Anal Fissures vs Fistulas vs Abscesses: What’s the Difference?

Anal fissures, fistulas and abscesses affect the anal area in different ways and can cause different patterns of pain, swelling and discharge.

Anal fissures, fistulas and abscesses can all cause pain or discomfort around the anus, which can make them difficult to tell apart. However, they are different conditions:

An anal fissure is a tear in the lining of the anus.
An anal fistula is an abnormal tunnel connecting the anal canal to the skin.
An anal abscess is a collection of pus caused by an infection.

Although some symptoms overlap, differences in the pattern of pain, bleeding, swelling and discharge can provide useful clues. Understanding these differences can help you recognise when anal symptoms should be medically assessed rather than assuming they are simply piles.

Anal fissure vs anal fistula vs anal abscess

The simplest way to distinguish these conditions is to understand what is happening beneath the symptoms:

The timing and pattern of anal pain can provide clues about whether a fissure, fistula or abscess may be involved.

CONDITION	WHAT IS IT?	COMMON CLUE
Anal fissure	A small tear or split in the lining of the anus	Sharp pain during or after a bowel movement, often with bright-red bleeding
Anal fistula	An abnormal tunnel between the anal canal and the skin near the anus	Recurrent discharge, irritation or a small opening in the skin
Anal abscess	A collection of pus caused by an infection near the anus or rectum	Constant, throbbing pain with swelling and tenderness

Acute anal fissures usually appear as a longitudinal tear in the anal lining, while chronic fissures can develop changes such as a small skin tag or enlarged tissue around the affected area.

Anal fistulas commonly develop following an anal abscess, when a tract remains between the anal canal and the surrounding skin after the abscess drains. Other causes are also possible.

Anal abscesses commonly occur when an anal gland becomes blocked and infected, allowing pus to accumulate in the surrounding tissue.

Is there a lump or swelling?

What you can see or feel around the anus can provide another useful clue.

An uncomplicated anal fissure usually does not cause a prominent lump. However, a chronic fissure can develop a small skin tag at the outer edge of the tear, which can sometimes be mistaken for a haemorrhoid.

An anal abscess is more likely to cause a tender, swollen area. A superficial abscess can make the skin appear red, warm or visibly swollen, with increasing tenderness as the collection enlarges. Deeper abscesses, however, can cause significant pain or pressure without producing an obvious external lump.

An anal fistula can appear as a small opening, indentation or raised area in the skin near the anus. If the external opening becomes blocked, the area can become swollen and tender before reducing in size again once it drains.

What about bleeding and discharge?

Bright-red bleeding is more typical of an anal fissure, while pus or recurrent discharge may indicate a fistula or draining abscess.

The type of bleeding or discharge can provide useful clues.

An anal fissure commonly causes a small amount of bright-red blood during or after a bowel movement, often alongside sharp pain.

An anal fistula is more commonly associated with recurrent discharge from an opening near the anus. This can contain pus or blood and can stop and return over time.

An anal abscess can release pus if it drains. Although this can relieve pain and pressure, it does not necessarily mean the infection has fully resolved.

SYMPTOM	FISSURE	FISTULA	ABSCESS
Bright-red bleeding	Common	Possible	Less typical
Pain during bowel movements	Characteristic	Variable	Possible, but pain is usually more constant
Pus or discharge	Not typical	Common	Can occur if it drains
Recurrent discharge	Not typical	Characteristic	Can occur after spontaneous drainage
Swelling	Usually absent	Can develop intermittently	Common

Why do fistulas and abscesses sometimes occur together?

An anal abscess can develop when an anal gland becomes blocked and infected, causing pus to collect in the surrounding tissue. If the abscess drains, either naturally or after treatment, the pain and pressure can improve.

However, a tract can sometimes remain between the anal canal and the skin. This tract is an anal fistula.

An anal abscess can develop when a blocked anal gland becomes infected. After the abscess drains, a persistent tract can sometimes remain and form an anal fistula.

Not every abscess develops into a fistula. Less commonly, fistulas can also be associated with underlying conditions such as Crohn’s disease, particularly when they are recurrent or complex.

An anal fissure develops differently. It is a tear in the anal lining and does not typically progress into an abscess or fistula.

Which is more serious: a fissure, fistula or abscess?

Of the three, an anal abscess generally requires the most urgent treatment because it involves an active infection and collection of pus. Prompt drainage is usually needed to prevent the infection from worsening or spreading.

An anal fissure is generally less urgent and often improves with conservative treatment. An anal fistula is usually not an emergency, but it is a persistent condition that requires colorectal assessment and often procedural or surgical treatment.

Rather than simply ranking these conditions by severity, the key concern is whether an active infection is present and whether symptoms are worsening or recurring.

When should you seek medical attention?

Not every episode of anal discomfort requires urgent treatment, but persistent or worsening symptoms should be assessed.

Arrange a medical assessment if you experience:

Persistent or worsening anal pain
A painful or rapidly enlarging lump
Pus or recurrent discharge
Repeated episodes of swelling followed by drainage
Persistent or recurrent rectal bleeding
Symptoms that are not improving with simple measures

Seek prompt medical attention if severe anal pain or swelling is accompanied by fever, chills or feeling generally unwell, as these symptoms can indicate an anorectal infection.

Persistent or unexplained rectal bleeding should also be assessed rather than assumed to be caused by piles or an anal fissure.

How are fissures, fistulas and abscesses diagnosed and treated?

Treatment depends on the underlying condition, its severity and how long symptoms have been present.

FACTOR	ANAL FISSURE	ANAL FISTULA	ANAL ABSCESS
Diagnosis	Usually diagnosed through examination of the anal area	Examination; imaging such as MRI can be needed for complex or recurrent fistulas	Usually diagnosed through clinical examination; imaging can be needed for deeper or unclear abscesses
Typical treatment	Stool regulation and medical treatment first; procedures can be considered for persistent or chronic fissures	Usually requires a procedure or surgery to treat the fistula tract	Prompt drainage is generally the main treatment
Urgency	Usually non-urgent unless symptoms suggest another problem	Requires specialist assessment but is not always an emergency	More urgent because an active infection is present

The appropriate treatment will depend on the findings during assessment. For fistulas in particular, treatment planning also depends on the location and complexity of the tract and its relationship to the anal sphincter muscles.

Book an appointment

Persistent or recurring anal symptoms can have several possible causes. A proper assessment can help identify the underlying problem.

Anal pain, bleeding, swelling and discharge can have several possible causes, and symptoms alone do not always make it clear which condition is responsible.

If your symptoms persist, recur or worsen, a medical assessment can help identify the underlying cause and determine whether treatment is needed.

Book an appointment with Dr Aaron Poh for an assessment of persistent or recurring anal symptoms and to discuss the appropriate treatment options for your condition.

Frequently Asked Questions

How long does an anal fissure take to heal?

