Colorectal Surgery in Singapore

Colorectal surgery is a specialised area of general surgery that focuses on conditions affecting the colon, rectum, and anus. It covers the diagnosis, treatment, and management of both benign and malignant diseases of the lower digestive tract.

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Understanding Colorectal Conditions

Colorectal conditions can vary widely in severity and symptoms. Some are minor and manageable through medical treatment, while others may require surgical intervention.
Common colorectal conditions include:

• Colorectal cancer
• Colon polyps
• Diverticular disease
• Haemorrhoids (piles)
• Anal fissures and fistulas
• Inflammatory bowel disease (IBD) such as Crohn’s disease and ulcerative colitis
• Rectal prolapse

Early evaluation and diagnosis are important, as certain symptoms — such as blood in stool, persistent constipation, abdominal pain, or unexplained weight loss — may indicate underlying colorectal issues.

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What Colorectal Surgery Involves

Colorectal surgery may involve the removal or repair of diseased segments of the colon or rectum, as well as procedures to manage anal conditions. Depending on the diagnosis, surgery may be performed using different approaches:

• Laparoscopic (keyhole) surgery: Small incisions and specialised instruments are used to access the affected area.
• Open surgery: Required in some cases where larger exposure is needed.
• Robotic-assisted surgery: Some surgeons are accredited to perform this form of minimally invasive surgery.

Colorectal surgery can also include endoscopic procedures such as colonoscopy, which allows for direct visualisation and removal of polyps, or the insertion of colon stents to relieve obstruction from tumour-related complications.

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When to See a Colorectal Surgeon

Individuals are advised to consult a colorectal surgeon if they experience symptoms such as:

• Rectal bleeding or blood in the stool
• Change in bowel habits (diarrhoea or constipation) lasting more than a few weeks
• Persistent abdominal discomfort or bloating
• Unexplained weight loss
• Pain or swelling around the anal region

Colorectal surgeons in Singapore are medical specialists trained in both diagnostic evaluation and surgical management of these conditions. They also perform screening colonoscopies, which are important for detecting early-stage colorectal cancer and removing precancerous growths.

Dr Ho Kok Sun is a Consultant Colorectal and General Surgeon in Singapore. He holds the following qualifications:

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

Education and Training

Dr Ho graduated from the National University of Singapore (NUS) in 1993 and obtained his Master of Medicine in Surgery from NUS in 1998. That same year, he became a Fellow of the Royal College of Surgeons of Edinburgh.

He completed his training in general surgery in 2002 and went on to undertake a fellowship at Cleveland Clinic Florida. Since then, he has subspecialised in colorectal surgery.

Professional Appointments and Contributions

Dr Ho is currently the Assistant Master of the Academy of Medicine, Singapore, which serves as the professional body for medical specialists in Singapore.

He has previously served in leadership positions, including:

• President of the College of Surgeons, Singapore
• President of the ASEAN Society of Colorectal Surgeons
• President of the Society of Colorectal Surgeons (Singapore)
• Vice President of the Singapore-China Association for the Advancement of Science and Technology

He is also a founding member of the Eurasian Colorectal Technologies Association and has been Organising Chairman of two major international colorectal conferences.

Teaching and Academic Roles

Dr Ho has held academic appointments as:

• Clinical Senior Lecturer at the Yong Loo Lin School of Medicine, NUS
• Assistant Professor with the Duke-NUS Graduate Medical School

He was also part of the core faculty for the SingHealth General Surgery Residency Programme and contributed to the development of the Colorectal Surgery training syllabus.

Areas of Surgical Interest

Dr Ho’s surgical interests include minimally invasive colorectal surgery. He performs laparoscopic (keyhole) colon and rectum operations and has experience with single-incision port (single keyhole) procedures.

He is among the surgeons in Singapore accredited to perform robotic colorectal surgery.

Dr Ho has also organised and conducted more than 20 animal laparoscopic workshops to train overseas surgeons and has taught laparoscopic and endoscopic skills using simulation-based methods for medical students and surgical trainees.

Endoscopy and Anal Conditions

Dr Ho’s other area of interest lies in advanced therapeutic endoscopy, including gastroscopy and colonoscopy. His work includes the use of colon stents to help relieve symptoms arising from colon cancer complications.

