is easy to manage, odourless, hides easily under clothings, and has negligible impact on quality of life. The patient is able to continue his or her way of life with no fuss. There are quite many prominent public figures with a permanent colostomy and they carry on their public functions without anyone knowing. I have many patients with permanent colostomies and no one has ever come back and say they regretted their operation.
You should contact the Ostomy Association of Singapore. They will send someone who lives with a colostomy to visit and show it isn't something to be afraid of.
As far as possible, surgery should be the first choice to deal with the problem.
Stenting is done when the patient is too weak to undergo surgery at the point of presentation. The patient may be dehydrated and have severe electrolyte imbalance due to the obstruction. In good hands, stenting produces good results, and allows both the patient and surgeon to buy time for proper stabilisation and work-up before definitive surgery. For this reason stenting is often called the "bridge to surgery".
Another option in obstructed cases is to create a temporary diversion colostomy to relieve the obstruction. This is often done in advanced cases where the tumour is so large and surgery becomes dangerous. The stoma relieves the obstruction, and the patient may be stabilised and then undergo chemo and/or radiotherapy to down-stage the tumour before surgery.
Based on your age and your 6 years of symptoms, and assuming you have no family history of colorectal cancers, the odds of your symptoms being due to a tumour are low.
However, a screening colonoscopy is still your best bet in excluding a potentially serious condition. Discuss with your GP to explore this option. Colonoscopy is still the gold standard and in trained hands a very safe and quick procedure.
Since end-July, I have been experiencing on and off rectum bleeding every few weeks. Bright red blood is visible when I wipe, but not in the stools. The amount of blood is usually around a 20c coin (or less) and does not seep through the toilet paper. The 1st occasion lasted a week, and was painful. I supposed it was anal fissure since it hurted badly.
However, the subsequent occurrences lasted only a day or two; sometimes it hurts and sometimes it doesn’t. More recently, I saw blood along with a burning sensation after bowel motion and attributed it to spicy meal. 3 days back I saw blood again despite having a normal, painless bowel motion.
I’m particularly worried about colon cancer. I’m turning 23 soon and had an aunt who died from colon cancer. May you advise?
I have history of piles for 3 years. Recently, it had seem to get worse as i can feel my poop getting block and unable to come out. Even if it does, it requires much strain which my piles hurt again. Have the same problem even with laxative. Few weeks back, I had deep red blood dripping into the toilet. Should i be worried of my condition? Thank you.
I have a cousin who had his internal intestine out in position after he had over-used his strength to carry heavy items. His jobs is to carry things that are twice his weight, but he did go to see a doctor to put his intestine back in place. After this, he feels his heart and stomach is a bit painful. May I know whether it requires surgery? My cousin stays in Indonesia, so their medical facilities are not so equipped. This is why I’m asking Singapore doctors.
I am a mostly sedentary guy in my late 20s, not obese, and I lift weights a few times a week. I began to get a brief dull pain near the tailbone occasionally when I get up from a chair and when I rock back while seated. I could not tell if it is muscle related, bone related, or anything deeper. I suspected bad sitting posture or some sort of injury to the coccyx, despite never experiencing direct trauma there before. I tried maintaining a neutral spine while seated, which seemed to reduce the times I felt the pain standing up. I still reliably feel the pain when I rock back.
After about a week I was woken up by a throbbing ache in my anus, similar to a mild urge for a normal bowel movement, except with slight pain. I could be wrong but the pain seemed to be situated on the right side. The sensation/pain lasted about 5 minutes. There was no blood or any other signs. I don’t know if the two cases are related but I have not experienced either before. Also, before you ask I have never inserted foreign objects up my rectum.
My dad survived a bout of colorectal cancer some years ago- I think that’s a risk factor for me. What should I do? Is this strange enough to require a colonoscopy or should I wait it out?
Hi, I recently noticed that there was blood in my stools on 2 occasions. Now there is no more blood in my stools. However, I felt a bump at my butt crack. It is somewhat in the middle of the butt crack. Is this a cause for concern?
What are the most important screening tests for colon cancer in Singapore, and what do doctors take into account when choosing one screening option for colon cancer over another? I have read online that there are many options, such as a colonoscopy, Fecal Occult Blood Test (FOBT), Fecal immunochemical test, stool DNA test etc.
What age do you recommend that I start screening for colon cancer in Singapore, and how old should I be when I start?
I have been told that both piles (hemorrhoids) and colon cancer can cause blood in stools. How can I distinguish between the two causes for bleeding in stools?
My aunt has colon cancer. I understand that she may need to have surgery, and is in the process of going for some staging investigations. I would like to find out more about how colon cancer surgery is performed, and how the staging of the cancer affects her surgery.
I've read that robotic surgery can result in less pain and blood loss. I was wondering if it is available and suitable for colon cancer surgery as well, as I am finding the best treatment options for my dad.
What is normal recovery like after gallbladder removal? Is there anything in particular to take note of during the recovery process?