Many acute anal fissures heal within several weeks, particularly when constipation, straining and other contributing factors are addressed. Fissures that persist or repeatedly reopen can become chronic and require medical treatment.

Can an anal abscess go away on its own?

An anal abscess should not be assumed to have resolved simply because the pain or swelling improves. Even if it drains spontaneously, infection can persist or a fistula can develop. Medical assessment is therefore recommended.

What happens if an anal abscess bursts?

If an anal abscess bursts, pus can drain and the pain or swelling can temporarily improve. However, this does not necessarily mean the infection has cleared. Continued pain, swelling, discharge or fever should be assessed.

Can an anal fistula come back after it stops draining?

Yes. Drainage can stop temporarily if the external opening closes while the underlying fistula tract remains. This can lead to recurrent swelling, pain or discharge.

How long can an anal fistula last?

An anal fistula can persist for months or longer if the tract does not heal. Symptoms can come and go, particularly when the external opening intermittently drains.

Can constipation cause an anal fissure?

Yes. Passing hard or large stools and straining during bowel movements can cause or contribute to an anal fissure. Repeated trauma to the area can also interfere with healing.

Can you have an anal fissure without bleeding?

Yes. Although bright-red bleeding is common, some people experience little or no noticeable bleeding. Sharp pain during or after a bowel movement can instead be the main symptom.

Can you have an anal abscess without a visible lump?

Yes. Deeper abscesses can cause significant anal or rectal pain without visible swelling. Persistent or worsening pain, particularly with fever or feeling unwell, should be assessed even when there is no obvious lump.

Is rectal bleeding always caused by piles (haemorrhoids)?

Illustration of internal and external haemorrhoids, a common cause of rectal bleeding. — Piles are a common cause of rectal bleeding, but bleeding can also occur for several other reasons.

Seeing blood after a bowel movement can be alarming. Although rectal bleeding is often caused by common and treatable conditions such as piles or anal fissures, it should not simply be dismissed as normal.

The colour, amount and pattern of the bleeding may provide useful clues, but they cannot confirm the cause on their own. What matters is knowing when the bleeding should be checked and what to expect during an assessment.

This article explains what different types of rectal bleeding may look like, the possible causes and how a doctor may investigate where the blood is coming from.

What does rectal bleeding look like?

Rectal bleeding does not always appear in the same way. Depending on where the bleeding originates and how much blood is present, you may notice:

Bright-red blood on toilet paper after wiping
Red streaks on the outside of the stool
Drops of blood in the toilet bowl
Toilet water that appears pink or red
Blood mixed within the stool
Bloody diarrhoea
Dark-red or maroon-coloured stool
Black, sticky or tar-like stool

Although the colour and appearance of the blood can provide useful clues, they cannot confirm where the bleeding is coming from or what has caused it.

Can the colour of the blood reveal the cause?

symptoms of internal haemorrhoids rectal bleeding Singapore. — Bright-red bleeding during bowel movements is one of the most characteristic symptoms of internal haemorrhoids, even when little or no pain is present.

The colour of the blood may provide clues about where bleeding has occurred, but it cannot establish the cause by itself.

Appearance	What it may indicate
Bright-red blood	Often comes from the anus, rectum or lower colon. Possible causes include haemorrhoids, anal fissures and other lower bowel conditions.
Dark-red or maroon blood	May indicate bleeding from farther inside the colon or small intestine, although the appearance can vary depending on the amount and speed of bleeding.
Black, sticky or tar-like stool	May indicate that blood has been digested after bleeding higher in the digestive tract, such as the stomach or upper small intestine.
No visible blood	Small amounts of bleeding may only be detected through a stool test or investigations for iron-deficiency anaemia.

It’s important to note that food, supplements and medicines can sometimes alter stool colour. However, black or red stools should not be attributed to food or medication without considering the possibility of bleeding.

What are piles (haemorrhoids)?

Piles, also known as haemorrhoids, develop when the blood vessels and supporting tissues within or around the anus become enlarged or displaced.

Haemorrhoidal tissue is a normal part of the body and helps support the anal canal. It becomes a problem only when it swells, prolapses or begins causing symptoms such as bleeding, discomfort, itching or a lump.

Internal vs external haemorrhoids

Piles are broadly divided into two types according to where they develop:

Feature	Internal haemorrhoids	External haemorrhoids
Location	Develop inside the anal canal, above the dentate line	Develop beneath the skin around the anus, below the dentate line
Typical symptoms	Bright-red bleeding, mucus, irritation or prolapse during bowel movements	Swelling, itching, tenderness or a noticeable lump near the anus
Pain	Often painless unless they prolapse or develop complications	More likely to be painful because the surrounding skin contains more pain-sensitive nerves
Can they protrude?	Yes. Larger internal haemorrhoids may prolapse through the anus	They are located externally and may be felt as a lump
Potential problem	Prolapse that may require manual reduction	A blood clot may form, causing a suddenly painful thrombosed haemorrhoid

A person can have internal and external haemorrhoids at the same time. Symptoms can also overlap, so the presence of bleeding, pain or a lump does not always reveal which type is responsible.

Medical diagram showing Grades I to IV internal haemorrhoids, from no prolapse to prolapse that cannot be pushed back inside. — Internal haemorrhoids are graded from I to IV according to the extent of prolapse and whether they return inside on their own.

Grades of internal haemorrhoids

Internal haemorrhoids are classified into four grades according to whether they prolapse and whether they return inside on their own.

Grade	Degree of prolapse
Grade I	The haemorrhoids remain within the anal canal and do not prolapse.
Grade II	The haemorrhoids prolapse during a bowel movement or straining but return inside on their own.
Grade III	The haemorrhoids prolapse during a bowel movement or straining and must be gently pushed back inside.
Grade IV	The haemorrhoids remain prolapsed and cannot be pushed back inside.

What else can cause rectal bleeding?

Piles and anal fissures are common causes of rectal bleeding, but they are not the only possibilities. Bleeding can originate anywhere from the anus to the upper digestive tract.

Anal fissures

An anal fissure is a small tear in the lining of the anus. It commonly develops after passing a hard or large stool and typically causes sharp or burning pain during or after a bowel movement.

The bleeding is usually bright red and may appear on toilet paper or along the outside of the stool. Unlike internal haemorrhoids, which may bleed without causing pain, an anal fissure often produces noticeable discomfort.

Colorectal polyps

Colorectal polyps are growths that develop on the lining of the colon or rectum. Most polyps do not cause symptoms, but some may bleed.

The blood may appear on the stool, be mixed within it or occur in amounts too small to be seen. Although most polyps are not cancerous, certain types can develop into colorectal cancer over time. Polyps found during a colonoscopy can usually be removed and sent for laboratory examination.

Inflammatory bowel disease

Inflammatory bowel disease includes conditions such as ulcerative colitis and Crohn’s disease. These conditions cause ongoing inflammation within the digestive tract, which may lead to ulcers and bleeding.