He also manages anal conditions, including:

• Haemorrhoids (piles)
• Anal fistula
• Anal fissures
• Anal abscesses

Research and Publications

Dr Ho has published over 45 articles in peer-reviewed journals and book chapters. He also serves as a reviewer and editorial board member for several medical journals.

In 2018, he was appointed by the Singapore Ministry of Health to a 13-member committee responsible for establishing national benchmarks for medical fees.

Summary

Colorectal surgery plays an important role in managing diseases of the colon, rectum, and anus. Early diagnosis, appropriate screening, and consultation with a qualified colorectal surgeon such as Dr Ho Kok Sun, can help in effective treatment and care planning.

For more information or to book an appointment, visit: www.hkscolorectal.com.sg

Pregnancy is a time of significant physical and emotional changes, with expectant mothers often experiencing a variety of health challenges. Among these, anal fissures are a relatively common yet often overlooked condition. An anal fissure is a small tear in the lining of the anus, which can cause pain, bleeding, and discomfort during bowel movements. Understanding the causes and adopting safe management strategies can help alleviate symptoms and improve quality of life during pregnancy.

This article provides an overview of anal fissures during pregnancy and offers practical advice tailored to Singapore’s healthcare standards.

What Causes Anal Fissures in Pregnancy?

Several factors contribute to the development of anal fissures during pregnancy, including:

1. Constipation:

• Hormonal changes in pregnancy, particularly increased progesterone levels, can slow down digestion and lead to constipation. Straining during bowel movements increases the risk of anal fissures.

2. Increased Pressure:

• As the uterus expands, it places additional pressure on the rectum and anus, which can contribute to fissure development.

3. Childbirth Trauma:

• Vaginal delivery may exert pressure on the anal region, causing tears or exacerbating existing fissures.

4. Hormonal Changes:

• Hormones can affect blood flow and tissue elasticity in the anal area, making it more susceptible to injury.

Symptoms of Anal Fissures

The common symptoms of anal fissures include:

• Sharp pain during and after bowel movements.
• Bright red blood on toilet paper or in the stool.
• Itching or irritation around the anus.
• A visible tear or crack near the anus.

If symptoms persist or worsen, it is essential to consult a healthcare professional to rule out other conditions, such as haemorrhoids or infections.

Safe Management of Anal Fissures During Pregnancy

Managing anal fissures during pregnancy requires a gentle and holistic approach to ensure the safety of both mother and baby. Below are some effective strategies:

1. Dietary Adjustments

• Increase Fibre Intake: A high-fibre diet can soften stools and reduce straining. Include foods like:
  • Whole grains: Brown rice, oats, and wholemeal bread.
  • Fruits: Apples, pears, and papayas.
  • Vegetables: Spinach, broccoli, and carrots.
• Stay Hydrated: Drink at least 8 glasses of water daily to keep stools soft and promote healthy digestion.

2. Regular Bowel Habits

• Avoid delaying bowel movements, as this can lead to harder stools.
• Use a footstool to elevate your feet while sitting on the toilet, which can help relax the anal muscles.

3. Topical Treatments

• Use pregnancy-safe creams or ointments containing lidocaine or petroleum jelly to reduce pain and promote healing.
• Consult your doctor before using any medicated creams to ensure they are safe for pregnancy.

4. Sitz Baths

• Soaking the anal area in warm water for 10 to 15 minutes, 2 to 3 times a day, can relieve discomfort and improve blood flow to promote healing.

5. Gentle Exercise

• Regular, low-impact exercises like walking or prenatal yoga can improve digestion and reduce the risk of constipation.

6. Avoid Straining

• Minimise strain during bowel movements by using a stool softener if recommended by your doctor. Common options in Singapore include lactulose or polyethylene glycol, which are safe for pregnancy.

When to Seek Medical Attention

While most anal fissures heal with conservative management, certain situations require medical intervention:

• Persistent or worsening pain and bleeding.
• Signs of infection, such as swelling or discharge.
• Difficulty passing stools despite dietary and lifestyle adjustments.

