In our current day and age, there are numerous health factors vying for our constant attention. From cardiovascular conditions to hypertension and diabetes, along with managing chronic stress levels, it’s easy to only focus on conditions which have a more tangible and immediate impact on our health. However, one area that often remains neglected is colorectal health, due to it playing an essential yet understated role as compared to other organs in the body.
The colon plays an important role in digestion, helping to absorb water and store food waste while utilising muscle contractions to move waste to the rectum to be expelled from the body. The colon has a smooth inner lining consisting of millions of cells, and changes in these cells can lead to conditions that many Singaporeans face, such as colorectal cancer, piles, and diverticular disease, amongst others.
Beyond colorectal conditions, other conditions such as gallstones, hernias, and abscesses can significantly affect one’s quality of life. While some conditions are merely unsightly or cause mild discomfort, others can be potentially life threatening if unaddressed due to the risk of complications, requiring surgery to treat them.
The saying of ‘prevention is better than cure’ certainly applies to various colorectal and health conditions. Compared to other types of cancer, colorectal cancer has a much higher rate of recovery if detected and treated early, with up to 90% of cases being fully cured if discovered in time. This highlights the importance of visiting a professional colorectal surgeon in Singapore to arrange for regular screening and treatment if necessary.
With over 10000 successful procedures, Dr Leong is an experienced endoscopist and surgeon who specialises in Single Incision Laparoscopic (keyhole) Surgery, as well as minimally invasive General Surgery. He also provides same day colonoscopy services at his Singapore-based clinic, in addition to treating a variety of colorectal conditions, making it a smooth and comfortable affair when seeking treatment or screening tests.
Read on to learn more about various colorectal and general conditions, their symptoms and risk factors, as well as the available treatment methods.
In this section, we will cover a few major colorectal conditions, such as colorectal cancer, piles, and diverticular disease.
2.1 Colorectal Cancer
Colorectal cancer refers to cancer that occurs in the colon (large intestine) or rectum area. It usually starts from benign polyps, which are fleshy clumps of tissue that form on the inner lining of the colon or rectum. If left untreated, these polyps can develop into malignant tumours across a duration of 5 to 10 years, spreading to nearby organs or lymph nodes. When this happens, it is known as metastasis, making colorectal cancer much harder to treat as well as being life-threatening.
Statistics have shown that colorectal cancer is the most common cancer in Singaporean males, while being the 2nd most common cancer in Singaporean females. Colorectal cancer tends to not exhibit any outward symptoms at the early stages. At later stages, common symptoms include a change in bowel habits such as diarrhoea or constipation; the presence of blood in your stools, as well as persistent abdominal discomfort such as cramps, flatulence, or pain. It is essential to visit a colorectal clinic in Singapore if you experience any of these symptoms.
Some risk factors of developing colorectal cancer are as follows:
- Having a family history of colorectal cancer
- Being over 50 years of age
- Smoking and heavy alcohol use
- A diet high in red and processed meats
- Being overweight
- An inactive lifestyle
One of the greatest dangers of colorectal cancer is that it usually does not present symptoms until it is at an advanced stage, which may greatly complicate treatment and significantly lower the likelihood of a complete recovery. The good news is that regular screening is highly effective at detecting colorectal cancer in Singaporeans, allowing for early and effective treatment at the initial stages. Screening comprises a variety of tests, such as fecal immunochemical tests, double-contrast barium enema, as well as colonoscopies.
A colonoscopy is a procedure where a colonoscope, which is a 1.6m flexible tube with a video camera at the end, is inserted into the rectal region to allow for visual examination of the entire colon lining. Colonoscopy clinics in Singapore are well-versed in conducting colonoscopies, with the entire procedure taking about 20 to 30 minutes from start to end. It is conducted with general anaesthesia, making it a painless affair. In addition, a colonoscopy can identify and remove benign polyps, making it both a diagnostic and therapeutic procedure. An estimated 90% of polyps can be removed during colonoscopy, preventing the need for further surgery.