Bleeding caused by inflammatory bowel disease may occur with:

Persistent or recurrent diarrhoea
Mucus in the stool
Abdominal pain or cramping
An urgent need to pass stool
Fatigue
Reduced appetite or unintentional weight loss

The symptoms can vary and may alternate between periods of activity and remission.

Diverticular disease

Diverticula are small pouches that develop in weak areas of the colon wall. Rectal bleeding can occur if a blood vessel within one of these pouches bursts.

Diverticular disease-related bleeding is often painless and may begin suddenly. In some cases, the amount of blood can be substantial.

This is different from diverticulitis, which occurs when the pouches become inflamed or infected. Diverticulitis more commonly causes abdominal pain, fever, nausea or changes in bowel habits.

Colorectal cancer

Colorectal cancer may cause visible rectal bleeding or smaller amounts of blood that are only detected through a stool test.

Other possible symptoms include:

A persistent change in bowel habits
Blood mixed within the stool
Abdominal pain or bloating
A feeling that the bowel has not emptied completely
Unexplained weight loss
Fatigue, breathlessness or anaemia

These symptoms do not necessarily mean that cancer is present. However, persistent bleeding should be investigated because colorectal cancer may not produce obvious symptoms during its earlier stages.

Bleeding higher in the digestive tract

Bleeding can also begin in the oesophagus, stomach or upper part of the small intestine. Possible causes include stomach ulcers, inflammation of the stomach lining and enlarged blood vessels within the oesophagus or stomach.

As the blood travels through the digestive tract, it may be partially digested and cause black, sticky or tar-like stools. Upper gastrointestinal bleeding may also cause vomiting of fresh blood or dark material resembling coffee grounds.

Black, tar-like stools should be medically assessed promptly, particularly when accompanied by dizziness, weakness, breathlessness or abdominal pain.

When should rectal bleeding be assessed?

A small amount of bleeding on a single occasion does not always indicate a serious condition. Nevertheless, medical assessment is advisable when the bleeding:

Persists or repeatedly returns
Is increasing in frequency or amount
Is mixed within the stool
Occurs without an obvious explanation
Continues despite measures taken to manage suspected piles
Is accompanied by a persistent change in bowel habits
Occurs with abdominal pain, diarrhoea or mucus
Is accompanied by unexplained weight loss
Occurs with unusual fatigue, breathlessness or symptoms of anaemia
Develops in someone with a personal or family history of colorectal polyps, inflammatory bowel disease or colorectal cancer

Rectal bleeding should also be assessed when its pattern changes, even if haemorrhoids have previously been diagnosed. The presence of piles does not exclude another source of bleeding.

When is rectal bleeding an emergency?

Seek emergency medical attention if the bleeding is heavy, continuous or accompanied by symptoms suggesting significant blood loss.

Warning signs include:

Bleeding that does not stop
A large amount of blood or toilet water turning red
Passage of large blood clots
Dizziness, fainting or difficulty remaining upright
Pale, cold or clammy skin
A rapid heartbeat or difficulty breathing
Severe or rapidly worsening abdominal or anal pain
Black, tar-like stools accompanied by weakness or feeling unwell
Vomiting blood or material resembling coffee grounds

How is rectal bleeding investigated?

An assessment for rectal bleeding is not only intended to confirm whether haemorrhoids are present. It also helps determine whether the bleeding could be coming from another part of the anus, rectum or digestive tract.

The assessment usually begins with a discussion about your symptoms. Dr Aaron Poh may ask:

When the bleeding began and how often it occurs
Whether the blood is bright red, dark red or black
Whether it appears on toilet paper, coats the stool or is mixed within it
Whether you have pain, itching, swelling or prolapse
Whether your bowel habits have recently changed
Whether you have experienced abdominal pain, weight loss or unusual fatigue
Which medicines you take, particularly blood thinners and anti-inflammatory medicines
Whether you have a personal or family history of polyps, inflammatory bowel disease or colorectal cancer

A physical examination may then be performed. This can include inspecting the area around the anus for external haemorrhoids, fissures, swelling or other abnormalities. A digital rectal examination may also be used to check the lower rectum for blood, lumps or other changes.

If internal haemorrhoids are suspected

If internal haemorrhoids are suspected, an anoscopy or proctoscopy may be performed. These examinations use a short instrument to allow the doctor to inspect the anal canal and lower rectum more closely.

Further investigations may be recommended when the source of bleeding is uncertain or when the symptoms suggest another bowel condition. These can include:

Blood tests to check for anaemia or evidence of significant blood loss
Stool tests to detect small amounts of blood that may not be visible
Flexible sigmoidoscopy to examine the rectum and lower colon
Colonoscopy to examine the entire colon and rectum
Gastroscopy when bleeding may be coming from the stomach or upper digestive tract
Imaging tests in selected cases of active, substantial or unexplained bleeding

Not everyone with rectal bleeding requires a colonoscopy. The investigations recommended will depend on the pattern of bleeding, accompanying symptoms, examination findings and individual risk factors.

Summary

Seeing blood after a bowel movement can be worrying. Although piles are a common cause, rectal bleeding can also occur for several other reasons, and its appearance alone cannot confirm what is causing it.

If the bleeding keeps returning, changes in pattern or occurs with other bowel symptoms, it is worth getting checked rather than continuing to assume it is piles.

At Alpine Surgical Practice, Dr Aaron Poh provides assessment for rectal bleeding, haemorrhoids and other colorectal concerns. Contact us to arrange a consultation and understand what may be causing your symptoms.

Frequently asked questions

Is bright-red rectal bleeding always caused by piles?

No. Piles commonly cause bright-red bleeding, but anal fissures, colorectal polyps and other bowel conditions can produce a similar appearance. The colour of the blood cannot confirm the cause by itself.

Can haemorrhoids bleed without causing pain?

Yes. Internal haemorrhoids often cause painless bright-red bleeding because they develop in an area with fewer pain-sensitive nerves. Pain is more likely when haemorrhoids prolapse, become trapped or involve the sensitive skin around the anus.

Can haemorrhoids and another bowel condition occur at the same time?

Yes. The presence of haemorrhoids does not exclude polyps, inflammation or another source of bleeding. Further investigation may be recommended when the bleeding pattern or accompanying symptoms cannot be fully explained by haemorrhoids.

Will everyone with rectal bleeding need a colonoscopy?

No. The need for a colonoscopy depends on factors such as the appearance and duration of the bleeding, accompanying symptoms, examination findings and personal or family history.

Can a FIT test confirm that the bleeding is caused by piles?

No. A faecal immunochemical test can detect blood in the stool, but it cannot identify haemorrhoids or determine exactly where the bleeding originated. Further assessment may be required to establish the cause.

Should rectal bleeding be assessed if it stops on its own?

A small, isolated episode may sometimes settle without treatment. However, you should seek medical advice if the bleeding returns, increases, has no clear explanation or occurs alongside changes in bowel habits, abdominal symptoms, weight loss or unusual fatigue.

