Ask a Colorectal Surgeon: Dr Teoh Tiong Ann from Mount Elizabeth (Orchard) Hospital Singapore

dr. Teoh Tiong Ann replied 2 years ago

Piles or hemorrhoids are natural structures in the anus that we all have. However, in some people, piles cause problems and symptoms. There are different degrees or severity of piles. Not all piles need to be treated and many can be left alone. Depending on the type of piles, there are different types of treatment and piles can be cured. However, piles can recur also if the patient does not change his or her lifestyle. I would suggest a consultation so that more accurate assessment of the piles can be made.

Many patients are afraid that piles eventually can become cancer. This is not true. However, it is important to see a doctor to make sure that the symptoms are due to piles. In some patients, further investigations are necessary to make sure that there is no other cause of the symptoms.

Thank You.

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dr. Teoh Tiong Ann replied 2 years ago

Your grandmother should be seen by a Colorectal Surgeon as soon as possible. From your description of pain and difficulty in moving her bowels and the requirement to take laxatives, the tumor may be obstructing her rectum and she may need urgent treatment or surgery. If the tumor blocks the rectum completely then there will be obstruction and an emergency procedure may be necessary.

Age, as a single factor, does not mean that she should not have surgery. Many other factors are taken into consideration. I have performed surgery on 97 year old patients who have recovered. I urge you to bring her to a Colorectal surgeon to discuss the options available to her. Please do not be afraid purely because of age.

I would be happy to see her but, unfortunately, the present, and indefinite, travel restrictions due to the Covid virus do not make this possible and your grandmother also needs urgent treatment and cannot wait. Taking laxatives will not solve the problem.

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dr. Teoh Tiong Ann replied 2 years ago

If the hemorrhoids are not too big, simple procedures like 'Rubber Band Ligation' may be performed. This procedure may be performed in the office without any need for anesthesia. There are also newer procedures like HET (Heat Energy Therapy for Hemorrhoids). This procedure, however, will require some sedation.

Simple procedures, however, can only be used for smaller hemorrhoids. Recurrence rates are also higher. However, the procedure is not major and recovery time is faster and with little pain.

Larger hemorrhoids require Surgical procedures like 'Excision Hemorrhoidecomy' where the hemorrhoids are surgically removed and 'Stapled Hemorrhoidectomy' where hemorrhoids are removed using a stapling device. Both these procedures require anethesia, either regional or general anesthesia. Recovery is also longer and ther is some associated pain and discomfort in the recovery phase. Although after surgery, there is a chance of recurrence, recurrence rates are reduced if good bowel habits are maintained. So there is a possibility of 'curing' hemorrhoids with surgery.

If your father has bleeding, as he is 50 years old, I would also recommend a Colonoscopy to exclude other causes of the bleeding and also for screening for Colorectal Polyps and Cancers.

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dr. Teoh Tiong Ann replied 2 years ago

If the blood is fresh red in color and you do not have any change in bowel habits and the stools are normal and you do not have a family history of Colon Cancer, it is likely that the bleeding is from either hemorrhoids or an anal fissure. Hemorrhoids may not cause any pain in the anal region. Anal fissures, however, are usually associated with pain in the anus on defecation.

However, it would be best that you consult a doctor and ensure that the doctor does an anal examination and proctoscopy. If no cause of the bleeding is found and if the symptoms persist, although the suspicion level is low given your age, I may consider advising a Colonoscopy to exclude other causes of bleeding.

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dr. Teoh Tiong Ann replied 2 years ago

I do not see 15 day old children. Perhaps an opinion from a Paediatric Surgeon would be best.

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dr. Teoh Tiong Ann replied 2 years ago

Can I confirm that you are experiencing fluid or something coming from your urine or vagina that smells like stool?

It is possible that you may simply have a urinary tract infection. This can be easily treated with antibiotics and drinking more water. You could also have a vaginal infection which is also easily treated. Your Doctor should be able to diagnose this.

However, if the symptom that you are feeling is a smelly discharge like stool from your vagina, I would encourage you to see a Colorectal Surgeon urgently. There is a rare condition called a recto-vaginal fistula where there is a connection between the rectum and vagina. This can occur in normal childbirth especially when the baby is big or there is a 'tear of the vagina' during delivery.

As stated, this a rare condition but you will need to be sure that you do not have this with your stated symptoms. Please see a doctor.

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dr. Teoh Tiong Ann replied 2 years ago

There are different grades of hemorrhoids. Depending on the grade, type and your tolerance of symptoms of the hemorrhoids, there are different treatment options available. It is also important to see a doctor to make sure that it is only hemorrhoids and not something else. However, it is possible to ‘cure’ some hemorrhoids with appropriate treatment. I am not certain about ‘herbal medicines’ as there are also many different types of herbal medicines with different components. Some of these components may be harmful if they are not properly registered or prepared.

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dr. Teoh Tiong Ann replied 2 years ago

This sounds like ‘stress incontinence’. Stress incontinence is more common for the urine but it can happen for the anus, though it is less common. Your mother will need assessment and further tests including ‘Anorectal Physiology Studies’ and also a consultation with a Colorectal Surgeon and also a Gynecologist.

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dr. Teoh Tiong Ann replied 2 years ago

This is a difficult question to answer without more information from you and also examining you. It would be best if you can be examined and then more information to your question can be provided. I would be most happy to see and examine you when the travel restrictions have been lifted. Thank you.

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dr. Teoh Tiong Ann replied 2 years ago

Thank you for your question.

It is likely that you have a hemorrhoid that is large enough and has prolapsed (come out). It could also be a skin tag or a fibroepithelial polyp. All these conditions are not serious. However, to be sure, I would have to examine you. With your young age, the suspicion of you having a serious condition is very low.

If it is a hemorrhoid, this can be left alone and observed. However, if it causes discomfort, then surgery may be required to remove it. If it is not too large, a rubber band ligation may be attempted, but it may not be successful if it is too large.

Please do see a doctor to confirm the diagnosis or please feel free to make an appointment to see me in Singapore when the travel restrictions are lifted.

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dr. Teoh Tiong Ann replied 2 years ago

Thank you for your question. ‘Piles’ or hemorrhoids do not usually affect your breathing or coughing or make you exhausted. Rarely, if you have a lot of bleeding from your piles and the hemoglobin (blood count) is low, it can cause tiredness, shortness of breath. But the haemoglobin would have to be very low and your hemorrhoids have bled a lot to cause that. You did not give your age, but you should see a doctor to find another cause of your symptoms and you should not assume that it comes from hemorrhoids. Heart conditions, lung conditions may all cause shortness of breath, exhaustion and cough.

If you have bleeding when you move your bowels, it may be important to make sure that the bleeding is not from another more serious cause. A Colonoscopy may sometimes be required to make sure that there is no other serious condition like a cancer present causing low hemoglobin and tiredness.

My advice is for you to see a doctor to find out what the cause of your symptoms are as It is not likely to be due to piles. This is unless the piles have been bleeding a lot, especially when you have defecation or a bowel movement.

