Understanding Piles

Piles, also known as haemorrhoids, are swollen veins located in the lower rectum or anus. They can cause discomfort, itching, pain, or bleeding during bowel movements. While mild cases often improve with lifestyle changes and non-surgical treatment, certain cases may require piles surgery for proper management.

Piles can be internal (inside the rectum) or external (under the skin around the anus). The symptoms and severity often determine whether surgical intervention is necessary.

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When to Consider Piles Surgery

Surgery is generally considered when conservative and non-surgical treatments do not relieve symptoms. You may be advised to undergo piles surgery if you experience:

• Persistent bleeding despite non-surgical treatment
• Large or prolapsed haemorrhoids that cannot be pushed back
• Severe pain or swelling around the anus
• Recurrent haemorrhoids after previous treatments
• Complications such as thrombosis (clot formation within a haemorrhoid)

A colorectal surgeon can evaluate your condition through examination and recommend whether surgical intervention is suitable.

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Non-Surgical Options Before Surgery

Before recommending surgery, a doctor may suggest non-surgical treatments such as:

1. Rubber Band Ligation

This procedure involves placing a small band at the base of the internal haemorrhoid to cut off its blood supply. The haemorrhoid then shrinks and falls off naturally within a few days.

2. Sclerotherapy

Sclerotherapy involves injecting a solution into the haemorrhoid to cause it to shrink. It is usually used for smaller or early-stage piles.

3. Haemorrhoid Energy Therapy (HET)

HET applies controlled heat energy to the haemorrhoids to reduce its size and symptoms such as bleeding.

Suitability depends on the patient’s condition and the doctor’s assessment.

4. Ultrasound-Guided Haemorrhoidal Artery Ligation

This method uses ultrasound to locate the arteries feeding the haemorrhoids. The surgeon then ties these arteries to reduce blood flow, helping the haemorrhoids shrink.

If these procedures do not provide relief or if haemorrhoids are large and prolapsed, piles surgery may be recommended.

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Common Types of Piles Surgery

1. Conventional Haemorrhoidectomy

This surgical procedure involves removing the haemorrhoidal tissue. It is usually recommended for severe or recurrent haemorrhoids.

2. Stapled Haemorrhoidopexy

Stapled haemorrhoidopexy involves repositioning the haemorrhoidal tissue using a circular stapling device, which also reduces blood flow to the piles.

3. Laser Piles Surgery

Laser piles surgery uses targeted energy to remove or reduce haemorrhoidal tissue.

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What to Expect After Piles Surgery

After piles surgery, patients may experience mild discomfort or swelling in the anal area. The doctor may prescribe medication to manage pain and prevent constipation. A high-fibre diet, adequate fluid intake, and regular follow-ups help support recovery and reduce recurrence risk.

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About the Piles Clinic in Singapore

The Piles Clinic at piles.com.sg is headed by Dr Ho Kok Sun, Consultant Colorectal & General Surgeon.

Dr Ho Kok Sun
MBBS (Singapore), M Med (General Surgery) (Singapore)
FRCS (General Surgery) (Edinburgh), FAM (Singapore)

Dr Ho obtained his medical and surgical qualifications from the National University of Singapore and completed his fellowship at the Cleveland Clinic Florida. He has held positions including Assistant Master of the Academy of Medicine Singapore and President of the College of Surgeons Singapore.

At the clinic, patients can consult Dr Ho for assessment and management of piles, including both non-surgical and surgical treatment options.

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When to Seek Medical Evaluation

If you experience persistent bleeding, anal pain, or swelling that affects daily activities, it is important to seek evaluation from a colorectal surgeon. Early assessment helps determine whether non-surgical treatment or piles surgery is the appropriate course of action.

Dr Ho Kok Sun of HKS Piles Clinic in Singapore offers assessment and management of piles, including both non-surgical and surgical treatment options. Visit his clinic at Piles.com.sg

Understanding Haemorrhoids

Haemorrhoids, commonly referred to as piles, are swollen veins located in the lower rectum or around the anus. They are a frequent condition that can cause discomfort, pain, itching, or bleeding during bowel movements. While some cases improve with lifestyle changes, others may require medical attention and specific haemorrhoids treatment.