When should I seek emergency help for rectal bleeding?

Seek emergency medical attention if the bleeding is heavy or continuous, the toilet water turns red, you pass large blood clots or you experience dizziness, fainting, breathlessness, confusion or severe pain.

What Happens After a Positive FIT Test? A Step-by-Step Guide

The Faecal Immunochemical Test (FIT) is a commonly used screening test for colorectal cancer that detects small amounts of hidden blood in the stool. It is often recommended as a routine screening method because it is simple, non-invasive and can be done at home. When the test detects blood in the stool, the result is reported as positive. For many people, receiving a positive FIT result can be worrying and may immediately raise concerns about colorectal cancer.

However, a positive FIT test does not necessarily mean cancer is present. Blood in the stool can occur for several reasons, including benign conditions such as haemorrhoids, inflammation, or non-cancerous polyps in the colon. The result simply indicates that further investigation is needed to determine the cause.

Understanding what happens after a positive FIT test can help reduce anxiety and allow individuals to take the appropriate next steps. Prompt follow-up testing, usually with a colonoscopy, helps doctors identify the source of bleeding and detect any potential problems at an early and treatable stage.

Why early screening matters

Many people assume they only need to be screened if they notice blood in their stool or develop bowel symptoms. However, colorectal cancer often causes few or no symptoms in its early stages. While blood in the stool can sometimes occur with colorectal cancer, it may also be caused by benign conditions such as haemorrhoids or polyps. Regular colorectal cancer screening aims to detect precancerous polyps or early-stage cancers before symptoms develop, when treatment is generally more effective and outcomes are better.

For individuals at average risk, colorectal cancer screening is generally recommended from age 50. People with a family history of colorectal cancer or other risk factors may need to begin screening earlier based on their doctor's recommendation.

Faecal Immunochemical Test (FIT) Singapore — The Faecal Immunochemical Test (FIT) is a stool-based screening test that detects hidden blood in the stool to help identify possible signs of colorectal cancer or colon polyps.

What does a positive FIT Test mean?

A positive FIT test means that the test has detected traces of blood in the stool sample [2]. The Faecal Immunochemical Test is designed to identify hidden blood that may not be visible to the naked eye. This blood can sometimes come from abnormalities in the colon or rectum, including polyps, inflammation or colorectal cancer.

However, a positive result does not confirm that cancer is present. The FIT test only indicates that blood has been detected and further investigation is needed to determine the source [3]. In many cases, the cause may be non-cancerous conditions such as haemorrhoids or benign polyps.

Does a positive FIT Test always mean cancer?

A positive FIT test does not necessarily mean that a person has colorectal cancer. The test simply detects hidden blood in the stool, and this blood can come from several different conditions, many of which are not cancerous. In fact, a significant number of people with a positive FIT result are later found to have benign causes of bleeding.

Blood in the stool may occur due to conditions such as haemorrhoids, inflammation of the colon or small tears in the lining of the rectum. Non-cancerous polyps in the colon can also bleed and trigger a positive FIT result. While some polyps have the potential to develop into cancer over time, many can be removed safely during further evaluation.

Because the FIT test cannot determine the exact cause of bleeding, a follow-up colonoscopy is usually recommended [4]. This procedure allows doctors to examine the colon directly and identify whether the bleeding is related to polyps, inflammation or other conditions that may require treatment.

Why blood can appear in stool

The FIT test detects small amounts of hidden blood in the stool, which may come from different sources within the digestive tract. While bleeding can sometimes be linked to colorectal cancer, it may also occur due to a range of non-cancerous conditions. Identifying the underlying cause requires further evaluation, often with a colonoscopy.

Haemorrhoids

Yes, haemorrhoids can sometimes cause a positive FIT test [5]. Haemorrhoids are swollen blood vessels in the rectum or anus that may bleed during bowel movements. Even small amounts of bleeding may be detected by the FIT test. Although haemorrhoids are common and usually harmless, doctors still recommend further investigation to rule out other possible causes.

Colon polyps

Colon polyps are growths that develop on the lining of the colon. Some polyps may bleed slightly, which can trigger a positive FIT test result [6]. While many polyps are benign, certain types can develop into colorectal cancer over time. Detecting and removing polyps early is an important step in preventing cancer.

Inflammation and other conditions

Yes, inflammation in the colon can also lead to blood in the stool. Conditions such as colitis, infections, or inflammatory bowel diseases may cause irritation and bleeding in the digestive tract. These conditions are usually treatable, but proper diagnosis is important to determine the most appropriate management.

What is the next step after a Positive FIT Test?

A positive FIT test result indicates that blood has been detected in the stool, but it does not identify the exact cause. Because of this, further evaluation is necessary to determine where the bleeding is coming from and whether any abnormalities are present in the colon. Acting promptly after a positive result helps ensure that potential problems are detected and treated early.

The next steps after a positive FIT test usually include:

Consultation with a doctor to review the test result, symptoms and medical history
Recommendation for a colonoscopy to directly examine the colon and identify the source of bleeding
Bowel preparation before the procedure to ensure the colon is clear for accurate examination
Removal or biopsy of any polyps or abnormal tissue found during colonoscopy
Laboratory analysis of collected tissue samples if a biopsy is performed
Follow-up discussion of the results and recommendations for further management or screening if needed.

Why is colonoscopy recommended after a positive FIT Test?

A colonoscopy is usually recommended after a positive FIT test because it allows doctors to directly examine the inside of the colon and identify the source of bleeding [7]. While the FIT test can detect hidden blood in the stool, it cannot determine where the blood is coming from or what condition is causing it.

During a colonoscopy, a thin flexible tube with a camera is used to carefully inspect the lining of the colon and rectum. This enables doctors to detect polyps, inflammation or other abnormalities that may be responsible for the bleeding. If polyps are found, they can often be removed during the same procedure and sent for further analysis.

Colonoscopy is considered the most reliable follow-up test after a positive FIT result because it provides a detailed view of the colon and allows both diagnosis and treatment in a single examination. This helps ensure that any potential problems are identified and managed as early as possible.

Colonoscopy Singapore — Colonoscopy is recommended after a positive FIT test to examine the colon directly and identify the source of bleeding.

What to expect in the follow-up colonoscopy

A follow-up colonoscopy is performed to examine the lining of the colon and rectum and determine the source of bleeding detected in the FIT test. Before the procedure, patients are required to undergo bowel preparation, which involves following a special diet and taking prescribed laxatives to clear the colon.

During the colonoscopy, a thin flexible tube with a small camera is gently inserted through the rectum and advanced through the colon. The camera transmits images to a monitor, allowing the doctor to carefully inspect the intestinal lining for polyps, inflammation or other abnormalities. Patients are typically given sedation to ensure comfort throughout the procedure.

If polyps or abnormal tissue are found, they can often be removed or biopsied during the same procedure. The collected samples are then sent to a laboratory for further analysis, helping doctors determine the appropriate next steps in management or treatment.