In Singapore, healthcare providers, including obstetricians and colorectal specialists, are equipped to diagnose and treat anal fissures during pregnancy. Advanced treatments like botulinum toxin injections or surgical intervention are reserved for severe cases and are generally avoided during pregnancy unless absolutely necessary.

Preventing Anal Fissures in Pregnancy

Prevention is always better than cure. Adopting the following habits can reduce the risk of developing anal fissures:

• Maintain a balanced, high-fibre diet.
• Stay hydrated throughout the day.
• Engage in regular physical activity.
• Avoid prolonged sitting or standing, which can increase pressure on the rectal area.
• Practise good perineal hygiene to minimise irritation.

Anal fissures can be an uncomfortable and distressing condition during pregnancy, but with proper care and lifestyle adjustments, most cases can be effectively managed. If you experience persistent symptoms, do not hesitate to seek medical advice from a trusted healthcare provider in Singapore.

By prioritising digestive health and adopting preventive measures, you can minimise the risk of anal fissures and focus on enjoying this special time in your life.

Inflammatory Bowel Disease (IBD) encompasses two primary conditions: Ulcerative Colitis (UC) and Crohn’s Disease. Both are chronic disorders that cause inflammation in the gastrointestinal (GI) tract, but they differ in their presentation, affected areas, and treatment approaches. Understanding these differences is vital for accurate diagnosis and effective management.

In Singapore, with its world-class healthcare system and increasing awareness of digestive health, more people are seeking early diagnosis and treatment for IBD. This article explores the distinctions between Ulcerative Colitis and Crohn’s Disease to help patients and caregivers make informed decisions.

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Overview of Ulcerative Colitis and Crohn’s Disease

Ulcerative Colitis (UC):

• Affects only the large intestine (colon) and rectum.
• Inflammation is continuous and limited to the innermost lining of the colon.
• Symptoms include bloody diarrhoea, abdominal pain, and urgency to defecate.

Crohn’s Disease:

• Can affect any part of the GI tract, from the mouth to the anus.
• Inflammation may occur in patches and can penetrate deeper into the bowel wall.
• Symptoms include abdominal pain, diarrhoea (often without blood), weight loss, and fatigue.

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Key Differences Between Ulcerative Colitis and Crohn’s Disease

1. Location of Inflammation:

• UC: Limited to the colon and rectum.
• Crohn’s: Can occur anywhere in the GI tract, often involving the small intestine and colon.

2. Pattern of Inflammation:

• UC: Continuous inflammation starting from the rectum.
• Crohn’s: Patchy inflammation, often with healthy sections of bowel between affected areas.

3. Depth of Inflammation:

• UC: Affects only the mucosal layer (innermost lining).
• Crohn’s: Can penetrate deeper layers of the intestinal wall, causing complications such as fistulas and strictures.

4. Symptoms:

• UC: Bloody diarrhoea, urgency, and tenesmus (feeling of incomplete evacuation).
• Crohn’s: Abdominal pain, weight loss, non-bloody diarrhoea, and malnutrition.

5. Complications:

• UC: Increased risk of colon cancer with long-standing disease.
• Crohn’s: Development of strictures, fistulas, abscesses, and malabsorption issues.

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Diagnosis

In Singapore, accurate diagnosis of IBD typically involves:

1. Medical History and Physical Examination:
   • Discuss symptoms, duration, and family history of IBD.
2. Endoscopy:
   • Colonoscopy: To visualise the colon and obtain biopsies for UC.
   • Endoscopy or Capsule Endoscopy: To evaluate the small intestine for Crohn’s Disease.
3. Imaging Studies:
   • CT or MRI scans to assess the extent and severity of inflammation, particularly in Crohn’s Disease.
4. Blood and Stool Tests:
   • To identify inflammation, infection, or anaemia.

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Treatment Approaches

Although the treatment goals for both UC and Crohn’s are similar—reducing inflammation, relieving symptoms, and maintaining remission—the strategies differ.

Medications:

• Aminosalicylates: First-line treatment for mild to moderate UC.
• Corticosteroids: Used for short-term relief during flare-ups in both conditions.
• Immunomodulators and Biologics: Target immune responses to control inflammation in moderate to severe cases of UC and Crohn’s.
• Antibiotics: More commonly used in Crohn’s to treat infections and complications.