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dr. Teoh Tiong Ann replied 2 years ago

Usually, surgery to remove gallstones is to remove the Gallbladder and not just the stones. The surgery is called a ‘Laparoscopic Cholecytectomy’ or common layman terms are ‘keyhole surgery to remove gallbladder and gallstones’ or ‘Laser Gallbladder or Gallstone removal’ even though we do not use lasers for this anymore.’ Thus, it is unlikely that there are still gallstones in the gallbladder as the gallbladder has already been removed.

However, sometimes, gallstones can recur in the bile duct. Bile duct stones will cause pain and jaundice (yellow skin) due to obstruction of the common bile duct.

You can go for a blood test and an ultrasound of the biliary system. The blood test are to check the liver enzymes and bilirubin. If the ultrasound is not clear, an MRCP (Magnetic Resonance Cholangio- Pancreatogram) can be performed. This is an MRI of the bile ducts.

If these tests do not show any bile duct stones or bile duct blockage, then you should do other tests to find another cause.

If the pain is epigastric in position, you may do a Gastroscopy (Endoscopy) to check the stomach. A CT scan may also be performed to check the pancreas and other organs nearby. If the pain is in the lower abdomen, you may also benefit from Colonoscopy.

I hope this answers your question. Please do feel free to ask more questions after you have undergone the tests. Thank You

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dr. Teoh Tiong Ann replied 2 years ago

I assume that you are referring to an inguinal hernia. An inguinal hernia is a hernia in the groin and is the most common hernia in males. Hernia surgery or hernia repair is usually performed either by the conventional surgery or by a Laparoscopic Hernia Repair. Laparoscopic hernia repair uses smaller incisions and is also known as the keyhole hernia surgery repair. This is a very common surgery now. Presently, in most hernia repairs, whether conventional or laparoscopic, the surgeon will place a hernia mesh to do the repair. The hernia mesh is usually very soft and thin.

If the hernia surgery has recently been performed, I suggest that you ask your husband to observe it for now. You can ask him to do some simple stretching exercises. It may sometimes take about 2 to 3 months for the discomfort to get better after surgery. The pain when he is urinating may be due to scar formation. The bladder is situated quite close to the inguinal hernia site. After 2 to 3 months, the scar may soften and the pain will get better.

Unfortunately, about 20% of patients do feel some sort of long-term pain after hernia repair. The pain is usually mild, like a discomfort, but in a very small number of patients, it can be quite painful. This is especially after strenuous exercise or lifting heavy weights.

It will be useful to ask a doctor to examine him or obtain an ultrasound of the groin to check if there is a recurrent inguinal hernia. If there is a recurrent hernia, this may be repaired again by surgery. Thank you.

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dr. Teoh Tiong Ann replied 2 years ago

This is an unusual symptom. I apologise but I am unable to answer your question with asking you more questions and examining you. It is likely that some other tests may be performed. If the pain is severe, I would recommend you to see a doctor and discuss the symptoms to see if further tests are necessary.

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dr. Teoh Tiong Ann replied 2 years ago

Colorectal Cancer can occur in anyone, even if they do not have any relatives with Colorectal Cancer. That is the reason why doctors recommend screening even for patients without any family history of Colorectal Cancer.

Screening means to do checks like stool tests or colonoscopy on patients who are well and do not have any symptoms. The usual recommendation is to have a colonoscopy by the age of 50 years old. For patients who have first degree relatives with colorectal cancer, the first colonoscopy is recommended when the patient reaches 40 years old and for it to be performed every 5 years.

For patients who have symptoms, it is best to consult a doctor/colorectal surgeon and further tests like a colonoscopy can be performed depending on the symptoms. In this scenario, the type of symptoms are more important than age.

Not all lower abdominal pain is die to colon cancer. It may be due to other causes. As your symptoms have already been present for 2 months, it is best to see a doctor or colorectal surgeon. Further tests can then be carried out. It is likely that a colonoscopy and CT scan can be performed depending on your symptoms, clinical examination and your age.

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dr. Teoh Tiong Ann replied 2 years ago

There are several ways to treat haemorrhoids depending on the size and type of haemorrhoids. A simple way is to avoid eating spicy food as it causes your symptoms! I am sure that you will not like my answer! LOL!!!

As there are different type of haemorrhoids, there are also different treatments available. Some treatments are simple and painless like injection sclerotherapy or rubber band ligation and can be performed in the office without any need for anesthesia.

Larger haemorrhoids may need surgery. There are also different types of surgery available. It would be best if I can examine you to explain what your options are. If the haemorrhoids do not bother you very much, they can also be observed without any need for treatment.

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dr. Teoh Tiong Ann replied 2 years ago

Thank you for your question. Change in diet may affect the type of stools. It is always important to drink adequate water also. A healthy diet comes with taking adequate fiber. Natural fiber can be found in vegetables, fruit, cereals. However, too much fiber is not advisable as the stools become hard and you may also feel ‘gassy’ and bloated’. The key is to eat everything in moderation. Drinking sweet drinks, tea or coffee is not a substitute for water and it is best that you drink water.
It is not good to use your fingers to force your stool out. You should try to stop doing this. It may cause local injury like tears and bleeding. If you get too used to doing this, you will also lose sensation.

You did not state your age. However, if you are 40 years old and above, it might be reasonable to undergo a colonoscopy to ensure that the recent change in bowel habits is not due to anything serious. The recent change of a few months and the feeling of ‘dissatisfaction’ of incomplete defecation are symptoms that need further investigation. The best method is a Colonoscopy.

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dr. Teoh Tiong Ann replied 2 years ago

Thank you for your question. I am sorry to hear that your brother has colon cancer. It would be better if I have more information to answer your question better. I am uncertain why he has this yellowish liquid but if your brother only had chemotherapy without surgery, it is possible that the yellow liquid could be from the Rectal Cancer. The nausea and vomiting could be due to the chemotherapy side effects. The oncologist can give him some medicine for this.

It is important for patients with cancer and those undergoing chemotherapy to have adequate nutrition. He will need to be able to eat nutritious meals. If he is unable to eat, dietary supplements can be given. Sometimes liquid meals like ensure can be given. For patients who really cannot tolerate any fluids or food, sometimes they can admitted for a short period of TPN. TPN is giving nutrition by a special infusion to build up strength until he can eat better.

On another note, it is very important for you and your other brothers and sisters to undergo a screening colonoscopy. When your brother’s children reach 40 years of age, they should also be encouraged to undergo a screening colonoscopy. First degree relatives (e.g. brothers, sisters, children) have an increased risk of developing colon cancer. So it is best to undergo Colonoscopy to look for and to remove colon polyps, if any are found. If colon polyps are found and removed, the risk of developing colon cancer may be reduced. You will also need to do a colonoscopy every 5 years to look for new colon polyps.

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dr. Teoh Tiong Ann replied 2 years ago

Gallstones are quite common. Previously, doctors thought that Gallstones were caused by increased cholesterol, fat, hormone imbalances. However, nowadays, Gallstones are so common that we do not really know why some people have them. There is no sure way to prevent gallstones.