What can a colonoscopy detect?

A positive FIT test indicates that blood has been detected in the stool, but it does not identify the exact cause of the bleeding. A follow-up colonoscopy helps doctors examine the colon more closely to determine the underlying condition. In many cases, the cause may be benign, although screening is important to rule out more serious conditions.

Colon polyps - Colon polyps are small growths that develop on the inner lining of the colon [8]. Many polyps are benign, but certain types can gradually develop into colorectal cancer if left untreated. During a colonoscopy, doctors can often remove polyps immediately, which helps reduce the risk of cancer developing later.

Colorectal cancer - In some cases, a positive FIT test may indicate colorectal cancer. Detecting cancer through screening allows it to be identified at an earlier stage, when treatment is generally more effective. Colonoscopy enables doctors to confirm the diagnosis and assess the location and extent of the disease.

Benign causes of bleeding - Blood detected by a FIT test can also come from non-cancerous conditions [9]. Common benign causes include haemorrhoids, inflammation of the colon or small tears in the lining of the rectum. While these conditions are usually less serious, proper evaluation is still important to confirm the diagnosis and guide appropriate treatment.

What happens if my doctor finds polyps?

If polyps or abnormal tissue are found during colonoscopy, doctors can often remove them during the same procedure. This process, known as polypectomy, helps prevent certain polyps from developing into colorectal cancer [10]. The removed tissue is usually sent to a laboratory for examination to determine the type of polyp and whether any cancerous or precancerous changes are present.

If other abnormalities such as inflammation, ulcers or suspicious growths are detected, the doctor may take small tissue samples (biopsies) for further analysis. The results help guide the next steps in management, which may include monitoring, additional treatment or referral to a specialist if necessary. Early detection and treatment significantly improve outcomes.

What if the colonoscopy is normal?

In some cases, a colonoscopy performed after a positive FIT test may not find any abnormalities in the colon. This can happen if the bleeding detected by the FIT test was caused by a minor or temporary condition that has resolved or if the blood originated from another benign source.

When colonoscopy results are normal, the doctor will usually advise returning to routine colorectal cancer screening at the recommended interval based on the individual’s age and risk factors. A normal colonoscopy is reassuring, but regular screening remains important to detect any future changes in the colon.

Summary

A positive FIT test can understandably cause concern, but it is important to remember that the result does not automatically mean colorectal cancer is present. The test simply detects hidden blood in the stool, which can occur for several different reasons, including benign conditions such as haemorrhoids, inflammation or colon polyps. Because the FIT test cannot determine the exact source of bleeding, a follow-up colonoscopy is usually recommended to examine the colon more closely.

Colonoscopy allows doctors to identify the cause of bleeding and detect conditions such as polyps, inflammation or colorectal cancer. In many cases, polyps can be removed during the same procedure, which helps prevent them from developing into cancer. Even when the colonoscopy does not reveal any abnormalities, the examination provides reassurance and helps guide future screening recommendations.

Prompt follow-up after a positive FIT result plays an important role in early detection and prevention of colorectal cancer. If you have received a positive FIT test result or are concerned about colorectal cancer screening, schedule a consultation with Dr Aaron Poh for a comprehensive evaluation and personalised advice on the most appropriate next steps.

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Colonoscopy in singapore – procedure & benefits | alpine surgical. Alpine Surgical Practice | Colorectal Surgeon | Lipoma Removal | Colonoscopy. Retrieved March 6, 2026, from https://alpinesurgical.sg/procedure/colonoscopy-singapore/
Fit testing for patients | north bristol nhs trust. Retrieved March 6, 2026, from https://www.nbt.nhs.uk/severn-pathology/pathology-services/clinical-biochemistry/fit-testing/fit-testing-patients
Understanding your results. Retrieved March 6, 2026, from https://www.bccancer.bc.ca:443/screening/colon/how-it-works/understanding-your-results
Screening tests to detect colorectal cancer and polyps—Nci. (2024, November 1). [cgvArticle]. https://www.cancer.gov/types/colorectal/screening-fact-sheet
Colonic & rectal polyps singapore—Symptoms & treatment. Alpine Surgical Practice | Colorectal Surgeon | Lipoma Removal | Colonoscopy. Retrieved March 6, 2026, from https://alpinesurgical.sg/conditions/colonic-rectal-polyps/
Bowel cancer screening. (2017, October 20). Nhs.Uk. https://www.nhs.uk/tests-and-treatments/bowel-cancer-screening/
Fyock, C. J., & Draganov, P. V. (2010). Colonoscopic polypectomy and associated techniques. World Journal of Gastroenterology : WJG, 16(29), 3630–3637. https://doi.org/10.3748/wjg.v16.i29.3630

Gastroscopy vs Colonoscopy Procedure in Singapore – What’s the Difference?

Gastrointestinal (GI) health is vital because it supports nutrient absorption, immune function, hormone regulation, and even mental well-being. However, many people overlook symptoms of GI problems like persistent stomach pain, bloating, or irregular bowel habits. While these symptoms are often harmless, they can signal more serious conditions. In Singapore, gastrointestinal issues like gastritis, acid reflux, irritable bowel syndrome (IBS), and colorectal cancer are becoming more and more common [1], particularly among the ageing population.

Early detection of gastrointestinal disorders is crucial, as it allows for timely treatment that can relieve symptoms and help prevent the progression of serious conditions like colorectal cancer. Gastroscopy and colonoscopy are two of the most common procedures used to detect GI issues. Although both endoscopic exams, they target different parts of the digestive system and serve different diagnostic purposes. Understanding the differences can help patients better prepare and make informed decisions about their symptoms.

Keep reading to learn more about the differences between gastroscopy and colonoscopy and the purposes of each.

What is a Gastroscopy?

Gastroscopy, also called upper endoscopy, is a diagnostic procedure that examines the upper part of the digestive tract. This includes the oesophagus, stomach, and duodenum. A gastroscopy diagnoses various conditions that affect this part of the body. These include:

Gastroesophageal Reflux Disease (GERD)
GERD occurs when stomach acid flows back into the oesophagus, causing symptoms like heartburn, chest discomfort, and regurgitation. Over time, it can damage the lining of the esophagus.
Gastric ulcers
Open sores that develop on the inner lining of the stomach. They can cause stomach pain, bloating, and bleeding, and may be often triggered by infections (like H. pylori) or long-term use of certain medications. They often cause symptoms such as abdominal pain, indigestion, loss of appetite, nausea, and vomiting.
Chronic gastritis
Long-term inflammation of the stomach lining can result from infections, autoimmune conditions, or prolonged irritant exposure. It may cause nausea, indigestion, and stomach discomfort.
Helicobacter pylori Infection (H. pylori)
A type of bacterial infection on the stomach lining that is a major cause of ulcers and gastritis. It’s typically diagnosed via biopsy during a gastroscopy. Symptoms include upper abdominal pain, nausea, vomiting, burping, bloating, loss of appetite, or weight loss.
Stomach Cancer
Stomach (gastric) cancer in its early stages may not show obvious symptoms but can be detected during a gastroscopy through abnormal tissue growth or biopsy, improving the chances of successful treatment.