Surgery:

• UC: Surgery (proctocolectomy) can be curative as it removes the entire colon and rectum.
• Crohn’s: Surgery is not curative but may be required to treat complications like strictures or fistulas.

Diet and Lifestyle:

• UC and Crohn’s: Adopting a low-residue or low-fibre diet during flare-ups can ease symptoms. Maintaining hydration and avoiding trigger foods (e.g., spicy, fatty, or high-sugar foods) is crucial.
• In Singapore, nutritionists and dietitians are available to provide tailored dietary advice.

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Living with IBD in Singapore

With growing awareness of IBD, Singapore offers extensive resources for patients, including specialised gastroenterology clinics and support groups like the Crohn’s & Colitis Society of Singapore (CCSS). Patients can access:

• Regular check-ups to monitor disease progression.
• Psychological support to address mental health challenges associated with chronic illness.
• Financial assistance through schemes like MediShield Life and Integrated Shield Plans.

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Ulcerative Colitis and Crohn’s Disease are distinct conditions under the umbrella of IBD, with unique characteristics and management strategies. Understanding these differences can help patients seek timely medical advice and receive appropriate care.

If you experience persistent digestive symptoms, consult a gastroenterologist in Singapore to ensure accurate diagnosis and treatment. Early intervention can make a significant difference in managing IBD and improving quality of life.

Lifestyle Choices to Prevent Appendix Pain and Appendicitis

Appendicitis, an inflammation of the appendix, is a common medical condition that often requires surgical intervention. The appendix is a small, tube-like structure attached to the large intestine, and while its exact function remains unclear, it can become a source of significant pain and health issues if inflamed. Although there is no guaranteed way to prevent appendicitis, certain lifestyle choices can reduce the risk of appendix pain and promote overall digestive health.

This article provides practical tips and advice for Singapore residents on maintaining a healthy lifestyle to minimise the risk of appendix-related issues.

Understanding Appendicitis

Appendicitis occurs when the appendix becomes blocked or infected, leading to swelling and, in severe cases, rupture. Symptoms include:

• Sudden pain starting near the navel and shifting to the lower right abdomen.
• Nausea and vomiting.
• Loss of appetite.
• Fever and chills.
• Abdominal bloating or discomfort.

A ruptured appendix can lead to life-threatening complications, such as peritonitis (infection of the abdominal lining), making prompt medical attention essential.

Dietary Choices to Promote Digestive Health

A well-balanced diet plays a vital role in maintaining a healthy digestive system, which can indirectly help prevent appendix-related issues.

1. High-Fibre Diet

• Fibre aids in regular bowel movements, preventing constipation and blockages that could potentially lead to appendicitis.
• Include fibre-rich foods such as:
  • Fruits: Apples, bananas, and guavas.
  • Vegetables: Spinach, carrots, and broccoli.
  • Whole grains: Brown rice, oats, and wholemeal bread.
  • Legumes: Lentils, chickpeas, and beans.
• Aim to meet the Health Promotion Board (HPB) guidelines of at least 20 to 38 grams of fibre daily, depending on age and gender.

2. Stay Hydrated

• Adequate hydration ensures smooth digestion and prevents hard stools.
• Drink at least 8 glasses (about 2 litres) of water daily, adjusting for activity levels and Singapore’s humid climate.

3. Limit Processed Foods

• Processed and low-fibre foods can increase the risk of constipation and digestive discomfort.
• Reduce consumption of fast food, refined carbohydrates, and sugary snacks.

4. Incorporate Probiotic-Rich Foods

• Probiotics support gut health by balancing good bacteria in the digestive system.
• Add foods like yoghurt with live cultures, kimchi, and miso to your diet.

Lifestyle Habits for a Healthy Appendix

In addition to a nutritious diet, certain lifestyle habits can further promote digestive health and reduce the likelihood of appendix pain or appendicitis.

1. Regular Physical Activity

• Exercise stimulates bowel movements and helps maintain a healthy weight.
• Engage in activities such as brisk walking, jogging, or swimming for at least 150 minutes a week, as recommended by HPB.

2. Avoid Smoking and Excessive Alcohol Consumption

• Smoking and heavy drinking can negatively impact gut health and increase the risk of digestive issues.
• If you smoke, consider seeking support from smoking cessation programmes available in Singapore.