Many times Gallstones are only diagnosed when there is acute symptoms like epigastric pain. They can also be found incidentally when patients undergo an ultrasound for other reasons. Usually, if there are no symptoms (asymptomatic gallstones) they can be observed. However, if symptoms like pain develop, then surgery is recommended.

Surgery for gallstones is usually by ‘keyhole surgery’. The operation is called a Laparoscopic Cholecystectomy or Laparoscopic Removal of the Gallstones together with the Gallbladder. Because of the small incisions, patients recover quite quickly.

There are several remedies that you may read about on the internet. Many patients ask me if by taking olive oil and apple or grape juice the stones can disappear. This is not proven at all.

If you like to check if you have gallstones, you can have an ultrasound of the Gallbladder performed. However, if you do not have any symptoms, it might be a better option to observe it and undergo surgery only if you develop symptoms.

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dr. Teoh Tiong Ann replied 2 years ago

There are basically 4 types of presentations of Gallstones.

The first are patient with no symptoms. The Gallstones are diagnosed incidentally when an ultrasound is performed for other reasons. Asymptomatic Gallstones can be observed and surgery may not be necessary unless the patient develops symptoms.

A second type of presentation is biliary Colic. This is a severe sudden pain that occurs in the upper abdomen. Sometimes, the pain can radiate (move) to the right side and to the back. Some patients may mistake these symptoms for ‘gastric’. However, gastric pain (maag) is usually not as severe. It is bet to undergo an ultrasound if a patient has severe upper abdominal pain. Surgery with a Laparoscopic Cholecystectomy is recommended for this patient with biliary colic and the pain (colic) should be cured and should not happen again, unless there are additional stones in the bile duct.

A third type of presentation is upper abdominal pain and mainly on the right upper part of the abdomen. Sometimes there is fever and when an examination is performed the right upper quadrant of the abdomen is very tender. An ultrasound may show a swollen gallbladder with thickened walls and gallstones. This is named ‘Acute Cholecystitis’ or Acute Gallbladder inflammation. Surgery with a Laparoscopic Cholecystectomy is recommended for patients with acute cholecystitis (acute gallbladder inflammation) and the inflammation would be cured and should not happen again.

The last type of presentation is a patient who feels ‘indigestion’ especially when eating oily food. The patient may burp a lot also after a fatty meal. In patients with these symptoms, other checks like an Gastroscopy (endoscopy) should be performed to ensure that there is nothing wrong with the stomach. Usually, a trial of some ‘maag’ medicine would be given first. If tis does not improve the symptoms, surgery may be discussed. However, in this type of patients, Laparoscopic Cholecystectomy may not relieve the symptoms and the patient should be made aware of this.

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dr. Teoh Tiong Ann replied 2 years ago

There are different causes of a ‘lump in the anus’. It is difficult for me to give you a good answer unless I see you and examine your anus. It could be haemorrhoids or sometimes it can be thickened skin.

However, not all haemorrhoids are painful. Many people have haemorrhoids which are not painful. It is also important to know that haemorrhoids that do not bother you may not need any treatment. It may not be necessary to have surgery.

However, I would suggest that you see a Colorectal Surgeon to get a proper diagnosis and ensure that this lump is not anything more serious.

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dr. Teoh Tiong Ann replied 2 years ago

Bleeding with diarrhea can arise from a few causes. You did not state your age.

If the blood is fresh red blood, the bleeding can be arising from hemorrhoids or an anal fissure. These occur as the diarrhea irritates the anal canal and the hemorrhoids and fissure may bleed.

If the blood is darker in color and mixed with the stools, then a source of bleeding from the Colon will need to be considered. There may be inflammation of the colon causing the blood. The commonest cause of inflammation is usually an infection like ‘food poisoning’ or ‘gastroenteritis’. Usually, the patient may also feel unwell with an infection and have other symptoms like fever and nausea

Blood that is mixed in the stools may also be a sign of bleeding from diverticuli or possibly a tumor.

If you are young, it is unlikely that there is a tumor.

My suggestion is that you should see a Gastroenterologist or Colorectal Surgeon for an assessment and let them discuss with you whether further tests like a Colonoscopy are required.

Thank You

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dr. Teoh Tiong Ann replied 2 years ago

Unfortunately, the answer to your question is Yes, rectal tumors/cancer can recur after surgery.

However, with careful pre-operative assessment, possible pre-operative radiotherapy and chemotherapy in some patients, and most importantly, an experienced Colorectal Surgeon performing the surgery, and with newer techniques in surgery, the recurrence rates have reduced from previously.

It is important to get an experienced Colorectal surgeon to perform the surgery, especially for rectal cancer. With experienced colorectal surgeons and a multidisciplinary team of oncologists and radiotherapists, many patients have been cured after treatment.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that with your intense activity like basketball, you may have strained some muscles. It may not necessarily be a hernia. As you have only had pain this week, maybe you can observe it first and you can take some pain-killers for the pain. You can also rest for a week from your basketball.

If the pain persists, it would be wise to consult a doctor. The doctor will examine you and see if there is a hernia present. Sometime, an ultrasound may be useful in helping to diagnose a hernia, but sometimes the results of an ultrasound may not be accurate. An examination by a surgeon is important.

When lifting weights, it is best to learn the proper technique of lifting weights. This will reduce chances of a hernia and muscle and back strains.

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dr. Teoh Tiong Ann replied 2 years ago

Femoral Hernia are quite uncommon. Inguinal Hernia is the more common type of hernia and is situated in the groin or inguinal region. Usually, on examination, there is a swelling in the groin region or in the upper thigh near the groin crease. An ultrasound of the area may help to diagnose a hernia, inguinal or femoral.

There may be other causes of the symptoms that are not due to a hernia. It would be best to consult a doctor who can examine you and advise the necessary tests/scans to diagnose the condition.

Thank You.

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dr. Teoh Tiong Ann replied 2 years ago

Thank You. You did not state your age. If you are of an older age, this may be a serious symptom and I would suggest that you see a Colorectal Surgeon or Gastroenterologist for a consultation and an examination. The doctor may also advise you to undergo a Colonoscopy to ensure that there are no serious causes like a tumor.

However, if you were previously well without symptoms, and you are young, the cause is likely to be not serious. Many people experience some constipation or change in bowel habits from time to time. However, it may be best if you went for a consultation with a doctor.

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dr. Teoh Tiong Ann replied 2 years ago

Thank You. From your description, I think that you may have an Anal Fistula. This is a discharging nodule with a path that leads into the anal canal. The usual treatment for Anal Fistula is surgery. However, it is important to ensure that it is properly assessed and performed by an experienced Colorectal Surgeon. There is a chance of recurrence and sometimes some degree of loss of control of the anus if the surgery is not properly performed. Some fistula are situated ‘higher up’ in the anal canal and surgery even by the most experienced colorectal surgeon may result in recurrence.