Haemorrhoids are generally classified as internal or external:

• Internal haemorrhoids develop inside the rectum and may bleed without causing significant pain.
• External haemorrhoids form under the skin near the anus and may cause discomfort or swelling.

The management approach depends on the severity, type, and symptoms experienced by the patient.

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When Haemorrhoids Treatment Is Needed

Mild haemorrhoids may respond to home care, such as increased fibre intake and proper hydration. However, persistent bleeding, discomfort, or prolapse (a haemorrhoid that protrudes outside the anus) may require medical evaluation.
A colorectal surgeon at a piles clinic can assess the condition and recommend either non-surgical or surgical haemorrhoids treatment, depending on the findings.

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Non-Surgical Haemorrhoids Treatments

Non-surgical approaches are usually recommended for mild to moderate haemorrhoids or when symptoms do not significantly interfere with daily life. These treatments are generally performed in a clinic setting.

1. Lifestyle and Dietary Modifications

A high-fibre diet, adequate hydration, and regular physical activity can help reduce straining during bowel movements. Topical creams or suppositories may relieve discomfort and inflammation.

2. Rubber Band Ligation

Rubber band ligation is one of the most common non-surgical treatments for internal haemorrhoids. A small rubber band is placed around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid then shrinks and eventually falls off within a few days.

3. Sclerotherapy

Sclerotherapy involves injecting a special solution into the haemorrhoid, causing it to shrink. It is suitable for early-stage haemorrhoids or for patients who are not candidates for surgery.

4. Haemorrhoid Energy Therapy (HET)

Haemorrhoid Energy Therapy uses controlled heat energy to treat internal haemorrhoids. The energy targets the tissue to reduce symptoms such as bleeding.
[Unverified] The procedure may be appropriate for mild to moderate haemorrhoids based on the doctor’s assessment.

5. Ultrasound-Guided Haemorrhoidal Artery Ligation

This procedure uses ultrasound to identify and tie off the arteries that supply blood to the haemorrhoids.
[Unverified] Reducing blood flow to the haemorrhoidal tissue may help reduce swelling and discomfort.

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Surgical Haemorrhoids Treatments

Surgical treatment may be considered when non-surgical methods do not provide sufficient relief, or when haemorrhoids are large, prolapsed, or associated with severe symptoms. These procedures are usually performed in a hospital or day-surgery facility.

1. Conventional Haemorrhoidectomy

Haemorrhoidectomy involves the surgical removal of haemorrhoidal tissue. It may be recommended for severe cases where other treatments have not been effective.
[Unverified] Recovery time varies depending on the extent of surgery and individual healing.

2. Stapled Haemorrhoidopexy

This procedure involves repositioning the prolapsed haemorrhoidal tissue using a circular stapling device. It reduces blood flow to the piles, which can help shrink them over time.
[Unverified] This technique may cause less discomfort compared to conventional surgery, depending on clinical suitability.

3. Laser Haemorrhoids Surgery

Laser surgery uses targeted energy to remove or reduce haemorrhoidal tissue.
[Unverified] It may offer a shorter recovery period for some patients, but suitability depends on the doctor’s evaluation.

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Comparing Non-Surgical and Surgical Treatments

Aspect	Non-Surgical Treatments	Surgical Treatments
Setting	Performed in clinic; typically no hospital stay	Usually performed in hospital or surgical centre
Invasiveness	Minimally invasive	Involves surgical removal or repositioning of tissue
Recovery Time	Shorter recovery; patients may resume activities quickly	Recovery period varies based on procedure type
Suitability	Mild to moderate haemorrhoids	Severe, prolapsed, or recurrent haemorrhoids
Pain and Discomfort	Usually mild and temporary	May involve more post-procedure discomfort
Follow-Up	Often requires repeat treatments	May achieve longer-term relief for suitable cases

The choice between non-surgical and surgical piles treatment depends on factors such as the severity of symptoms, type of haemorrhoids, and the patient’s overall health. Consultation with a qualified colorectal surgeon helps ensure the treatment plan is appropriate for each individual.