Prior to a colonoscopy, your doctor will inform you on what you should eat and how to empty your bowels for a smooth procedure. Dr Leong is a firm believer of Same Day Colonoscopy, where the consult, bowel preparation, colonoscopy, and results of the procedure all occur on the same day. With colonoscopies only being required approximately every 10 years, a reputable colonoscopy clinic in Singapore plays an important part in promoting screening and prevention of colorectal cancer by making the process smooth and comfortable.
Similar to other cancers, colorectal cancer is diagnosed across Stages 1 to 4. Generally, Stages 1 and 2 require surgery alone, while Stages 3 and 4 require surgery in combination with chemotherapy and/or radiotherapy/immunotherapy. Treatments vary from patient to patient, with doctors factoring in the stage of cancer when diagnosed as well as the overall health of the patient.
Contact our colorectal clinic in Singapore today to find out more about our screening and treatment procedures.
2.2 Piles
Piles, also known as haemorrhoids, are swellings containing enlarged blood vessels, and can be found either inside or around the rectum or anus. They are caused by increased pressure in the blood vessels in and around your anus, which can cause these vessels to become swollen and inflamed, resulting in discomfort and bleeding. In severe cases, it is advised to seek treatment for piles in Singapore.
Haemorrhoids can be classified based on four degrees based on size and severity.
- First degree: small swellings that develop on the inside lining of the anus and remain inside
- Second degree: larger swellings that prolapse (appear) when defecating, before spontaneously reducing (going back inside)
- Third degree: swellings that prolapse during defecation, but require digital reduction (with a finger)
- Fourth degree: swellings that are persistently prolapsed
Often, most people do not realise they have haemorrhoids until they exhibit symptoms, such as:
- Bleeding after passing a stool (with bright red blood)
- An itchy sensation at the anus
- A lump that hangs down outside the anus
- Mucus discharge after passing a stool
- Soreness, redness, or swelling around the anus
One of the main risk factors that can increase the likelihood of haemorrhoids is spending too much time seated on the toilet, causing blood vessels around the anus to be congested and enlarged. Other risk factors include having a family history of haemorrhoids, weakening of your body’s supporting tissues with age, as well as increased pressure on pelvic blood vessels as a result of pregnancy.
Generally, treatment for piles in Singapore varies based on the aforementioned degree of severity. For First and Second degree haemorrhoids, topical medication and lifestyle changes are often sufficient. Some lifestyle changes include increasing the amount of fibre in your diet via fruits and vegetables, drinking plenty of water, avoiding constipation medicine, and exercising regularly to reduce both weight and blood pressure.
One non-surgical procedure is rubber band ligation, where a tight elastic band is wound around the base of the haemorrhoid, cutting off its blood supply and letting it fall off naturally after a week. Other non-surgical procedures include injecting a chemical solution into haemorrhoid tissue to shrink it, or using coagulation techniques involving infrared light or heat to harden and shrivel haemorrhoids.
For Third and Fourth degree haemorrhoids, your doctor will likely recommend you to undergo surgery. Before undergoing surgery treatment for piles in Singapore, your surgeon will inform you of the risks that may occur after haemorrhoid surgery, ranging from bleeding, infection, urinary retention, faecal incontinence, and stenosis. Two options include undergoing a haemorrhoidectomy or a stapler haemorrhoidopexy.
A haemorrhoidectomy is the most effective and complete way of treating severe or recurring haemorrhoids, where small cuts are made around the anus to slice them away. It is conducted with either general or local anesthesia to reduce the pain, and takes a couple of weeks for recovery. A stapled haemorrhoidopexy is used to treat prolapsed haemorrhoids and is also carried out under anaesthesia, which uses stapling to block blood flow to haemorrhoidal tissue and causing them to shrivel up.
2.3 Diverticular Disease & Diverticulitis
Diverticular disease stems from diverticula, which are small bulges or weakness that develop in the lining of the colon as Singaporeans age. They are formed by increased pressure on weakened spots along the intestinal walls, such as experiencing straining during constipated bowel movement. Generally, diverticula are discovered during a routine colonoscopy or CT scan, or if patients are exhibiting symptoms of discomfort.