3. Maintain a Healthy Weight

• Obesity is linked to a higher risk of abdominal and digestive problems.
• Combine a balanced diet with regular exercise to achieve and sustain a healthy weight.

4. Practice Good Hygiene

• Proper handwashing helps prevent infections that may indirectly affect the appendix.
• Wash your hands thoroughly with soap and water before eating and after using the restroom.

Recognising Early Warning Signs

Appendicitis can develop quickly and requires immediate medical attention. Familiarising yourself with the symptoms is crucial for early detection and treatment. In Singapore, healthcare facilities, including public hospitals and private clinics, are well-equipped to diagnose and treat appendicitis promptly.

• Do not ignore persistent abdominal pain, especially if it worsens over time.
• Seek medical advice if you experience nausea, vomiting, or fever alongside abdominal discomfort.
• Avoid self-medicating with painkillers, as they can mask symptoms and delay diagnosis.

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When to See a Doctor

While lifestyle adjustments can reduce the risk of appendix pain, they cannot entirely prevent appendicitis. Consult a doctor if:

• You experience severe or worsening abdominal pain.
• Symptoms like fever, vomiting, or diarrhoea accompany the pain.
• You have a family history of appendicitis or recurrent digestive issues.

Early diagnosis and treatment are essential to prevent complications such as a ruptured appendix. In Singapore, general practitioners and specialists in gastroenterology or surgery can provide expert care.

Although appendicitis cannot always be prevented, adopting a healthy lifestyle can reduce your risk of digestive problems and promote overall well-being. By maintaining a high-fibre diet, staying hydrated, exercising regularly, and practising good hygiene, you can lower the likelihood of appendix pain and related complications.

If you suspect appendicitis or experience persistent abdominal discomfort, do not delay seeking medical attention. Early intervention is key to avoiding severe outcomes and ensuring a swift recovery. Embrace these lifestyle habits today to protect your digestive health and enjoy a healthier, more active life.

Diet and Lifestyle Adjustments to Prevent and Ease Haemorrhoids

Haemorrhoids, also known as piles, are swollen blood vessels in the anal and rectal area. They can cause discomfort, itching, pain, and even bleeding. While haemorrhoids are common and treatable, they can significantly impact quality of life. Fortunately, certain diet and lifestyle adjustments can help prevent their onset and alleviate symptoms. In Singapore, where a variety of food options and a busy lifestyle can contribute to digestive health issues, adopting healthy habits is particularly important.

This article outlines practical steps you can take to manage and prevent haemorrhoids through dietary and lifestyle changes.

Dietary Adjustments

1. Increase Fibre Intake

• Fibre is essential for softening stools and promoting regular bowel movements, reducing the risk of straining during defecation.
• Good sources of fibre include:
  • Whole grains: Brown rice, oats, and wholemeal bread.
  • Fruits: Papaya, bananas, and apples (with the skin).
  • Vegetables: Spinach, carrots, and broccoli.
  • Legumes: Lentils, chickpeas, and beans.
• The Health Promotion Board (HPB) in Singapore recommends 20 to 38 grams of fibre daily, depending on age and gender.

2. Stay Hydrated

• Drinking enough water is crucial for preventing constipation, a leading cause of haemorrhoids.
• Aim for at least 8 glasses (about 2 litres) of water daily. Adjust your intake based on activity levels and weather conditions.
• Limit dehydrating beverages like coffee, tea, and alcohol.

3. Avoid Processed and Low-Fibre Foods

• Minimise consumption of:
  • Fast food and fried items.
  • Refined grains such as white bread and rice.
  • Sugary snacks and beverages.
• These foods can contribute to constipation and worsen haemorrhoid symptoms.

4. Incorporate Probiotics

• Probiotic-rich foods promote gut health and aid digestion, reducing the likelihood of constipation.
• Include foods such as yoghurt with live cultures, kimchi, miso, and tempeh.

5. Moderate Spicy and Acidic Foods

• While not a direct cause, spicy and acidic foods can irritate the anal area and worsen haemorrhoid symptoms.
• Consume chilli, sambal, and acidic foods like citrus fruits in moderation.