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dr. Teoh Tiong Ann replied 2 years ago

At 56 years old, it is important to ensure that the bleeding is not due to more serious conditions. You are encouraged to undergo a Colonoscopy, both to look for other causes of the bleeding and also to screen for Colon Polyps and Cancer. With the pain on defecation, it is possible that you may have an anal Fissure rather than haemorrhoids. Patients with Anal Fissures experience quite some pain on defecation. A Colorectal Surgeon can examine you and diagnose a fissure. The treatment for fissures is different for haemorrhoids. Thus it is important to get an accurate diagnosis so that the appropriate treatment can be given.

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dr. Teoh Tiong Ann replied 2 years ago

Chalk (Pale) coloured stools may be a serious problem. It usually occurs in patients with obstructive jaundice. This is a situation when the bile ducts are obstructed and the bile that causes the usual colour of stools cannot flow into the intestines. I would suggest that you see a doctor for further investigations. A Liver Function Blood tests and an Ultrasound of the Liver and Bile ducts or a CT scan may be necessary.

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dr. Teoh Tiong Ann replied 2 years ago

You did not state your age. However, the commonest cause of painless blood during defecation are Haemorrhoids. If you are young, that will likely be the cause. However, if you are older, it would be important to make sure that the blood is not from any other more serious cause in the Colon and Rectum. You may wish to consult a doctor to see if further investigations are necessary.

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dr. Teoh Tiong Ann replied 2 years ago

For Rectal Cancers, the main treatment is Surgery, Radiotherapy and Chemotherapy. Often, it is a combination of these three treatments. There are no other good options. Please speak to your father and encourage him to seek and accept the doctor’s advice. However, in stage 4, you should have a good discussion with the treating doctors to discuss risks, benefits, side effects and expectations of treatment.

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dr. Teoh Tiong Ann replied 2 years ago

This is an unusual symptom. If it is of small amounts, this may be due to an anal fistula. There may be a smelly discharge of pus from the fistula opening. I would suggest that you consult a Colorectal Surgeon for a more accurate diagnosis.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that you have hemorrhoids or an anal fissure. Usually, hemorrhoids are not very painful but can cause some anal discomfort. Patients with an Anal fissure experience pain on defecation and bleeding. The pain feels like a tearing pain as the stools come through the anus. The treatment of anal fissures is different from hemorrhoids. It is important to avoid hard stools.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that you may have a prolapsing haemorrhoid or an anal fistula. It is possible also that the growth is a skin tag that is associated with an anal fissure. Anal Fissures can cause quite a bit of pain when one defecates. You should consult a Colorectal Surgeon for an accurate diagnosis so that the appropriate treatment can be recommended. The treatment for these three conditions are different so it is important to get an accurate diagnosis.

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dr. Teoh Tiong Ann replied 2 years ago

If the ‘lump’ occurred suddenly, it is possible that you may have thrombosed External Haemorrhoid. These are usually not serious and should get better by itself in a couple of weeks. It is also possible that there may be an abscess but abscesses are usually painful. You should consult a Colorectal Surgeon for an accurate diagnosis so that the appropriate treatment can be recommended.

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dr. Teoh Tiong Ann replied 2 years ago

It is likely that she has some degree of Anal Incontinence. In women, this is commonly due to childbirth. She will need specialised assessment by a Colorectal Surgeon. There are several tests that should be performed. This will include a physical examination, Colonoscopy, Anorectal Physiology tests like manometry, Endoanal Ultrasound and nerve conduction studies. After these tests, a recommendation for appropriate treatment can be discussed. The treatment for Anal Incontinence can be difficult.

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dr. Teoh Tiong Ann replied 2 years ago

The best treatment for Colon Cancer is Surgery. Nowadays, if you have a good well trained and experienced Colorectal Surgeon, Surgery is performed very safely with good results. I perform most of the surgery with Laparoscopic Colorectal Surgery. This is using small incisions (lobang kunci) to do the colon cancer surgery. Because of the small incisions, patients recover faster and with less pain. It is also important to perform a radical operation to remove the tumour and the lymph nodes for best results. In present day, many Stage 2 Colon Cancers can be cured!

I would encourage you to follow your doctor’s advice and undergo surgery as it is your best chance for a cure. I would be happy to see you and advise you but the present Covid Travel restrictions do not allow travel into Singapore.

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dr. Teoh Tiong Ann replied 2 years ago

Anal Fistula is a condition where there is an ‘origin or source or head’ which is usually located within the anal canal. The part that can be seen on the skin around the anus is the ‘tail’. It is important to get to the ‘head or source’ of the fistula. If the source is not dealt with, the fistula is likely to recur.

To treat a fistula, accurate assessment must be made. ‘Low fistula’ can be treated fairly easily. However, ‘high fistula’ are difficult to treat. If an endoanal ultrasound is available, it is a good guide to the type of the fistula.

The best treatment of an anal fistula is surgery. There are different types of surgery that can be performed, depending on the type of fistula. The most important factors that are taken into consideration when treating anal fistula are preserving continence (control of the anus) and reducing chances of recurrence.

Anal fistula can be cured with surgery, but the difficult or high anal fistula may be difficult to cure.

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dr. Teoh Tiong Ann replied 2 years ago

The commonest cause of bleeding on defecation is hemorrhods. However, with the other symptoms that you describe like stomach ache, feeling weak, nausea and vomiting, it is very important to have a proper assessment by a Colorectal Surgeon or Gastroenterologist and undergo investigations like a Colonoscopy, Blood tests and possibly a CT scan. The bleeding may be due to more serious causes. Please see a Colorectal Surgeon or Gastroenterologist as soon as possible.

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dr. Teoh Tiong Ann replied 2 years ago

Did you have surgery for your appendicitis? Appendicitis is best treated with early surgery to remove the appendix. Usually, this can be performed with key-hole surgery. Laparoscopic Appendicectomy or Laparoscopic Removal of the Appendix is very commonly performed.

If you have had surgery already, it might be worthwhile to get a CT scan of the abdomen performed to see if there are any postoperative problems. A plain X-Ray is unlikely to provide useful information.

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dr. Teoh Tiong Ann replied 2 years ago

It is good to maintain good bowel movements. You do not need to move your bowels daily. However, if you have hard and dry stools, it is best that you change your diet.

It is good to drink adequate water and take adequate fiber in your diet. However, too much fiber is also not recommended. You can also look at the type of foods that make you bloat and avoid those foods.

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dr. Teoh Tiong Ann replied 2 years ago

There are a few causes of inflammation of the intestine. The commonest cause is an infection. If the bacteria causing the infection can be identified, anti-biotics can be given to treat the inflammation.

However, there are some types of inflammation of the intestines that are not caused by infection. Two of the more types are Ulcerative Colitis and Crohns’ Disease. Treatment of these inflammatory bowel diseases need specialist treatment and special medication. You will likely need a colonoscopy to make a diagnosis. You are advised to see a Gastrointestinal Specialist for a proper assessment, diagnosis and treatment.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that you have an anal fissure. This is a tear in the lining of the anal canal. It is usually quite painful, especially when the stools are coming through the anus and the pain continues for a period after that. The growth may be a sentinel pile which is usually associated with an anal fissure. However, it is best to see a doctor for an accurate diagnosis and then the appropriate treatment can be advised.