There are three varying diagnoses related to diverticula. If diverticula are present but exhibiting no symptoms, it is known as diverticulosis. Diverticulosis is very common and affects approximately 50% of people over 60 years of age, but generally results in no negative symptoms. Diverticular disease occurs when symptoms are exhibited, and diverticulitis is when infection or inflammation occurs as a result of diverticula tearing.
Some symptoms of diverticular disease in Singaporeans include abdominal pain that is aggravated by eating and relieved by bowel movement or flatulence, constipation or diarrhoea, as well as occasional blood in stools. With diverticulitis, additional symptoms include constant and more severe abdominal pain, along with the onset of a fever.
Here are some of the risk factors that can increase the risk of diverticulitis:
- Aging
- Obesity
- Smoking
- Lack of exercise
- A low-fibre and high fat diet
- Certain medications
If left untreated, diverticulitis can result in complications such as abscesses, stenosis, fistulas, and peritonitis. Peritonitis in particular is a medical emergency due to the rupturing of the infected diverticula and spilling intestinal contents into your abdominal cavity. Treatment for Singaporeans experiencing diverticular disease and diverticulitis depends on the severity of complications.
For mild cases, a high fibre diet with painkillers and antibiotics may be sufficient, as well as adopting lifestyle changes such as a healthier diet and increased exercise. Severe cases usually require a colectomy, which is the removal of the affected section of your large intestine and helps treat fistulas, peritonitis, and stenosis. To facilitate surgery, most surgeons utilise a technique known as percutaneous drainage to first deal with abscesses. A needle or catheter is inserted through the skin into the abscess to drain the infected fluid, facilitating an easier surgery process for diverticulitis.
Part 3: General Health & Surgery
Beyond colorectal conditions, there are other conditions that can affect one’s quality of life. Learn more about their symptoms and risk factors, as well as how surgery is effective in treating them.
3.1 Gallstones & Gallbladder Surgery
Gallstones, also known as gallbladder stones, are hardened deposits that form in your gallbladder. Bile is a liquid produced by your liver to help digest fats, and is passed into the gallbladder via bile ducts. Doctors suggest that high levels of cholesterol and bilirubin in your bile contribute to the formation of gallstones. Gallstone surgery is often required for Singaporeans who exhibit severe symptoms that impact their quality of life.
Some risk factors for developing gallstones include:
- Being over 40 years of age
- Being female
- Having a family history of gallstones
- Eating a high fat/cholesterol diet
- Being overweight
- Lack of exercise
Gallstones are a common occurrence, affecting an estimated 1 in every 10 adults. Generally, gallstones do not exhibit symptoms unless they become trapped in an opening inside your gallbladder. In such scenarios, blocked gallstones can cause a sudden and intense abdominal pain known as biliary colic. Left untreated, gallstones can lead to other complications such as jaundice (yellow skin), cholecystitis (inflamed gallbladder), and pancreatitis as a result of a blocked pancreatic duct, which can be life-threatening.
Gallstone surgery in Singapore is often required if complications to one’s health arise. A surgeon will conduct a laparoscopic cholecystectomy, also known as keyhole surgery, for symptomatic cases. A surgeon will make 4 small incisions in your abdomen, before a laparoscope is inserted to help identify and remove the gallstones. Imaging tests may be utilised as well to identify other related problems in your bile duct. As an established medical procedure that takes approximately 1 to 2 hours, keyhole surgery is usually a smooth affair for patients.
Dr Leong specialises in conducting Single Incision Laparoscopic Surgery (SILS). SILS confers a number of advantages over traditional keyhole surgery, such as significantly reduced pain and lowered risk of infection due to only requiring a single incision, helping to expedite patients’ recovery. It also provides a more cosmetic option by leaving no scar, due to the insertion of instruments through the navel region.
Prior to a surgery, your doctor will inform you on preparations you need to take, such as avoiding food and drink the night before surgery as well as stopping certain medications and supplements to minimise bleeding. Contact our colorectal clinic in Singapore today to learn more about SILS and how we treat gallstones.
3.2 Hernias
A hernia occurs when an internal organ or body part protrudes through the wall of muscle or tissue that normally contains it. It usually shows up as a lump that may go away when it is pressed or when you lie down. They can cause pain when coughing, bending over, or lifting heavy objects, and treating hernias requires professional help from surgeons in Singapore.