What happens during a gastroscopy?

During a gastroscopy procedure, a flexible tube with a tiny camera (endoscope) is gently inserted through the mouth and down the throat. This tube has a small camera at its tip that sends live video to a monitor, allowing the doctor to detect abnormalities such as ulcers, inflammation, bleeding, or tumours.

Before the procedure, patients are usually required to fast for six to eight hours to ensure the stomach is empty. A local anaesthetic spray is often applied to numb the throat, and a mild sedative is usually given to help the patient stay relaxed and comfortable.

During the procedure, the patient lies on their side while the doctor carefully inserts the endoscope through the mouth and throat into the stomach. If necessary, your doctor can also collect tissue samples (biopsies) for further testing.

The entire process typically takes about fifteen to twenty minutes. Afterwards, the patient is observed until the effects of the sedative wear off. Some people may experience a sore throat or mild bloating, but these symptoms usually resolve quickly. Most individuals can resume normal eating and drinking within a few hours and go home the same day if there are no complications.

What is a colonoscopy?

A colonoscopy is a medical procedure used to examine the inside of the colon (large intestine) and rectum. It involves the use of a long and flexible tube called a colonoscope, which has a camera and light at its tip. This allows the doctor to view the inner lining of the colon and identify any abnormalities such as polyps, tumours, or signs of inflammation.

A colonoscopy is typically performed to diagnose or rule out various gastrointestinal conditions, including:

Colon polyps

Abnormal growths on the colon lining that can potentially develop into cancer if left untreated.

Colorectal cancer

Cancer that begins in the colon or rectum, often diagnosed through the identification of tumours or other abnormal growths.

Diverticulosis

The presence of small pouches in the colon wall, which may become inflamed or infected, and lead to diverticulitis.

Inflammatory Bowel Disease (IBD)

A group of inflammatory conditions that affect the colon and small intestine, with Crohn's disease and ulcerative colitis being the most common types.

Bleeding

A colonoscopy can identify the source of gastrointestinal bleeding that could be due to ulcers, haemorrhoids, or other issues.

What happens during a colonoscopy?

During a colonoscopy procedure, the patient lies on their side, and the colonoscope is gently inserted through the rectum and guided into the colon. The patient will be under mild sedation to ensure comfort during the procedure. The camera at the end of the scope sends live images to a monitor, allowing the doctor to closely inspect the colon. If necessary, the doctor may take biopsy samples or remove polyps for further examination. The entire procedure usually takes between thirty to sixty minutes.

Preparation for a colonoscopy is an important aspect of the procedure to ensure the best results. A few days before the procedure, you will be instructed to follow a special diet that mainly consists of clear liquids while avoiding solid foods. You will also need to take laxatives the day before to thoroughly empty your colon. On the day of the procedure, you will be asked to fast and refrain from eating or drinking for several hours. This helps to ensure the colon is clear and provides the doctor with the best possible view of your colon during the examination.

Key Differences Between Gastroscopy and Colonoscopy

Gastroscopy and colonoscopy are both essential procedures for diagnosing gastrointestinal conditions, but they focus on different parts of the digestive system and are used to identify distinct health issues. Understanding the differences between these two procedures can help patients make informed decisions about which procedure may be right for their symptoms.

Here are the key differences between the two procedures:

Target area:

A gastroscopy focuses on the upper gastrointestinal (GI) tract, which includes the oesophagus, stomach, and the duodenum (the upper part of the small intestine). A colonoscopy, on the other hand, targets the lower gastrointestinal (GI) tract, specifically the colon (large intestine) and rectum.

Preparation before procedure:

Preparation for both procedures differs significantly. For a gastroscopy, patients typically need to fast for six to eight hours before the procedure to ensure the stomach is empty. In contrast, preparing for a colonoscopy requires more steps, including following a clear liquid diet for a few days before the procedure and taking laxatives to thoroughly empty the colon.

Used for diagnosing and treating different diseases:

A gastroscopy is commonly used to diagnose and treat conditions affecting the upper GI tract, such as acid reflux (GERD), gastric ulcers, chronic gastritis, and in some cases, early-stage stomach cancer. A colonoscopy, however, is used to investigate the lower GI tract for conditions like colon polyps, colorectal cancer, inflammatory bowel disease (IBD), and to explore causes of gastrointestinal bleeding or persistent changes in bowel habits.

Procedure length and recovery time:

A gastroscopy typically takes around ten totwelve twenty minutes, and recovery is relatively quick. Most patients experience only minor discomfort, like a sore throat or bloating, which usually resolves soon after the procedure. In comparison, a colonoscopy is slightly longer, usually taking between fifteen to twentythirty to sixty minutes, with a longer recovery period. After the procedure, some people may experience gas or bloating. Patients may also feel drowsy and require more time to fully recover from the effects of the sedative.

When Do You Need Each Procedure?

Knowing when to seek either a gastroscopy or colonoscopy is crucial for early diagnosis and effective treatment of gastrointestinal conditions. While only a doctor or gastrointestinal specialist can determine whether you need one of these procedures, understanding the key symptoms and risk factors associated with each procedure can help you take the next step, such as booking an appointment if required.

Symptoms that may require a gastroscopy:
A gastroscopy is typically recommended if you are experiencing symptoms related to the upper gastrointestinal (GI) tract, such as:

Chronic heartburn or acid reflux that doesn't improve with medication.
Persistent nausea or vomiting.
Difficulty swallowing or feeling like food is getting stuck in your throat.
Unexplained weight loss.
Upper abdominal pain that doesn’t improve.
Blood in vomit or black stools which may indicate internal bleeding.
Chronic bloating or indigestion.
Potential signs of stomach cancer or a family history of the disease.

Symptoms that may require a colonoscopy:

A colonoscopy is generally recommended for symptoms affecting the lower GI tract, such as:

Chronic diarrhoea or constipation.
Blood in stool or rectal bleeding
Persistent abdominal pain or cramping.
Unexplained weight loss.
Iron-deficiency anemia
Change in bowel habits, such as persistent constipation or diarrhoea.
Screening for colorectal cancer, especially if you have a family history or belong to a high-risk group.

Existing conditions:
If you have existing conditions like gastroesophageal reflux disease (GERD), gastric ulcers, or inflammatory bowel disease (IBD), your doctor may recommend a gastroscopy or colonoscopy based on your symptoms or to monitor the progression of the condition. For example, a colonoscopy is often used for ongoing management of Crohn’s disease or ulcerative colitis.