Lifestyle Adjustments

1. Practice Healthy Bowel Habits

• Avoid straining during bowel movements as it increases pressure on the rectal veins.
• Go to the toilet as soon as you feel the urge to prevent hard stools from forming.
• Spend minimal time on the toilet and avoid distractions such as mobile phones.

2. Exercise Regularly

• Regular physical activity improves bowel function and reduces the risk of constipation.
• Aim for at least 150 minutes of moderate-intensity exercise weekly, as recommended by HPB.
• Activities such as brisk walking, cycling, and swimming are excellent options.

3. Maintain a Healthy Weight

• Excess body weight can increase pressure on the pelvic area and worsen haemorrhoid symptoms.
• Combine a balanced diet with regular exercise to achieve and maintain a healthy weight.

4. Avoid Prolonged Sitting or Standing

• Sitting or standing for extended periods can increase pressure on the rectal veins.
• Take short breaks to stretch or walk around if you have a sedentary job.

5. Use Proper Lifting Techniques

• Heavy lifting can strain the abdominal muscles and increase pressure in the rectal area.
• When lifting objects, bend your knees and keep your back straight to minimise strain.

Home Remedies for Managing Symptoms

If you are already experiencing haemorrhoid symptoms, the following remedies can provide relief:

1. Warm Sitz Baths:
   • Soak the anal area in warm water for 10 to 15 minutes, 2 to 3 times a day, to reduce swelling and discomfort.
2. Over-the-Counter Treatments:
   • Use haemorrhoid creams, ointments, or suppositories to relieve itching and pain.
3. Cold Compresses:
   • Apply ice packs wrapped in a cloth to the affected area to reduce swelling and provide temporary relief.
4. Wear Comfortable Clothing:
   • Opt for loose-fitting cotton underwear to minimise irritation and keep the area dry.

When to Seek Medical Attention

While dietary and lifestyle changes can significantly improve symptoms, certain cases require medical intervention. Consult a doctor if you experience:

• Persistent pain or discomfort.
• Severe bleeding during bowel movements.
• Prolapsed haemorrhoids that do not retract.
• Symptoms that do not improve with home remedies.

In Singapore, you can seek help from general practitioners, gastroenterologists, or colorectal surgeons. Advanced treatments such as rubber band ligation, sclerotherapy, or surgical procedures are available if necessary.

Preventing and managing haemorrhoids involves a combination of dietary adjustments and lifestyle changes. By incorporating fibre-rich foods, staying hydrated, and maintaining healthy habits, you can reduce the risk of haemorrhoids and improve overall digestive health. In Singapore, where healthcare resources are accessible, do not hesitate to seek professional advice for persistent symptoms.

Start making these changes today to enjoy a healthier and more comfortable life. Remember, small adjustments can make a significant difference!

Haemorrhoids vs. Other Anal Lumps: How to Tell the Difference

Anal lumps are a common health concern that can cause discomfort and anxiety. While many associate anal lumps with haemorrhoids, it is important to understand that not all anal lumps are haemorrhoids. In Singapore, where advanced healthcare services are readily available, distinguishing between haemorrhoids and other causes of anal lumps can help ensure timely and appropriate treatment.

This article provides an overview of haemorrhoids, how they differ from other anal lumps, and when to seek medical attention.

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Understanding Haemorrhoids

Haemorrhoids, also known as piles, are swollen blood vessels in the rectal or anal area. They can develop due to increased pressure in the lower rectum, often caused by straining during bowel movements, chronic constipation, or pregnancy.

Types of Haemorrhoids:

1. Internal Haemorrhoids:
   • Located inside the rectum and usually painless.
   • May cause bleeding during bowel movements or a prolapse (protrusion through the anus).
2. External Haemorrhoids:
   • Found under the skin around the anus.
   • Can cause pain, swelling, and itching.
3. Thrombosed Haemorrhoids:
   • Occur when a blood clot forms in an external haemorrhoid.
   • Extremely painful and may require medical intervention.