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When to Seek Medical Advice

If you experience persistent rectal bleeding, swelling, or discomfort, it is advisable to consult a colorectal surgeon for assessment. Early evaluation helps determine whether non-surgical or surgical haemorrhoids treatment is more suitable.

Understanding Piles and When to Seek Medical Care

Piles, also known as haemorrhoids, are swollen blood vessels in or around the anus and lower rectum. They can cause discomfort, itching, bleeding during bowel movements, or a noticeable lump near the anal opening.

If these symptoms persist or affect daily life, visiting a piles clinic in Singapore can help identify the cause and provide appropriate management options.

Piles are common and may develop due to factors such as chronic constipation, prolonged sitting, pregnancy, or ageing. Although home remedies may relieve mild symptoms, medical evaluation is recommended to confirm the diagnosis and rule out other possible conditions like anal fissures, polyps, or colorectal cancer.

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What to Expect at a Piles Clinic

At a piles clinic, a colorectal surgeon typically conducts a consultation and assessment. This may include a review of medical history, discussion of symptoms, and a physical examination. Diagnostic procedures such as digital rectal examination, proctoscopy, or colonoscopy may be performed if needed.

These assessments help determine the severity and type of haemorrhoids, guiding the treatment plan.

Management approaches can range from conservative methods, such as dietary changes and topical treatments, to minimally invasive procedures like rubber band ligation, sclerotherapy, or laser piles surgery.

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Key Factors to Consider When Choosing a Piles Clinic in Singapore

1. Qualifications and Experience of the Doctor

When choosing a piles clinic, it is important to check the credentials of the attending specialist. In Singapore, piles management is typically handled by a colorectal surgeon—a doctor trained in the diagnosis and treatment of conditions affecting the colon, rectum, and anus.

Dr Ho Kok Sun, Consultant Colorectal & General Surgeon holds qualifications including:

• MBBS (Singapore)
• M Med (General Surgery) (Singapore)
• FRCS (General Surgery) (Edinburgh)
• FAM (Singapore)

He has subspecialised in colorectal surgery after completing fellowship training at the Cleveland Clinic Florida. Dr Ho has also served in various professional roles, including Assistant Master of the Academy of Medicine Singapore, and President of both the College of Surgeons Singapore and the ASEAN Society of Colorectal Surgeons.

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2. Range of Diagnostic and Treatment Options

A well-equipped piles clinic should offer a range of diagnostic tests and management options. These may include:

• Proctoscopy and Anoscopy for internal examination
• Colonoscopy for comprehensive evaluation of the colon and rectum
• Rubber Band Ligation for internal piles
• Sclerotherapy for early-stage haemorrhoids
• Ultrasound-Guided Haemorrhoidal Artery Ligation and Laser Piles Surgery for suitable cases

The choice of treatment depends on the clinical findings and the patient’s overall health.

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3. Accreditation and Clinic Facilities

Before booking an appointment, you may check whether the piles clinic is accredited and whether its procedures are performed in licensed facilities. Accreditation ensures that the clinic meets standards of safety and hygiene set by Singapore’s Ministry of Health (MOH).

Consulting a piles clinic that operates within these guidelines helps ensure proper care and accountability.

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4. Post-Treatment Care and Follow-Up

After piles treatment, follow-up consultations are important to monitor healing and prevent recurrence. During these visits, the doctor may review recovery progress, adjust medication, and provide advice on bowel habits or diet.

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5. Accessibility and Communication

Accessibility is another practical factor when selecting a clinic. Consider the clinic’s location, appointment availability, and ease of communication with its medical team.
A clear explanation of the diagnosis, treatment options, and aftercare can help patients make informed decisions about their care.

A hernia occurs when an internal organ or tissue pushes through a weak spot in the surrounding muscle wall. It often appears as a visible bulge under the skin, most commonly around the abdomen or groin. Many people notice that the lump may flatten when they lie down and wonder whether it will eventually heal by itself.