Hernias arise as a result of muscle weakness and strain, and can either develop quickly or over a long duration of time. Some risk factors include being overweight, doing strenuous exercise, undergoing a pregnancy, experiencing chronic coughing or constipation, as well as ageing.
Here are some of the most common types of hernia:
- Inguinal hernias occur when fatty tissue or a part of the intestine protrudes into the groin at the top of the inner thigh. It mainly affects men, and is associated with ageing and repeated strain on the tummy. Inguinal hernias can be further classified into direct and indirect inguinal hernias, with the latter having a higher risk of bowel complications
- Femoral hernias also occur when fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. They occur less frequently and tend to affect older women. They carry a high risk of bowel complications and should be addressed with surgery.
- Umbilical hernias occur when fatty tissue or part of the intestine protrudes through the abdomen near your belly button. It can occur due to previous incisions such as keyhole surgery, or due to obesity. They are common in newborns and infants, and can also affect adults as well.
In particular, complications of inguinal and femoral hernias can result in obstruction and strangulation. Obstruction occurs when part of the intestine becomes stuck in the inguinal canal, causing stomach pain and vomiting. Strangulation occurs when part of the intestine becomes trapped and cuts off blood supply, necessitating emergency surgery to prevent tissue death.
Similar to treating gallstones, hernia surgeons in Singapore can either utilise open or laparoscopic (keyhole) surgery to treat hernias. Open hernia surgeries involve an incision into the groin, before the surgeon pushes the hernia back into the abdomen before strengthening the abdominal wall with stitches or synthetic mesh. Keyhole surgeries utilise a laparoscope to allow for a smaller incision, promoting faster recovery and less pain but require the expertise of a trained surgeon.
3.3 Cyst & Abscess Removal
Cysts and abscesses occur throughout the body and are a common occurrence that affect numerous Singaporeans. In certain circumstances, surgical removal is highly recommended to improve one’s quality of life and prevent further infection and inflammation.
A cyst is a sac that is filled with fluid, air, or other material, and is generally harmless. A sebaceous cyst is a lump under the skin filled with sebum, which is an oily and waxy protective substance produced by your sebaceous glands. They may become infected due to bacteria growth, leading to enlargement and pain which may require surgery to treat if antibiotics and anti-inflammatory drugs fail to improve its condition.
An abscess is a collection of pus that has built up within the tissue. A perianal abscess is one of the most common types of abscesses, appearing as a painful swelling near the anus. Left untreated, anal abscesses can result in a complication known as an anal fistula, which is a small tunnel that forms between the abscess and an opening on the skin around the anus. It allows faeces to collect, resulting in chronic infection with pus and discharge.
Cyst formation is caused by a variety of reasons, ranging from genetic conditions to cell defects, chronic inflammatory conditions, blocking of ducts which cause fluid buildup, or injuries. Some factors that can increase the likelihood of abscess formation are a weakened immune system, as well as having other conditions such as diabetes, Crohn’s disease, or being overweight.
One of the main techniques utilised for cyst and abscess removal in Singapore is drainage. A small incision is made to insert a needle, facilitating the drainage of liquid (for cysts) or pus (for abscesses) before the wound is packed with gauze. It is a simple procedure that allows for local anaesthesia, as well as a speedy recovery.
There are multiple surgery procedures to treat anal fistulas, depending on the nature of the fistula, as well as aiming to avoid damage to the sphincter muscles that can lead to bowel incontinence. A fistulotomy is the most common and effective treatment for anal fistulas, cutting open the whole length of the fistula to allow it to heal into a flat scar. For more complex fistulas, other surgery procedures include inserting a seton, an advanced flap procedure, as well as a LIFT procedure.
Part 4: Conclusion
With the numerous conditions that can affect one’s colorectal health, it is important to learn about their symptoms and risk factors, allowing you to recognise them and promptly visit your doctor for effective treatment. In addition, undergoing regular colorectal cancer screening in Singapore is essential in avoiding an easily preventable condition, giving you the peace of mind to enjoy life with your loved ones.
Contact our colorectal clinic in Singapore today and take the first step into a better and healthier tomorrow.