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Other Causes of Anal Lumps

While haemorrhoids are a common cause of anal lumps, other conditions can present with similar symptoms. Identifying the underlying cause is crucial for effective treatment. Here are some common conditions that may be mistaken for haemorrhoids:

1. Anal Fissures:
   • A small tear in the lining of the anus, often caused by passing hard stools.
   • Symptoms include sharp pain during bowel movements and bleeding.
   • Unlike haemorrhoids, anal fissures are characterised by intense pain rather than swelling.
2. Anal Abscesses:
   • A collection of pus due to infection in the anal glands.
   • Symptoms include a painful, swollen lump near the anus, fever, and redness.
   • Requires prompt medical treatment to prevent complications.
3. Perianal Haematomas:
   • Caused by ruptured blood vessels leading to a small pool of blood under the skin.
   • Appear as blue or purple lumps near the anus and can be mistaken for thrombosed haemorrhoids.
4. Anal Skin Tags:
   • Benign, painless growths of excess skin around the anus.
   • Often a result of healed haemorrhoids or anal trauma.
   • Do not cause pain or bleeding but may cause hygiene concerns.
5. Anal Warts (Condyloma):
   • Caused by the human papillomavirus (HPV).
   • Small, painless growths around the anal area that can spread if untreated.
6. Rectal Prolapse:
   • Occurs when part of the rectum protrudes through the anus.
   • May appear similar to a prolapsed haemorrhoid but requires different management.
7. Anal Cancer:
   • A rare but serious condition.
   • Symptoms include persistent pain, bleeding, and non-healing lumps.
   • Early diagnosis is critical for successful treatment.

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Key Differences Between Haemorrhoids and Other Anal Lumps

While some symptoms overlap, there are distinct differences that can help differentiate haemorrhoids from other anal conditions:

Symptom/Sign	Haemorrhoids	Other Conditions
Pain	Mild to severe (external/thrombosed)	Intense (fissures, abscesses)
Bleeding	Bright red, often painless	May accompany other symptoms
Appearance	Swollen, bluish or skin-coloured lumps	Varies (warts, skin tags, abscesses)
Associated Symptoms	Itching, discomfort, or prolapse	Fever, discharge, or persistent growth

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When to Seek Medical Attention

It is important to consult a healthcare professional if you experience any of the following:

• Persistent pain or swelling in the anal area.
• Bleeding that does not resolve after a few days.
• Fever, discharge, or signs of infection.
• Unexplained lumps or changes in the anal area.
• Symptoms that do not improve with over-the-counter treatments.

In Singapore, general practitioners, gastroenterologists, and colorectal surgeons are well-equipped to diagnose and manage anal conditions. Diagnostic tools such as physical examinations, anoscopy, or imaging studies may be used to confirm the cause of your symptoms.

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Treatment Options

Treatment depends on the underlying cause of the anal lump:

1. For Haemorrhoids:
   • Lifestyle changes: High-fibre diet, increased water intake, and avoiding straining during bowel movements.
   • Medications: Over-the-counter creams, ointments, or suppositories to reduce swelling and discomfort.
   • Medical procedures: Rubber band ligation, sclerotherapy, or surgical haemorrhoidectomy for severe cases.
2. For Other Conditions:
   • Anal fissures: Topical medications, stool softeners, or botulinum toxin injections.
   • Anal abscesses: Drainage and antibiotics.
   • Anal warts: Cryotherapy, topical treatments, or surgical removal.
   • Anal cancer: Chemotherapy, radiation, or surgery depending on the stage.

Although haemorrhoids are a common cause of anal lumps, other conditions may present with similar symptoms. Understanding the differences and seeking prompt medical attention can prevent complications and ensure appropriate treatment. In Singapore, with access to excellent medical care, there is no reason to endure discomfort or uncertainty about anal health issues.

If you are experiencing anal lumps or related symptoms, consult a healthcare professional for an accurate diagnosis and tailored treatment plan. Early intervention can make all the difference in your health and well-being.

The Worst & Best Foods to Eat for IBS

Irritable Bowel Syndrome (IBS) is a common gastrointestinal condition that affects the large intestine, causing symptoms such as abdominal pain, bloating, diarrhoea, or constipation. While the exact cause of IBS remains unclear, diet plays a significant role in managing its symptoms. In Singapore, where food is an integral part of life, understanding what to eat and what to avoid can greatly improve the quality of life for those with IBS. This article explores the best and worst foods for managing IBS symptoms.