In most cases, a hernia does not go away on its own. Understanding why helps explain when medical review is necessary.

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Why a Hernia Usually Does Not Heal Without Treatment

A hernia develops because of a defect or weakness in the muscle or connective tissue. Once that weak area forms, the body cannot typically repair it naturally. While symptoms such as mild discomfort may improve temporarily with rest or reduced strain, the opening in the muscle wall remains.

Over time, everyday activities that increase pressure in the abdomen — such as lifting, coughing, or straining — can make the hernia more noticeable or cause it to enlarge.

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Situations Where Watchful Waiting May Be Considered

In some cases, doctors may suggest monitoring the hernia rather than proceeding with immediate surgery. This approach is usually recommended when:

• The hernia is small and not causing discomfort
• There is no pain, swelling, or change in size over time
• The patient’s overall health or other conditions make surgery less suitable at that moment

Even during observation, regular medical follow-up is important to ensure the hernia does not worsen or develop complications.

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When to Seek Medical Advice

A hernia should be reviewed by a hernia specialist if any of the following occur:

• The bulge increases in size or becomes more prominent
• There is pain or discomfort, especially when coughing, bending, or lifting
• The area feels tender, firm, or discoloured
• There are symptoms of nausea, vomiting, or abdominal distension

These symptoms may indicate that the hernia has become trapped (incarcerated) or obstructed, both of which require prompt medical attention.

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Treatment Options

When a hernia causes symptoms or poses a risk of complications, hernia surgery may be recommended. The goal is to repair the weakened tissue and prevent the hernia from recurring.

The choice of surgical method depends on the hernia’s type, size, and location, as well as the patient’s general health. A hernia specialist can discuss the options and determine the most appropriate approach based on clinical findings.

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Summary

A hernia rarely heals on its own because the muscle wall cannot close naturally once a defect has formed. Small, symptom-free hernias may be observed for a period under medical supervision, but surgical repair is generally needed if pain or complications arise. Consulting a specialist helps determine whether hernia surgery is appropriate and ensures the condition is managed safely.

A hernia occurs when an internal organ or tissue pushes through a weak area in the muscle wall. It often appears as a visible bulge under the skin, especially around the abdomen or groin. While hernias can happen to anyone, certain everyday activities and health factors can increase the likelihood of developing one.

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Understanding What Causes a Hernia

A hernia forms when muscle or connective tissue becomes weakened or stretched. This weakness can be present from birth or develop gradually over time due to strain and pressure. Common types include inguinal, femoral, umbilical, and incisional hernias.

When a hernia develops, the affected area may feel tender, and a bulge may become more noticeable when standing, coughing, or lifting heavy objects.

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Common Triggers in Daily Life

While hernias can sometimes occur without a clear cause, certain habits and conditions can contribute to their development. Some of the most common triggers include:

1. Heavy Lifting

Frequent or improper lifting can place pressure on the abdominal wall, especially when core muscles are not well supported. Occupations or activities that involve repeated lifting increase the risk of muscle strain.

2. Persistent Coughing

Chronic coughing, such as from asthma, bronchitis, or smoking, can repeatedly strain the abdominal muscles and lead to a hernia over time.

3. Constipation and Straining

Regular straining during bowel movements increases abdominal pressure. Managing constipation through hydration and a fibre-rich diet may help reduce this strain.

4. Obesity

Excess body weight can weaken the abdominal wall and increase pressure inside the abdomen, making it easier for tissue to protrude through a weak spot.

5. Pregnancy

During pregnancy, increased pressure in the abdomen and stretching of muscles can contribute to hernia formation, particularly around the belly button (umbilical hernia).

6. Previous Surgery

An incisional hernia can develop at the site of a previous surgical incision if the surrounding muscle does not heal fully or becomes weakened.

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Recognising the Signs of a Hernia

Common symptoms that may indicate a hernia include:

• A noticeable lump or bulge in the abdomen or groin
• Discomfort or pain, particularly when lifting, coughing, or bending
• A heavy or dragging sensation in the lower abdomen
• Swelling around the groin or scrotum (in men)

These symptoms may vary depending on the type and location of the hernia.