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dr. Teoh Tiong Ann replied 2 years ago

A ’boil’ is an infection. If it has been present for 3 months, it is likely that he requires surgery. It is best to see a Colorectal Surgeon for a proper diagnosis and possible surgery.

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dr. Teoh Tiong Ann replied 2 years ago

There is no definite cause for hemorrhoids. However, common associated factors are excessive straining during a bowel movement, hard stools, pregnancy and childbirth. Having a good bowel movement helps to reduce the incidence of hemorrhoids. Sitting for long periods may make the flare-ups of hemorrhoids worse.

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dr. Teoh Tiong Ann replied 2 years ago

From your description, you have symptoms of a few organ systems. I am unable to think of a condition that would have all the above symptoms. It would be best to consult a doctor for a proper assessment.

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dr. Teoh Tiong Ann replied 2 years ago

Haemorrhoids are quite common during pregnancy. As the pregnancy progresses, the haemorrhoids may become worse. What you are doing by pushing the haemorrhoids back after defecation is the correct thing to do. It is best to use some gloves and lubricant like to do this as using your fingers may cause damage. Surgery is possible but it is best not to have surgery unless it is unavoidable for example if the haemorrhoids are thrombosed or infected. Sometimes, a few months after delivery, the haemorrhoids do become smaller and less troublesome.

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dr. Teoh Tiong Ann replied 2 years ago

The only treatment for a Hernia is surgery. No medication can cure this as it is a mechanical defect. However, hernia surgery is quite common and many patients can be cured. Hernia surgery can also now be performed by the ‘key-hole Hernia Repair’ or Laparoscopic Hernia Repair. With smaller incisions, recovery may be faster with less pain.

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dr. Teoh Tiong Ann replied 2 years ago

Your symptoms are not specific enough and there is not enough information for me to provide a reasonable answer. Various factors have to be considered. If you are older in age, if your symptoms are recent, if there are other associated factors, then it is important for you to see a doctor and undergo a proper consultation, examination and possibly further tests.

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dr. Teoh Tiong Ann replied 2 years ago

It sounds like you may have an inguinal hernia. This is reducible as it becomes normal sized when you press it. There is only one way to cure hernia and this is by surgery. Hernia Repair can be performed by key-hole or laparoscopic surgery. Laparoscopic Hernia repair is commonly done nowadays. Usually, the hernia is repaired with a mesh that is placed at the hernia defect in the inguinal region.

Some patients do not want surgery. Unfortunately, there is no medication to treat this. One of the dangers of having a hernia is a strangulation. This is when the intestine cannot be pushed back and when you press the scrotum, it will not become normal and it will be painful and swollen. This is when the hernia contents which could be intestines are stuck in the hernia and the blood supply to the intestines is reduced. The intestine may die. This condition requires urgent surgery and the surgery may have to be more major and more complicated than when it is performed when the hernia is not strangulated or ‘stuck’.

As you are still young, it is recommended that you consider surgery.

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dr. Teoh Tiong Ann replied 2 years ago

The cost depends on the type of fistula and the complexity of the operation. It is difficult to predict without seeing the patient.

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dr. Teoh Tiong Ann replied 2 years ago

You should bring your wife to consult a Colorectal Surgeon. She could be suffering from an anal fissure or haemorrhoids that will cause pain. If your wife had an episiotomy, which is a cut at the vagina during Childbirth for bigger babies to be delivered, it is important to ensure that there is no infection of the wound and there is no tear into the anal sphincter. Another less common, but serious, possibility is a recto-vaginal fistula. This is a tear from the vagina into the rectum. Her urine should also be checked to ensure there is no urine infection.

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dr. Teoh Tiong Ann replied 2 years ago

It is important to ensure that you do not have an intestinal blockage from other causes. You should consult a doctor to assess this. The doctor may require you to undergo further investigations like XRays, Scans and a Colonoscopy. If there is no other cause that is found, then you can take some steps to improve your bowel movements. Drinking adequate fluids like water is important together with adequate fiber. Excessive fiber is not good as it causes bloating. Natural fiber like vegetables and fruit is good. Fiber supplements can be purchased at the pharmacy. Try not to take medication like laxatives. If you have to, start with the most gentle types. Avoid strong laxatives as after a while, the strong laxatives may not work anymore and you will have to take increasing doses and it would still not work. It is best to seek a doctor’s assessment for advice.

It is also important to know, that many people do not have a bowel movement daily and some people move their bowels every 2 to 3 days and this is normal for them. However, it is important that the stools are not hard. Natural remedies are better than medication.

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dr. Teoh Tiong Ann replied 2 years ago

A ‘distended stomach’ or ‘distended abdomen’ can be due to may different causes. Intestinal obstruction is just one of them.It is not common for feces to block a colon. Usually, there is another cause. Sometimes, it is just the feeling of being distended and it is not really distension when examined by a doctor or when investigations are performed. ‘Distended abdomen’ should be investigated especially in an older person. A good clinical history taking and examination by a doctor is important. After that some sort of scan and perhaps endoscopy like gastroscopy and colonoscopy.

As a general guideline, I feel that natural ways are better than laxatives. Taking a laxative is an easy way out but it may lead to being dependent on laxatives which is not good. Adequate fluid intake, a good diet and exercise is the best way.

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dr. Teoh Tiong Ann replied 2 years ago

It is unlikely that your mother’s present symptoms are due to what happened nearly 30 years ago. Her symptoms are recent and recent symptoms must be properly investigated, especially at her age. I would strongly recommend that you bring her for a proper consultation with a colorectal surgeon or a gastroenterologist. She would likely have to undergo some scans like a CT scan and Endoscopy like Gastroscopy and Colonoscopy. It is important to ensure that she does not have any serious condition causing the symptoms.

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dr. Teoh Tiong Ann replied 2 years ago

You must bring your mother to an experienced Colorectal Surgeon. I have not examined your mother to give an accurate diagnosis. However, at 7 cm it is possible to join back the rectum after removal of the tumor and avoid a permanent stoma. Often a temporary stoma is required and as smaller surgery is performed after a few months to close the stoma and the patient can pass motion through the anus after that. This operation of removing the rectal tumor can also be performed with laparoscopy. Laparoscopic Colorectal Surgery is now commonly performed.

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dr. Teoh Tiong Ann replied 2 years ago

It is common to have some sort of pain one week after surgery. However, it is best that you go back to see your surgeon to ensure that there are no complications from surgery.

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dr. Teoh Tiong Ann replied 2 years ago

You should consult a gastroenterologist or colorectal surgeon. It would be best if you undergo some tests like an ultrasound or CT scan of the abdomen and an endoscopy or gastroscopy and colonoscopy to ensure that there are no serious causes.

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dr. Teoh Tiong Ann replied 2 years ago

The treatment of piles is the treatment of tolerance of symptoms or it depends on how much the symptoms bother the patient. Some patients who have symptoms are not overly bothered by them and do not want surgery. This is possible and not wrong.

