Hemorrhoids or piles are anal cushions filled with blood vessels that are present in every normal person. Their function is to fill the space inside the anal canal and they ontribute to continence of feces. When these cushions enlarge or the attachment to the underlying anal sphincter becomes loose, these cushions can bleed or prolapse (pop out) of the anus and cause problems.
Hemorrhoids can be aggravated with constipation, diarrhea and pregnancy. Conservative treatment with high fibre diet, stool softeners and medication may relieve the symptoms but if they persist, you should consult your doctor. The symptoms most often associated with hemorrhoids are fresh bleeding in the stool, an anal lump, itch and pain. Colonoscopy may be required to rule out more serious conditions like colon cancer as a cause of the symptoms.
Hemorrhoids are usually graded depending on whether they remain inside the anal canal or prolapse out, and treatment is tailored according to the severity of the condition.
1st degree – Bleeding but do not prolapse
2nd degree – Hemorrhoids prolapse but reduce spontaneously
3rd degree – Prolapsing hemorrhoids that require manual reduction
4th degree – Prolapsed hemorrhoids that cannot be reduced
First degree hemorrhoids can be treated with medication, injection and dietary modification. Second degree hemorrhoids usually respond well to rubber band ligation if they are not too large, but surgery may be indicated in certain situations. Third and Fourth degree hemorrhoids usually require surgery to fix the problem.
Conventional Surgery for hemorrhoids involves removing the involved anal cushion. This results in wounds at the anus which may take as long as 4-6 weeks to heal and can be associated with a fair amount of pain.
Stapler Hemorrhoidectomy (Longo Operation) utilizes a circular stapler to remove the excess hemorrhoidal tissue, interrupt the blood flow to the hemorrhoidal cushions and fix the tissue within the anal canal. The major advantage of this procedure is that the staples close the wound and so pain is much reduced and recovery is quicker – typically 2 weeks.
Transanal Hemorrhoidal Dearterialization is a new procedure where an ultrasound probe is used to identify the feeding vessels to the hemorrhoidal cushions so that they can be ligated accurately. This procedure has the least pain and the fastest recovery but is not so effective for large hemorrhoids.
We will advise you which procedure will work best in your situation.
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Find out more from the Expert, Dr Melvin Look as he speaks about HET Procedures & the Treatment Recovery.
Colonoscopy is a procedure where the inside of the colon is examined by passing a flexible lighted tube through the length of the colon via the anus. The procedure is usually performed under sedation – so you will be comfortable and free of pain. If a growth in the colon is detected, your doctor will remove the growth completely if possible and send it for further testing to rule out cancer. Colonoscopy has been shown to be very safe and is the best way to rule out and screen for colorectal cancer.
Before colonoscopy screening can be performed, the colon will need to be clear of feces, and you will have to take some medicine to clear the colon. The medication will induce diarrhoea and you must complete the preparation. You will need to drink a lot (2L) of water or clear fluids (no milk products) to avoid becoming dehydrated. You may also drink sweet drinks like honey or fruit juice without pulp. If you experience abdominal pain or vomiting when taking the medicine, please contact your doctor immediately. When the bowel preparation is completed, you should be passing clear fluid through the anus – somewhat like urine.
You should avoid taking fruit, vegetables, cereals, nuts and fibre rich products one day before the procedure as they will result in a large amount of fecal residue in the colon. You should take a light meal before consuming the before taking the Bowel Preparation Medication – Porridge or Noodles with lean meat or eggs. You should stop eating 6H before colonoscopy screening, but you may continue to drink up to 2H before the procedure unless you are having a gastroscopy at the same time..
1. Patients with underlying heart or kidney problems: Oral fleet has high sodium and phosphate content that can cause electrolyte problems.Inform your doctor and check that the it is alright to go ahead with the bowel preparation and the procedure.
2. Medications: Blood thinning agents like Coumadin (Warfarin), Plavix or Aspirin can result in severe bleeding – and may need to be stopped 5-7 days before the procedure.
You should continue with you blood pressure and other medication.
3. Diabetics: You may need to modify or omit taking your diabetic medication on the day of the procedure because your blood sugar level may fall while you are fasting.
4. Antibiotic prophylaxis: Patients with heart valve replacement, certain prosthetic implants or a hole in the heart and who have been advise to have antibiotics during dental procedures must inform the doctor of their condition – so that antibiotics can be taken before the colonoscopy.
After the procedure:
You will be observed and monitored until you have fully recovered from the sedatives you have been given. You may experience some abdominal distension – because of the air used to distend the colon during the procedure. This will resolve as you pass out flatus. You may not have any passage of stool for a few days after colonoscopy, because the colon has been cleared of feces and you should not be alarmed.
If you experience sudden severe abdominal pain or large amount of bleeding in the stool, please contact the doctor immediately.
Listen to Dr. Melvin Look’s Radio Interview about Gastroscopy & Colonoscopy Screening for Cancer Prevention.
Colorectal cancer is the most common cancer in Singapore, and afflicts both men and women. The lifetime risk of developing colon cancer about 5% (1 in 20) and the risk is increase 2-3 times if you have a close relative with colorectal cancer. Most cases of colorectal cancer occur in individuals above the age of 50 but it can also develop in younger people in cancer families.
What are the symptoms of Colorectal Cancer?
Common symptoms are:
- Bleeding in the stool
- Abdominal bloating / distension
- Abdominal pain / discomfort
- Anemia (Low blood count)
- Unexplained weight loss
- Lump in the abdomen
The symptoms may vary depending on the location and size of the tumor. Tumors located near the anus tend to present with bleeding in the stool, an anal lump, constipation or diarrhoea. Tumors located in the upper colon tend to have vague symptoms like bloating, abdominal discomfort, a lump in the abdomen, weight loss and anemia (low blood count).
Diagnosis and Treatment
Colorectal cancer is a serious condition but in many cases with early diagnosis and treatment, patients have an excellent chance for cure. The initial evaluation will involve doing colonoscopy to visualize the tumor, obtain tissue to confirm the diagnosis and clear the colon of polyps. A CT scan or PET scan will be obtained to determine if the tumor is localized or has spread to other parts of the body. Blood tests will also be obtained to check for your general health status and prepare for surgery.
Surgery is the generally most effective way to deal with Colorectal Cancer. If all tumor can be removed, the prognosis is good. In patients with rectal cancer, or where the tumor is very large or invading an adjacent organ, we may recommend initial chemotherapy or radiotherapy to shrink the tumor before proceeding with surgery.
One of the great advances in Colorectal Surgery is the use of minimally invasive surgery for Colorectal Cancer. Dr Cheong is an expert in laparoscopic colorectal surgery and has performed more than 180 such procedures for various colorectal conditions. Laparoscopic surgery avoids the trauma of a large abdominal wound associated with conventional surgery and results in less pain and much quicker recovery for our patients.
The advantages of laparoscopic surgery for Colorectal Cancer are:
- less pain
- quicker recovery
- less risk of chest infection and postoperative complications
- shorter hospital stay
- possible improvement in long term survival for selected patients