Risk factors:
Certain risk factors may increase your likelihood of needing either procedure. Those with a family history of colon cancer, stomach cancer, or inflammatory bowel disease are often advised to undergo screenings. If you are over the age of 50, regular colonoscopy screenings are recommended, even without symptoms, to detect colorectal cancer early. For gastroscopy, risk factors like heavy alcohol consumption, smoking, or prolonged use of certain medications may also increase the need for examination of the upper GI tract.

Screening guidelines in Singapore:
In Singapore, colorectal cancer screening is recommended for individuals aged 50 and above who are at average risk. The Ministry of Health advises [2] regular colonoscopy screenings every ten years for those in this age group. If you have higher risk factors, such as a family history of colorectal cancer, screenings may begin earlier or be done more frequently. Gastroscopy is not part of standard screening guidelines, but may be recommended based on symptoms or family history of stomach cancer.

Understanding these guidelines and symptoms will help you know when to consult a doctor for either procedure, ensuring timely diagnosis and treatment. In some cases, both gastroscopy and colonoscopy can be performed simultaneously, depending on your doctor’s advice. This approach can be particularly beneficial for patients with symptoms that involve both the upper and lower GI tracts, reducing the need for multiple appointments and providing a more comprehensive examination in one session.

If you're experiencing gastrointestinal symptoms or need a screening, don’t wait. At Alpine Surgical, our experienced specialists are here to guide you through the process of gastroscopy or colonoscopy, while tailoring personalised treatment plans depending on the outcome of the procedure. We also offer screening packages to help detect gastrointestinal conditions like colorectal cancer and gastritis early. Contact us now to schedule a consultation.

What to Expect After the Procedure

After a gastroscopy, most patients can resume normal activities within a few hours, although some mild discomfort, such as a sore throat or bloating, may persist temporarily. For a colonoscopy, the recovery time may be slightly longer, with patients potentially experiencing mild cramping or bloating. It’s important to follow the post-procedure care instructions provided by your doctor to ensure a smooth recovery.

Both procedures are generally safe, but like any medical procedure, they come with certain risks. Potential complications include bleeding and infection, which are rare. If you experience any unusual symptoms after the procedure, such as severe pain, fever, or persistent bleeding, it is important to contact your doctor immediately.

Your doctor will discuss the results with you after the procedure. In some cases, further treatment may be necessary depending on the findings. For example, if polyps are discovered during a colonoscopy, they may be removed and sent for biopsy. Your doctor will also recommend follow-up care to ensure your condition is properly managed and monitored over time.

How Much Do These Procedures Cost in Singapore?

The cost of gastroscopy and colonoscopy procedures in Singapore can vary based on factors such as the doctor and the specific type of procedure. Typically, the cost ranges from SGD 800 to SGD 2,500 for a gastroscopy, and SGD 1,200 to SGD 3,000 for a colonoscopy. Take note that additional tests or treatments may increase the overall cost.

For Singaporean citizens and permanent residents, Medisave can help cover part of the costs for both procedures. Private insurance coverage may also assist in reducing expenses, but the extent of this coverage will vary depending on the policy. It is advisable to contact your insurer ahead of time to understand the coverage limits.

Choosing the Right Specialist or Clinic in Singapore

When selecting a gastrointestinal specialist or clinic for your gastroscopy or colonoscopy, there are several key factors to consider. First, ensure that the specialist has the appropriate qualifications and experience. Look for doctors with recognised credentials and significant experience in performing gastrointestinal procedures. A comfortable and well-maintained facility will also contribute to a positive experience.

When you’ve scheduled a consultation with a gastrointestinal specialist, consider asking important questions such as:

What is your experience with performing gastroscopies/colonoscopies?
Are there any risks or complications I should be aware of?
How long will the recovery process take?
When will I receive my results?

Conclusion

Understanding the key differences between gastroscopy and colonoscopy can help you make informed decisions about your gastrointestinal health. Early detection and regular screenings are important for preventing serious conditions like cancer. Symptoms such as abdominal pain, bloating, vomiting, indigestion, and others associated with gastrointestinal issues can be debilitating and affect your quality of life.

If you're experiencing symptoms or are at risk for gastrointestinal diseases, it's crucial to consult with a gastrointestinal specialist and undergo either a gastroscopy or colonoscopy to find out the root cause. These procedures can help identify underlying conditions, alleviate discomfort, give you peace of mind, and prevent the progression of more serious health issues, while ensuring your digestive system remains in good condition.

Frequently Asked Questions

Are gastroscopy and colonoscopy procedures painful?

Neither of these procedures is typically painful as sedation is commonly used to keep patients comfortable. You may feel side effects such as mild bloating or cramping afterward, but pain is rare.

How long after an endoscopy or colonoscopy can I eat?

You should be able to eat like you normally do within 24 hours, but check with your doctor for specific instructions.

Can endoscopy remove tumours?

Yes, endoscopy can be used to remove certain types of tumours, particularly if they are small and found early.

Why do people avoid colonoscopies?

Many people avoid colonoscopies due to fear of discomfort, embarrassment, or the bowel prep, but modern techniques make the procedure safe, quick, and usually painless.

References

Siah, K. T., Wong, R. K., Chan, Y. H., Ho, K. Y., & Gwee, K. A. (2016). Prevalence of Irritable Bowel Syndrome in Singapore and Its Association with Dietary, Lifestyle, and Environmental Factors. Journal of neurogastroenterology and motility, 22(4), 670–676. Retrieved from: https://doi.org/10.5056/jnm15148
Ministry of Health Singapore. (n.d.). Colorectal cancer screening. Retrieved from https://www.moh.gov.sg/newsroom/crc-screening

A Complete Guide to Hernia Surgery in Singapore: What should I look out for?

A hernia is a common medical condition that occurs when an internal organ or tissue protrudes through a weak spot in the muscle or surrounding tissue wall. Types include inguinal (groin), femoral (upper thigh), umbilical (belly button), and incisional (at the site of a previous surgical incision) hernias. Hernias are common [1] among men and women in Singapore.

Hernias can develop due to various factors including heavy lifting, chronic coughing, obesity, and pregnancy. If left untreated, hernias can lead to severe complications such as obstruction and strangulation which can be fatal. Keep reading to find out what you should do if you or a loved one has a suspected hernia.

A hernia occurs when there is a visible bulge in the abdomen or groin, commonly caused by weakened muscles that allow the internal tissues to protrude.

The Need for Hernia Surgery

Surgery is often recommended when the hernia causes symptoms or if there is a risk of complications. There is no medication treatment for hernias. Delaying treatment can lead to incarceration, where the herniated tissue becomes trapped, or strangulation [2] when the blood supply to the trapped tissue is cut off.

If you are unsure if you’ll need hernia surgery, be aware of the common signs and symptoms that your condition is worsening.