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When to See a Specialist

If you suspect a hernia, it is advisable to consult a hernia specialist for assessment. Diagnosis often involves a physical examination and, when needed, imaging tests such as ultrasound or CT scans.

In cases where the hernia causes pain, discomfort, or risk of complications, hernia surgery may be recommended to repair the weakened muscle wall. The specific surgical approach depends on the hernia’s type, size, and the patient’s overall health.

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Takeaways

Hernias can result from everyday activities that increase pressure within the abdomen, such as lifting, coughing, or straining. Early recognition and consultation with a hernia specialist can help determine whether hernia surgery is necessary. Timely management reduces the risk of further complications and helps restore comfort in daily life.

Appendicitis is a common cause of right-sided abdominal pain and requires medical attention to avoid complications. Because the symptoms of appendicitis can resemble other abdominal conditions, doctors in Singapore use a combination of physical assessment, laboratory investigations, and imaging tests to confirm the diagnosis.

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Understanding the Appendix and Appendicitis

The appendix is a small pouch attached to the beginning of the large intestine. When it becomes inflamed or infected, the condition is known as appendicitis. It can cause pain that typically begins near the navel and shifts to the lower right abdomen, often accompanied by nausea, vomiting, or fever.

An accurate diagnosis is important because appendicitis may progress and lead to complications if untreated.

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Initial Assessment and Clinical Examination

When a patient presents with right-sided abdominal pain, the doctor first performs a detailed medical history review and physical examination. This may include:

• Identifying the location, duration, and nature of the pain
• Checking for tenderness in the lower right abdomen
• Assessing for rebound pain, which can indicate irritation of the abdominal lining
• Observing accompanying symptoms such as fever, nausea, or changes in bowel movement

Clinical evaluation helps determine whether further tests are necessary to confirm appendicitis or exclude other conditions.

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Laboratory Tests

Blood and urine tests may support the diagnosis of appendicitis. These tests can help detect:

• Raised white blood cell count, which suggests infection or inflammation
• Urinary abnormalities, which may point to urinary tract or kidney conditions that mimic appendicitis

While blood tests cannot diagnose appendicitis on their own, they provide useful information to guide further investigation.

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Imaging Tests

Imaging is often recommended to confirm the diagnosis and to rule out other causes of abdominal pain. Common imaging tests used in Singapore include:

• Ultrasound scan – often used as a first-line imaging test, especially in children and pregnant women.
• CT scan (Computed Tomography) – may be ordered if ultrasound results are inconclusive. It provides detailed images of the appendix and surrounding structures.

These imaging methods help doctors visualise inflammation, swelling, or complications such as abscess formation.

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When Surgery May Be Needed

If appendicitis is confirmed, the doctor may recommend appendix removal surgery (appendicectomy). This procedure removes the inflamed appendix to prevent rupture and infection.

In Singapore, appendicitis specialists assess the patient’s condition to decide whether surgery should be performed immediately or managed initially with antibiotics in selected cases. The approach depends on clinical findings and imaging results.

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Why Accurate Diagnosis Matters

Because the symptoms of appendicitis overlap with many abdominal conditions, an accurate and timely diagnosis is essential. Identifying the condition early can help doctors plan appropriate treatment and minimise the risk of complications such as perforation or abscess formation.

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Summary

Appendicitis is diagnosed in Singapore through a structured process that includes physical assessment, blood and urine tests, and imaging scans. If appendicitis is confirmed, an appendicitis specialist may recommend appendix removal surgery. Early medical review is advisable if abdominal pain persists or worsens, particularly when accompanied by fever or nausea.

Appendicitis occurs when the appendix — a small, finger-shaped pouch attached to the large intestine — becomes inflamed. It can affect both adults and children, and early recognition is important to prevent complications. Because its symptoms can mimic other abdominal issues, identifying the early signs and knowing when to seek medical attention can make a difference in timely management.

What Causes Appendicitis?

Appendicitis often develops when the appendix becomes blocked by stool, infection, or swollen tissue. The blockage can lead to inflammation and, if untreated, may cause the appendix to rupture. While the condition can occur at any age, it is more common among individuals in their teens and twenties.