Understanding IBS Triggers

IBS triggers vary from person to person, making it essential for individuals to identify their specific dietary sensitivities. Keeping a food diary can help track what causes symptoms and what alleviates them. However, certain foods are commonly recognised as problematic or beneficial for most people with IBS.

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The Worst Foods for IBS

Some foods can aggravate IBS symptoms, either by increasing gas production, causing bloating, or speeding up or slowing down digestion. Here are the main culprits:

1. High-FODMAP Foods:
   • FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are short-chain carbohydrates that are poorly absorbed in the gut.
   • Common high-FODMAP foods include:
     • Onions, garlic, and asparagus.
     • Legumes like lentils and chickpeas.
     • Fruits such as apples, pears, and watermelon.
     • Dairy products containing lactose, such as milk and ice cream.
2. Fried and Fatty Foods:
   • High-fat foods can worsen diarrhoea in IBS patients. Examples include:
     • Deep-fried snacks like fried chicken and fries.
     • Creamy curries and rich gravies often found in local cuisines.
3. Spicy Foods:
   • Dishes with high levels of spice, such as chilli crab or sambal belacan, can irritate the gut lining and trigger symptoms in sensitive individuals.
4. Caffeine and Alcohol:
   • Beverages such as coffee, tea, and alcoholic drinks can stimulate the gut, leading to diarrhoea or abdominal cramps.
5. Artificial Sweeteners:
   • Sorbitol and mannitol, often found in sugar-free gums and candies, can cause bloating and gas.
6. Carbonated Drinks:
   • Soft drinks and sparkling water can increase bloating and discomfort by trapping gas in the digestive system.

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The Best Foods for IBS

While some foods can worsen IBS symptoms, others can help soothe the digestive system and promote gut health. Here are the best choices:

1. Low-FODMAP Foods:
   • Many people with IBS find relief by following a low-FODMAP diet. Examples include:
     • Vegetables like spinach, carrots, and zucchini.
     • Fruits such as bananas, blueberries, and oranges.
     • Lactose-free dairy products or plant-based alternatives like almond milk.
2. Soluble Fibre:
   • Soluble fibre helps regulate bowel movements and alleviate both diarrhoea and constipation.
   • Foods rich in soluble fibre include:
     • Oats, quinoa, and brown rice.
     • Root vegetables like sweet potatoes and carrots.
3. Lean Proteins:
   • Low-fat proteins are easier on the digestive system. Options include:
     • Skinless chicken, fish, and tofu.
     • Eggs, which are generally well-tolerated by most people with IBS.
4. Probiotic-Rich Foods:
   • Probiotics can support gut health by promoting a balance of good bacteria.
   • Include foods like:
     • Yoghurt with live cultures (lactose-free if needed).
     • Fermented foods such as kimchi and miso.
5. Hydrating Foods and Beverages:
   • Staying hydrated is crucial, especially for those with diarrhoea. Drink plenty of water and include hydrating foods like cucumbers and watermelon (in moderation, as high amounts can be problematic for some).

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Practical Tips for Managing IBS in Singapore

1. Customise Your Hawker Orders:
   • When dining at hawker centres, ask for modifications such as less spice, avoiding gravy, or opting for steamed dishes.
2. Avoid Overeating:
   • Large meals can overwhelm the digestive system, so opt for smaller, more frequent meals.
3. Chew Your Food Thoroughly:
   • Proper chewing aids digestion and reduces the likelihood of bloating and gas.
4. Monitor Your Triggers:
   • Keep a food diary to identify which local dishes or ingredients may be problematic.
5. Consult a Dietitian:
   • A dietitian in Singapore can provide personalised advice and guidance on following a low-FODMAP or IBS-friendly diet.

Managing IBS requires a proactive approach to diet and lifestyle. While it may involve avoiding some favourite local dishes, there are plenty of delicious and safe options to enjoy. By understanding trigger foods and incorporating gut-friendly alternatives, individuals with IBS can lead a more comfortable and fulfilling life.

If you suspect you have IBS or struggle to manage symptoms, consult a healthcare professional for a comprehensive evaluation and tailored dietary advice. With the right approach, it is possible to enjoy Singapore’s vibrant food culture while keeping IBS symptoms under control.