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dr. Teoh Tiong Ann replied 2 years ago

Hernia can recur after surgery. The reported recurrence rates range from 1% to 20%. As in all surgical procedures, it would be best to consult an experienced surgeon to perform the surgery. The common type of surgery performed nowadays is Laparoscopic Hernia Repair. This is the key-hole method where a few small incisions are made and a hernia mesh is used to repair the hernia. It is also important that the patient has adequate rest and restrain from carrying heavy weights and strenuous physical exercise for a few weeks after surgery to allow the wound to heal and for the repair to be strong. This can also help to reduce the recurrence.

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dr. Teoh Tiong Ann replied 2 years ago

At 68 years old with recent bowel symptoms, it is important to get an accurate diagnosis and ensure that there are no serious conditions causing her symptoms. I would suggest that you bring her to consult a gastroenterologist or colorectal surgeon for assessment. She may require tests like blood tests, stool tests and a colonoscopy.

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dr. Teoh Tiong Ann replied 2 years ago

At 32 years old, it is unlike that you have a serious disease. Chronic constipation is a relatively common condition. It usually arises out of poor habits. It is important to drink adequate water, have a healthy diet with adequate fibre, exercise regularly. It is also important not to hold your stool for too long as the stools will harden and it makes it more difficult to defecate after that. It is also best not to consume laxative medication. If your symptoms are recent, it would be better to see a gastroenterologist or colorectal surgeon to ensure that there are no other serious causes.

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dr. Teoh Tiong Ann replied 2 years ago

Chronic constipation is a relatively common condition. It usually arises out of poor habits. It is important to drink adequate water, have a healthy diet with adequate fibre, and exercise regularly. It is also important not to hold your stool for too long as the stools will harden and it makes it more difficult to defecate after that. It is also best not to consume laxative medication. If your symptoms are recent, it would be better to see a gastroenterologist or colorectal surgeon to ensure that there are no other serious causes.

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dr. Teoh Tiong Ann replied 2 years ago

The symptoms that you describe suggest a prolapse of the hemorrhoids. This is when the hemorrhoids ‘pop out’ or ‘prolapse of the anus. Hemorrhoids do not affect the size of stools as hemorrhoids are usually soft and do not obstruct the anal canal. It would be best to consult a colorectal surgeon to examine your anus properly to find any causes of the change in calibre of the stools. You may require a colonoscopy to ensure that there are no other serious causes.

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dr. Teoh Tiong Ann replied 2 years ago

From the combination of symptoms as well as the one month history without any improvement, I strongly suggest that you consult a specialist like a gastroenterologist or colorectal surgeon for proper assessment and more tests. You may require blood tests, stool tests and a colonoscopy. Many conditions do not require surgery and can be treated with medication.

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dr. Teoh Tiong Ann replied 2 years ago

It is common for itch after surgery while the surgical wounds are healing. Give it some time and it will get better once the wounds are fully healed.

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dr. Teoh Tiong Ann replied 2 years ago

You may have hemorrhoids or an abscess. Both can be treated easily with surgery. Please consult a Colorectal Surgeon for advice.

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dr. Teoh Tiong Ann replied 2 years ago

It is best that you have a proper assessment. If you are sensitive to the ointments, then you can consider other options like surgery or other procedures. It would be best to consult a colorectal surgeon to discuss your options. There many options available and even a repeat surgery may give you good relief of symptoms.

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dr. Teoh Tiong Ann replied 2 years ago

Spicy foods can irritate the stomach and also trigger a bowel movement in some people. The spicy foods can also cause itch and irritation in the anus. My suggestion is to avoid spicy foods for a few weeks and see if your symptoms improve. If the symptoms improve, then you will know that it is the spicy foods that are the cause. With that knowledge, you can then make a decision of whether or not to avoid spicy foods or that if you enjoy your spicy foods, then you must be prepared to suffer and tolerate the symptoms.

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dr. Teoh Tiong Ann replied 2 years ago

It would depend on how high the SGOT and SGPT levels are. Gallstones do not usually cause a high liver enzymes unless there is infection or there is blockage of the bile duct. The elevated SGOT and SGPT levels may be due to another cause. Gallstones also do not cause tiredness. It would be best to see a surgeon or gastroenterologist to make a proper assessment.

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dr. Teoh Tiong Ann replied 2 years ago

Usually, there is a swelling (or lump) associated with a hernia. This becomes more obvious when you are straining, coughing or standing up. This swelling also usually gets smaller or disappears (reduces) when you lie down. These are the typical signs of a hernia. It would be best to consult a surgeon to see if you actually do have a hernia. Most hernia can be repaired. Presently, a Laparoscopic Hernia Repair is performed. This is a ‘key hole’ surgery. It would also be best if you stop straining so hard when you defecate.

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dr. Teoh Tiong Ann replied 2 years ago

There are some possibilities that I can think of. The pain can be the common post-operative pain from the wounds. This occurs when the patient is starting to get active. However, there are also more serious possibilities. One of the possibilities is a post-operative infection. Especially, in patients where the appendix was severely inflamed, there may be some residual inflammation/infection. Occasionally, there may be another cause of the original pain that has not been addressed.

The diarrhea can be because of prolonged use of antibiotics. This is an antibiotic associated diarrhea where the antibiotics have replaced the ‘good bacteria’ in the intestine allowing an overgrowth of ‘bad bacteria’.

As in any symptoms that occur after an surgery. It would be best to bring your brother back to see the surgeon who performed the surgery on him. This surgeon would be in the best position to advise you.

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dr. Teoh Tiong Ann replied 2 years ago

It would be best to provide more accurate report of her endoscopy and colonoscopy results. Pain after eating can sometimes be due to gallstones. An ultrasound of the Gall Bladder can easily be performed to check for gallstones. There are several causes of bleeding in the stools. Simple causes like hemorrhoids can cause bleeding. But it is important to make sure that there are no other causes. I assume that the rectal polyp has been removed in the colonoscopy. If the histology result shows a non-serious result, there should be no cause for worry. Depending on the exact result, a repeat colonoscopy may be required in a couple of years.

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dr. Teoh Tiong Ann replied 2 years ago

Fruit juices like papaya and lemon can be consumed regularly. However, depending on your age, it may be a good idea to consult a colorectal surgeon or gastroenterologist to assess why you have constipation. If your constipation is of a recent onset, you may require further investigations like a colonoscopy.

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dr. Teoh Tiong Ann replied 2 years ago

If the piles recur, it is still possible to undergo surgery again. However, it is important not to remove too much anal mucosa as it may give rise to a scar and stricture. I am not familiar with a ‘bipolar tech surgery’. However, it sounds like using a bipolar forceps to cut the piles. This is just another mode of a surgical device but the basic principle remains – and that is not to remove too much anal mucosa. It would be recommended that you consult an experienced Colorectal Surgeon.

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dr. Teoh Tiong Ann replied 2 years ago

The symptoms are not common symptoms. I would suggest that you consult a Colorectal Surgeon to examine you properly to get an accurate diagnosis. It is possible that the wound has not healed or there is another cause of the symptoms.

