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Understanding Symptoms - Blood in Stools
What does “blood in stool” indicate? Are haemorrhoids a common cause?
Bright red bleeding during or after defecation is the hallmark symptom of haemorrhoids. This is the leading of rectal bleeding. The bleeding is described as painless. Sometimes dripping into the commode or coating the surface of stool. In early cases, blood may only be visible when wiping with toilet paper.
There are other causes of rectal bleeding, like anal fissures (a tear in the anus), Inflammatory bowel disease, anal fistula, and rectal ulcers, to name the commoner causes.
Most importantly, colorectal cancer can exist with haemorrhoids and even present very similarly, so it is essential to seek medical help early.
Piles or haemorrhoids are the leading cause of perianal disease. These are swollen or dilated veins from venous cushions at 3 positions 3-4 cm within the anal canal. When the ligaments attaching the haemorrhoids to the anal canal become loose due to chronic straining from constipation, age, or previous childbirth, they protrude out (prolapse) through the anal canal, causing bleeding, swelling, itching, and pain.
How are haemorrhoids treated?
Managing less severe cases is possible through dietary, medicinal, and ligation techniques. In haemorrhoid ligation, a special grasper or suction device is used to draw haemorrhoid tissue into a proctoscope. After that, rubber bands are placed on the base of the haemorrhoid. This is best for internal haemorrhoids and will cause the haemorrhoid to slough off and for the wound to heal with scarring, thereby reducing vascularity and bleeding. Maximal effects are noted at 6 weeks.
However, surgery is sometimes necessary when the prolapse is irreducible or bleeding is significant.
Closed excisional haemorrhoidectomy is a method of surgical excision of the external haemorrhoid component closure of the wound using absorbable sutures. In current practice, minimal skin is taken, and the procedure can often be done as a day surgery procedure. This results in faster healing as opposed to the previous open technique. Formal haemorrhoid techniques like this result in better cosmesis as excess skin can be trimmed.
Stapled haemorrhoidectomy using the circular haemorrhoid stapler has allowed patients a safe, rapid, and pain-free experience. This device fires a double row of staples within the anal canal that disrupts the blood supply of the haemorrhoids and also hitches the prolapse back into the anal canal, restoring the normal position. Because there is no external skin wound, recovery is rapid and relatively pain-free. This procedure is now offered in a day surgery setting in selected patients.
Transanal Hemorrhoidal Dearterialisation (THD)
This is a novel technique where the haemorrhoids are not removed. Still, the supplying vessels are accurately identified by ultrasound, and suture ligated using a unique anal retractor under sedation. Recovery is fast and relatively painless.
Understanding Symptoms - Abdominal Pain
Understanding Abdominal Pain
Explanation of abdominal pain and its possible causes:
Abdominal pain is a prevalent symptom with many possible causes. It is a widespread problem. This is pain felt anywhere between the bottom of the ribs down to the pelvic bone. Abdominal pain can be severe, but most improve without special treatment.
Often, it is referred to as stomach pain, stomach ache, cramps, tummy pain, a sore stomach, gas pain, or belly ache. It is essential to identify the location of the pain accurately to come to an accurate diagnosis.
Pain above or below the umbilicus (Belly Button) is an excellent place to start.
If the pain is above the umbilicus, the common possibilities are but not limited to:
1. Stomach inflammation (gastritis)
2. Stomach ulcer
3. Acid reflux
4. Gallbladder disease
5. Food poisoning
6. Pancreas inflammation (pancreatitis)
If the pain is below the umbilicus, the common possibilities are but not limited to:
1. Appendicitis
2. Food poisoning
3. Intestinal Obstruction
4. Diverticulitis
5. Urinary tract infection
6. Urine tract stones (especially if referred to the flank)
Pain or discomfort in the abdomen can be mild or severe. It may come on suddenly (acute); it could be something that you experience from time to time (recurrent), or it could be an ongoing symptom that lasts for more than three months (chronic). It can also start mild and steadily worsen (progressive). Pain that comes and goes in waves is referred to as colicky pain.
This information about abdominal pain is focused on adults. Pain in children may have different causes and implications. Pain related to meals and bowel habits, especially when blood in the stool is present and vomiting, is more likely to be related to the gastrointestinal tract. Severe pain that does not go away and is constantly present, especially of a short duration of onset, is significant, and medical attention is required. It may signify severe inflammation of an organ in the body, appendix, gall bladder, or intestine.
Note
- Pain in the abdomen may be described as sharp, constant, dull, squeezing, or burning.
- Identifying the position of the pain (above or below the umbilicus) helps in diagnosis.
- There are many causes of abdominal pain.
- Abdominal pain is discomfort between the bottom of the ribs and the pelvic bone.
What Should I do If I experience “abdominal pain” in Singapore?
Abdominal pain can be serious, but most abdominal pain improves without special treatment. If the pain does not improve in a few hours, then: Don’t ignore abdominal pain — see your doctor if your symptoms are severe, get worse over time, keep coming back, or are ongoing.
Is “abdominal pain treatment” different for various underlying conditions?
The most important approach to abdominal pain is arriving at an accurate and timely diagnosis. Your doctor can assist you if the pain has lasted several hours and is not going away with simple over-the-counter medications (Link- suggested OTC meds on website).