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Early Signs to Watch For

Recognising the initial symptoms of appendicitis can be challenging, as they often resemble common digestive problems. Some of the early warning signs include:

• Pain around the navel that gradually shifts to the lower right abdomen
• Loss of appetite or disinterest in food
• Nausea or vomiting, particularly after the onset of abdominal pain
• Mild fever that may worsen as inflammation progresses
• Abdominal swelling or bloating
• Discomfort that increases with movement, coughing, or sneezing

If these symptoms develop, it is advisable to seek medical review to determine the underlying cause.

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When Right-Sided Pain May Not Be Appendicitis

Right-sided abdominal pain does not always indicate appendicitis. Other conditions, such as gallstones, kidney stones, or a hernia, can produce similar symptoms. A hernia doctor can help evaluate whether a bulge or pain in the groin or lower abdomen is due to a hernia. At a hernia clinic, tests such as an ultrasound or CT scan can help confirm the diagnosis and guide treatment.

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Why Prompt Medical Evaluation Matters

Appendicitis can progress rapidly. If inflammation worsens, the appendix may rupture, potentially leading to infection in the abdominal cavity. For this reason, medical evaluation should not be delayed if symptoms persist or intensify.

Doctors typically diagnose appendicitis through a combination of physical examination, blood tests, and imaging studies such as ultrasound or CT scan. Early diagnosis allows for timely surgical or non-surgical management.

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Summary

The early signs of appendicitis can be subtle but should not be ignored. Persistent right-sided abdominal pain, nausea, and loss of appetite may indicate the need for a prompt medical review. If a hernia or other abdominal condition is suspected, consulting a colorectal doctor can help provide clarity and appropriate care.

Right-sided abdominal pain is a common reason for medical consultation. While it can result from many causes, one condition that often requires timely attention is appendicitis — an inflammation of the appendix, a small pouch attached to the large intestine. Identifying the symptoms early and seeking appropriate medical evaluation is important in managing the condition effectively.

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Understanding Right-Sided Abdominal Pain

The right side of the abdomen houses several organs, including the appendix, part of the colon, gallbladder, and reproductive structures (in women). Pain in this area can arise from various causes, such as:

• Appendicitis
• Gallstones
• Hernia
• Kidney stones
• Ovarian or gynaecological conditions (in women)

Because these conditions can overlap in symptoms, medical assessment is often needed to determine the exact cause.

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Could It Be Appendicitis?

Appendicitis typically begins with vague pain near the navel, which later shifts to the lower right abdomen. Common accompanying symptoms include:

• Loss of appetite
• Nausea or vomiting
• Low-grade fever
• Abdominal bloating or discomfort that worsens with movement

If these symptoms are present, it is advisable to seek medical attention promptly, as untreated appendicitis can lead to complications such as an abscess or a ruptured appendix.

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When a Hernia Might Cause Similar Pain

A hernia occurs when an internal organ pushes through a weak spot in the muscle or tissue wall. Depending on the location, hernias can also cause right-sided abdominal discomfort or swelling. Some types that may mimic appendicitis include:

• Inguinal hernia – occurs in the groin area
• Femoral hernia – appears just below the groin
• Incisional hernia – develops at a previous surgical site

If you suspect a hernia, visiting a hernia doctor or a hernia clinic can help confirm the diagnosis and discuss suitable treatment options. Evaluation may involve physical examination and imaging tests such as an ultrasound or CT scan.

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When to See a Specialist

Persistent or worsening abdominal pain should not be ignored. If the pain is sudden, severe, or associated with vomiting and fever, an urgent medical review is recommended.
A specialist can assess whether the pain is due to appendicitis, a hernia, or another abdominal condition. At a hernia clinic, comprehensive assessment and management options are available for patients with hernia-related pain or swelling.

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Summary

Right-sided abdominal pain can have many causes, including appendicitis and hernias. Because these conditions may present with similar symptoms, proper evaluation is essential. Early consultation with a doctor ensures accurate diagnosis and timely care.