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dr. Teoh Tiong Ann replied 2 years ago

Yes, surgery can be performed twice, if necessary. If the hemorrhoids are not too big, simple procedures like ‘Rubber Band Ligation’ may be performed. This procedure may be performed in the office without any need for anesthesia. There are also newer procedures like HET (Heat Energy Therapy for Hemorrhoids). This procedure, however, will require some sedation. Simple procedures, however, can only be used for smaller hemorrhoids. Recurrence rates are also higher. However, the procedure is not major and recovery time is faster and with little pain. Larger hemorrhoids require Surgical procedures like ‘Excision Hemorrhoidecomy’ where the hemorrhoids are surgically removed and ‘Stapled Hemorrhoidectomy’ where hemorrhoids are removed using a stapling device. Both these procedures require anesthesia, either regional or general anesthesia. Recovery is also longer and there is some associated pain and discomfort in the recovery phase. Although after surgery, there is a chance of recurrence, recurrence rates are reduced if good bowel habits are maintained. So there is a possibility of ‘curing’ hemorrhoids with surgery.

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dr. Teoh Tiong Ann replied 2 years ago

Chronic constipation is a relatively common condition. It usually arises out of poor habits. It is important to drink adequate water, have a healthy diet with adequate fibre, and exercise regularly. It is also important not to hold your stool for too long as the stools will harden and it makes it more difficult to defecate after that. It is also best not to consume laxative medication. If your symptoms are recent, it would be better to see a gastroenterologist or colorectal surgeon to ensure that there are no other serious causes.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that the bleeding is due to hemorrhoids or an anal fissure. Tis is due to straining and hard stools. He should drink adequate fluids and ensure that he does not have hard stools. If necessary, gentle laxatives like lactulose may help. It is best to avoid strong laxatives. Seek an opinion from a Colorectal surgeon.

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dr. Teoh Tiong Ann replied 2 years ago

A hernia is a swelling through a defect in the abdominal wall. It usually does not come with fever and cough. A cough, however, may cause the hernia to protrude and get bigger. Your husband may have two different illnesses. He may actually have an abscess that needs urgent attention. It would be best to consult a surgeon to get an accurate diagnosis.

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dr. Teoh Tiong Ann replied 2 years ago

In view of his dialysis, this may not be a straightforward answer. If the hernia is strangulated or obstructed, surgery should definitely be performed. If the hernia is easily reducible, it would be best to consult a surgeon and you can discuss both the pros and cons of having surgery and the risks involved.

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dr. Teoh Tiong Ann replied 2 years ago

Gallstones that do not give symptoms or have never given pain or other symptoms are quite common. Many times, asymptomatic stones do not need to be treated unless there are symptoms. The size of stones is not important. In fact, small stones tend to give more problems than big stones. Small stones can travel out of the Gallbladder and cause blockage of the bile duct. This becomes more complicated to treat. It will then require two operations – An ERCP which is a special scope to remove Bile duct stones. This is followed by a Laparoscopic Cholecystectomy or Gallbladder removal using key-hole surgery to remove the Gall Bladder together with the stones. Gallstones cannot usually be cured with medicines alone.

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dr. Teoh Tiong Ann replied 2 years ago

Megacolon is not a common disease. There are a few different types of megacolon. If it is a toxic megacolon, the patient is very ill and needs emergency surgery. Many times a stoma may be necessary but this may sometimes be reversed when the acute illness has improved. There are patients with chronic constipation and megacolon. Surgery for these may not require a stoms.

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dr. Teoh Tiong Ann replied 2 years ago

There may be several reasons for these symptoms. What you have described is intestinal colic. This can be due to mild infections. However, mechanical causes like obstruction from adhesions may have to be considered if you have had surgery before. If you have the urge to defecate but no stools come out, you may require a colonoscopy. It would be best for you to consult a digestive surgeon.

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dr. Teoh Tiong Ann replied 2 years ago

Piles can sometimes recur after surgery. It would be best to consult a Colorectal Surgeon. Sometimes when it is inflamed, it can be treated with medication first. Surgery can be performed again even if you have had surgery before. The haemorrhoids need to be examined before accurate treatment options are discussed with you.

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dr. Teoh Tiong Ann replied 2 years ago

Diarrhoea will irritate the anus due to the repeated usage. I would advise you to avoid oily food and spicy food. It is best to eat bland food like porridge for a few days until your diarrhoea gets better. You may also wish to try some probiotics. If your diarrhoea persists and your symptoms worsen, it is best to consult a doctor.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that you have an anal abscess and an anal fistula. This may not be haemorrhoids. Anal abscess usually requires surgery for treatment. I would advise you to consult a Colorectal Surgeon for a proper diagnosis.

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dr. Teoh Tiong Ann replied 2 years ago

I would advise you to wait for a while and not rush into surgery. Sometimes after surgery, there is swelling that will get better after a few weeks without surgery before you decide your next course of action.

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dr. Teoh Tiong Ann replied 2 years ago

The treatment of haemorrhoids is the treatment of tolerance of symptoms. If a patient has grade 3 haemorrhoids, and it does not bother him, no treatment is necessary. If the haemorrhoids do bother him, then he can consider surgery. There are a few surgical treatments available like a stapled haemorrhoidectomy or an excision haemorrhoidectomy. It is best to consult a colorectal surgeon and obtain the appropriate advice after he examines you.

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dr. Teoh Tiong Ann replied 2 years ago

The symptoms are very general. Constipation does not cause weakness. It is possible that you might have a mild infection. It would be best for you to consult a doctor so that the doctor can assess your symptoms and arrive at a proper diagnosis.

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dr. Teoh Tiong Ann replied 2 years ago

Bleeding with a bowel movement can arise from a few causes. If the blood is fresh red blood, the bleeding can be arising from hemorrhoids or an anal fissure. These occur as the stools irritate the anal canal and the hemorrhoids and fissure may bleed. If the blood is darker in color and mixed with the stools, then a source of bleeding from the Colon will need to be considered. There may be inflammation of the colon causing the blood. The commonest cause of inflammation is usually an infection like ‘food poisoning’ or ‘gastroenteritis’. Usually, the patient may also feel unwell with an infection and have other symptoms like fever and nausea. Blood that is mixed in the stools may also be a sign of bleeding from diverticuli or possibly a tumor. At 58 years old with recent bowel symptoms, it is important to get an accurate diagnosis and ensure that there are no serious conditions causing his symptoms. I would suggest that you bring him to consult a gastroenterologist or colorectal surgeon for assessment. He may require tests like blood tests, stool tests and a colonoscopy.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that you may have either a haemorrhoid or an anal fissure with a sentinel pile. You will need to see a Colorectal Surgeon to examine you and to arrive at a proper diagnosis. It is also important to avoid hard stools by drinking adequate fluids and consuming adequate fibre.

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dr. Teoh Tiong Ann replied 2 years ago

You did not provide any information of what check up she had. Did she have a colonoscopy, CT scans etc? It would be best to bring her back to the doctor, preferably a colorectal surgeon, so that a proper assessment can be performed. This may include a colonoscopy and CT scans.