Diagnosing whether the abdominal pain is treatable with medication for pain relief, infection, and inflammation or more serious and requires surgery is important. This requires an experienced doctor to examine the abdomen thoroughly. Confirmatory tests will help to refine the diagnosis, requiring blood tests and sometimes medical imaging, X-rays, ultrasound scans, and computerized tomographic (CT) scans.
Surgery is often required in acute inflammatory conditions like appendicitis and gallbladder infection(cholecystitis). These procedures can now be performed using a minimally invasive approach (keyhole surgery)
Diagnosing whether the abdominal pain is treatable with medication for pain relief, infection, and inflammation or more serious and requires surgery is important. This requires an experienced doctor to examine the abdomen thoroughly. Confirmatory tests will help to refine the diagnosis, requiring blood tests and sometimes medical imaging, X-rays, ultrasound scans, and computerized tomographic (CT) scans.
Surgery is often required in acute inflammatory conditions like appendicitis and gallbladder infection(cholecystitis). These procedures can now be performed using a minimally invasive approach (keyhole surgery)
Pre/Post Surgery
Bowel Preparation
The large intestine needs to be clear of faecal matter for adequate visualisation otherwise small polyps can be missed. Medication to evacuate stool plus a clear liquid diet is necessary at least 6 hours prior to colonoscopy or bowel surgery.
Clear liquids - this may consist of water, tea or coffee with sugar only, barley water, sugar cane juice, chrysanthemum tea, fruit juice without pulp like apple juice, clear broth, jello without milk or coconut. Electrolyte drinks like Gatorade, 100 plus and H2O are also acceptable. Drink at least 2 litres.
For best results, avoid fruit and vegetables, high residue foods like oats for 3 days prior to the procedure.
Medications taken usually consist of oral fleet 45 mls which is a concentrated salty liquid best consumed chilled and rapidly without dilution. PEG (Fortrans) is a synthetic laxative powder prepared by mixing a sachet in a litre of water. Best flavoured with Ribena or Lemon juice as it is tasteless.
Important: Please let your doctor know if you are on any blood thinning mediations like aspirin, plavix, xarelto, warfarin because you will need to stop them for at least days prior to the procedure. Also if you have any kidney or heart disease, your physician should be informed so that adjustments can be made.
Regular medications: High blood pressure medications should be consumed with a sip of water on the morning of the procedure. Diabetic medications are best omitted from the night before when bowel preparation is being performed.
Following Anal Surgery
What should you do?
Wound Care
Please remove all packing and dressings after shower spray of the anal area with warm water the morning following your surgery. The dressing may fall off or out prior to that time, which is fine.Please perform sitz baths twice each day as well as after each bowel movement (10-15 minute soak in warm water), only if you have an open wound. You may do this more frequently for cleanliness or if they help relieve discomfort.Do not sit on a "donut". For prolonged sitting, use a pillow or styrofoam pad.
Bowel Medications
Please take 1 tablespoon of Fybogel, Mucilin or other fiber supplement of your choice once each day. Dissolve this in a glass of water or juice. Drink additional 8-10 glasses of water during the course of each day.You may use Lactus syrup 20cc per day to supplement the fibre if stool consistency is still hard.If you go 72 hours without a bowel movement, please contact your doctor as you may need a gentle enema to relieve stool impaction.
Pain Medication
You will be given pain medications(usually Naproxen and Tramadol). Take the Naproxen as directed every 6 hours and the Tramadol can be taken in between for breakthrough pain.
Activity
Rest today. Do not do any heavy lifting or vigorous exercise for 5 days.
Urination
If you cannot urinate, sit in a warm bath or shower then try again.
Diet
Resume a regular diet.
Following Endoscopy
Immediately post procedure
Be sure not to drive as the sedative drugs used can impair your judgement.Get plenty of sleep to ward off the effects of the sedative.Drink lots of water to clear your system.Progressively move onto your normal diet from liquids. Avoid eating too much if you are feeling nauseous. In some cases, you may require additional medication.
What you should look out for
1. Abnormal bleeding per rectum after colonoscopy. This is especially important if a polypectomy has been done as the base of the cauterized blood vessel may slough off and give rise to bleeding. Contact your doctor immediately as repeat endoscopy and hospitalization is usually necessary.
2. Black tarry stool
3. Pain on swallowing
4. Abdominal pain - you should be pain free following gastroscopy and colonoscopy. If there is pain and fever, please contact your doctor immediately.
Following Ligation of Piles
What to expect
1. Pain and swelling is expected 4-6 hours following the procedure. Please take pain medications (Naproxen or double strength panadol) for 24 hours. This pain subsides after a day.
2. There may be some bleeding 7-10 days post ligation when the rubber slips off or from ulceration. Most of the time, this is self limited. Should bleeding persist, please contact your doctor immediately. An examination and injection of the haemorrhoidal complex is usually required.
Most surgery and endoscopy is done under either sedation or general anesthesia. This requires a fast of at least 6 hours with, no solids or liquids prior to surgery. You may continue to take antihypertensive medication with a sip of water on the morning of surgery but avoid diabetic medication. Blood “thinner” medication such as aspirin, plavix (clopidrogel), Brilinta, Elliquis, Pradaxa or other similar cardiac drugs should be stopped at least 3 days prior to surgery.
If in doubt, call your doctor. Bowel preparation may be required if your doctor has instructed you.
If in doubt, call your doctor. Bowel preparation may be required if your doctor has instructed you.