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dr. Teoh Tiong Ann replied 2 years ago

If the surgery is recent (about a week), it is expected to have a change in the stools. This will improve after a while. This will also depend on how much intestine was actually removed during the surgery. I would wait for a couple of months and the stools are likely to improve. This may also improve after he has started eating normally.

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dr. Teoh Tiong Ann replied 2 years ago

If this occurred suddenly and recently, you could have a thrombosed external hemorrhoid. This is a blood clot and it usually will resolve in a few weeks without any need for treatment. It is also possible that this is an abscess. An abscess will need surgical treatment. It would be best to consult a colorectal surgeon for a proper diagnosis.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that you may have an anal fissure. This is a wound in the anal canal. You could als have some hemorrhoids. It would be best to consult a Colorectal surgeon for a proper diagnosis and treatment.

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dr. Teoh Tiong Ann replied 2 years ago

A polyp can recur. It would be best to consult a colorectal surgeon or gastroenterologist and have a colonoscopy performed.

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dr. Teoh Tiong Ann replied 2 years ago

Grade 2 hemorrhoids can even be cured with a proper diet, adequate fluid intake and good bowel habits. Medication or minor procedures like injection or ligation of the hemorrhoids may also help.

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dr. Teoh Tiong Ann replied 2 years ago

It is important to establish the cause of the bleeding first. Suspicious bleeding should be further investigated. If no other cause is found, having adequate fiber and fluid to ensure good bowel habits is important.

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dr. Teoh Tiong Ann replied 2 years ago

There are specific Colon Inflammations like ulcerative colitis that may predispose to cancer. Common colon inflammation like from food poisoning or infections do not usually predispose to cancer.

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dr. Teoh Tiong Ann replied 2 years ago

First degree family members of a patient with colorectal cancer are at an increased risk of developing cancer. This is especially if the patient had colorectal cancer before the age of 60 years old. The recommendation is for first degree family members to undergo a screening colonoscopy starting at age 40 years. This should be repeated every 5 years if no polyps were found, or earlier depending on how many and the type of polyps. If there are symptoms, then consideration will be made whether or not to have an earlier colonoscopy.

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dr. Teoh Tiong Ann replied 2 years ago

Bleeding with a bowel movement can arise from a few causes. If the blood is fresh red blood, the bleeding can be arising from hemorrhoids or an anal fissure. These occur as the stools irritate the anal canal and the hemorrhoids and fissure may bleed. If the blood is darker in color and mixed with the stools, then a source of bleeding from the Colon will need to be considered. Blood that is mixed in the stools may also be a sign of bleeding from diverticuli or possibly a tumor. You did not specify your age. If you are above 50 years of age with recent bowel symptoms, it is important to get an accurate diagnosis and ensure that there are no serious conditions causing your symptoms. I would suggest that you consult a gastroenterologist or colorectal surgeon for assessment. You may require tests like blood tests, stool tests and a colonoscopy.

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dr. Teoh Tiong Ann replied 2 years ago

These could be residual skin tags. Skin Tags are sometimes difficult to remove completely. It is best to consult the surgeon who performed the surgery for his/her opinion.

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dr. Teoh Tiong Ann replied 2 years ago

Yes, Stage 1 Colorectal Cancer can be cured by surgery alone, without any need for chemotherapy or radiotherapy. The cure rate exceeds 95% to 98%. The chance of recurring is very low (<2% to 5%). However, new cancers can appear. Thus, it is advisable that close follow-up for up to 5 years with Colonoscopy and Scans would be useful. After 5 years, regular Colonoscopies are advised, at least once every 5 years.

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dr. Teoh Tiong Ann replied 2 years ago

It is most important to establish exactly what this ‘lump’ is. A feces test may not give you the answer. A Colonoscopy and biopsy would give the best idea of what the ‘lump’ actually is. If it is a cancer, there are options to treatment.

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dr. Teoh Tiong Ann replied 2 years ago

The testicles and cord are the structures that surgeons strive to preserve with hernia surgery. It is not the intent to remove the testes. However, in rare circumstances, for example recurrent large herniae in an older man, there may be consideration for removing the tests. I stress again, this is a rare circumstance and usually the testes are preserved. Unfortunately, hernia can recur after surgery. The rate of recurrence will depend on several factors including size of hernia, persisting aggravating factors after surgery like recurrent coughing, carrying heavy weights etc. The type of procedure and experience of the surgeon are also factors to consider.

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dr. Teoh Tiong Ann replied 2 years ago

It is possible that you may have an anal fissure. This is a painful condition that is caused by hard stools in constipated patients. To prevent hard stools, drinking adequate fluids like water is important together with adequate fiber. Excessive fiber is not good as it causes bloating. Natural fiber like vegetables and fruit is good. Fiber supplements can be purchased at the pharmacy. Try not to take medication like laxatives. If you have to, start with the most gentle types. Avoid strong laxatives as after a while, the strong laxatives may not work anymore and you will have to take increasing doses and it would still not work. It is best to seek a doctor’s assessment for advice. If the constipation persist, it is important to ensure that you do not have an intestinal blockage from other causes. You should consult a doctor to assess this. The doctor may require you to undergo further investigations like XRays, Scans and a Colonoscopy. If there is no other cause that is found, then you can take some steps to improve your bowel movements.

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dr. Teoh Tiong Ann replied 2 years ago

This is unusual. It is best to bring your friend to see a Gynecologist or Colorectal Surgeon. If the symptom is correct, there is an unusual condition called a Recto-Vaginal Fistula. This is not a common condition and is difficult to treat. However, it is most important to get an accurate diagnosis.

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dr. Teoh Tiong Ann replied 2 years ago

The immediate issue is the abscess and a possible anal fistula which is commonly associated with an abscess. It is best to address these two conditions first. Hemorrhoid treatment can be addressed later.

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dr. Teoh Tiong Ann replied 2 years ago

Dark red blood with abdominal pain are symptoms that you should consultation with a Gastroenterologist or Colorectal Surgeon. This may indicate an issue in the Colon or Rectum. Further tests like a colonoscopy may have to be performed. If thee blood is fresh red in color and you do not have any change in bowel habits and the stools are normal and you do not have a family history of Colon Cancer, it is likely that the bleeding is from either hemorrhoids or an anal fissure. Hemorrhoids may not cause any pain in the anal region. However, it would be best that you consult a doctor and ensure that the doctor does an anal examination and proctoscopy. If no cause of the bleeding is found and if the symptoms persist, although the suspicion level is low given your age, I may consider advising a Colonoscopy to exclude other causes of bleeding.

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dr. Teoh Tiong Ann replied 2 years ago

Constipation is quite common during pregnancy without any serious cause. Rarely, it may be due to more serious conditions. Generally, a colonoscopy would not be advised if there is constipation during pregnancy unless there are suspicious factors in the history and clinical presentation. I would suggest that you consult your gynecologist or a gastroenterologist or Colorectal surgeon for advice. Sometimes, just drinking adequate fluids and a gentle laxative may relieve your symptoms

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