Symptoms to look out for include:

A noticeable bulge or lump in the abdomen or groin that may flatten when lying down
Pain or discomfort especially when coughing, lifting, or bending over
Experiencing pressure or a heavy sensation in the affected area
Having mild to moderate pain around the bulge.
Swelling and tenderness in the groin or abdominal region
Worsening discomfort that increases with physical exertion

Severe symptoms that require immediate medical attention include:

Sudden, severe pain.
Redness or discolouration over the bulge.
Nausea and vomiting.
Inability to push the hernia back in (incarceration).
Fever (may indicate a strangulated hernia).

Risk Factors and Causes of Hernia

Why do hernias develop? Hernias form when an organ or tissue pushes through a weak spot in the muscle or connective tissue. This weakness may be present from birth or develop over time due to strain and pressure on the abdominal wall.

Common causes and risk factors include:

Increased abdominal pressure: This may occur when lifting heavy objects incorrectly, straining during bowel movements due to chronic constipation, or persistent coughing or sneezing (due to smoking, allergies, or lung disease).
Muscle weakness: Often due to ageing and natural wear on muscles, previous abdominal surgeries (risk of incisional hernias), or congenital conditions (patent processes vaginalis).
Lifestyle factors: Obesity (excess weight increases strain on muscles), pregnancy (increased pressure on abdominal muscles, poor diet (reduces muscle and tissue strength), lack of exercise (weakened core muscles).
Genetics and family history: Some people are born with weaker connective tissues, increasing their risk of hernias.

Types of Hernia Surgery

Hernia surgery can be performed [3] using two primary methods: open surgery and laparoscopic (keyhole) surgery. The choice of procedure depends on factors such as the size and location of the hernia, your overall health, and your surgeon’s recommendation.

Open Hernia Surgery

In open hernia surgery, a single incision is made over the hernia site to access the affected area. The protruding tissue is carefully pushed back into place, and the weakened muscle is reinforced with sutures, often with the addition of a mesh[4] for extra support. Once the repair is complete, the incision is closed using stitches or surgical glue to promote proper healing.

This is a suitable option for one sided inguinal hernias and large or complex hernias and is generally more affordable than laparoscopic surgery. Post surgery recovery time is usually a week and post-operative pain can be controlled with oral painkillers

Laparoscopic (Keyhole) Hernia Surgery

Laparoscopic hernia surgery involves making several small incisions instead of a single large cut. A tiny camera (laparoscope) is inserted to provide a clear view of the hernia so that the surgeon can repair it using specialised surgical tools. The displaced tissue is gently repositioned, and the weakened muscle is strengthened with sutures, often supplemented with a mesh for added support. Once the procedure is complete, the incisions are closed with sutures or surgical glue.

This minimally invasive approach offers some advantages, namely a slightly faster recovery time (compared to open surgery), slightly less post-surgical pain, reduced scarring, and a lower risk of infection. It is particularly beneficial for patients with recurrent or bilateral hernias. However, laparoscopic surgery may be more expensive than open surgery in some cases. It also may not be suitable for very large or complex hernias.

A surgical mesh used during hernia surgery is designed to provide support while the body heals.

Choosing the Right Surgery for Hernia

The best surgical approach depends on several factors:

Hernia type and size: Larger or more complex hernias may require open surgery or a planned laparoscopic surgery
Health condition: Patients with certain medical conditions may not be able to undergo general anaesthesia.
Recovery time: Laparoscopic surgery generally allows for a quicker return to daily activities.
Cost considerations: Open surgery is typically more affordable than laparoscopic surgery.

Choosing the Right Surgeon and Clinic in Singapore for Hernia Surgery

Selecting the right surgeon and clinic is crucial for ensuring a successful hernia repair and a smooth recovery. A highly experienced and accredited surgeon that specialises in hernia repair procedures offers the most effective treatment options, whether through open surgery or laparoscopic techniques.

In Singapore, hernia repair procedures are widely available, with laparoscopic surgery being the common choice due to its minimally invasive nature and shorter recovery time. However, open surgery is still performed for larger or more complex hernias. Patients should also ensure that their chosen clinic is well-equipped with modern surgical facilities and provides comprehensive post-operative care.

At Alpine Surgical Practice in Singapore, we specialise in hernia repair procedures to offer safe, effective, and minimally invasive treatments for a quicker recovery. Our experienced and accredited surgeons provide personalised care tailored to each patient's needs, ensuring comprehensive support from diagnosis to post-surgery recovery. Schedule a consultation today at Alpine Surgical Practice.

*Several types of hernias occur due to various factors. Consult a doctor if you suspect you have one of th*ese.

Cost Considerations for Hernia Surgery in Singapore

The cost of hernia surgery in Singapore varies depending on the type of procedure and the complexity of the condition. Laparoscopic hernia repair is generally more expensive than open surgery, as it requires specialised equipment and expertise. On average, the cost of hernia surgery ranges from SGD 8,000 to SGD 15,000.

Insurance and subsidy options can significantly reduce expenses. You should check your health insurance policies to determine coverage for hernia surgery, including consultation fees, surgical costs, and hospital stays. Singapore residents may also be able to use MediSave [5] and MediShield Life [6] to help offset expenses, depending on the eligibility criteria.

Preparing for Hernia Surgery

If you’re expecting to undergo surgery for a hernia, don’t fret as proper preparation before hernia surgery usually ensures a smooth recovery. You are typically required to undergo pre-operative assessments, including blood tests, imaging scans, and a medical review to assess your overall health and be sure that you’re a suitable candidate for surgery. It is important to inform your surgeon of any existing medical conditions or medications being taken, as some may need to be adjusted before surgery.

Patients should also follow pre-surgery precautions, such as fasting before the procedure and avoiding certain medications that could increase bleeding risk. Maintaining a healthy lifestyle before surgery can also aid in recovery. Speak to your surgeon if you have any questions or concerns about surgery.

Post-Surgery Recovery

The recovery timeline depends on the type of hernia surgery performed. Laparoscopic surgery typically allows for a faster recovery of about one to two weeks, while open surgery may require four to six weeks for complete healing. In the first few days after surgery, patients may experience mild discomfort, swelling, or bruising, which can be managed with prescribed pain medication.

To minimise complications, patients should follow post-surgery care instructions carefully. It is recommended to avoid strenuous activities, heavy lifting, and intense physical exercise for a few weeks. Other recommendations include wearing supportive garments and following a high-fiber diet with adequate hydration to prevent constipation, which can strain the surgical site. You should also make sure you attend follow-up appointments with your surgeon to monitor progress and address any concerns.

Conclusion

Timely treatment for a hernia is essential to prevent serious and life-threatening complications such as strangulation or obstruction. Consulting an experienced surgeon ensures that patients receive the most appropriate treatment for their condition, leading to better outcomes and improved quality of life.

Hernia surgery, whether open or laparoscopic, is a safe and effective procedure with high success rates. Taking a proactive approach by taking note of your symptoms, seeking specialist advice, and understanding the available treatment options can make a significant difference in recovery. With personalised care and medical guidance, you can achieve a smooth healing process and return to your daily activities with minimal disruption.

Frequently Asked Questions

Is hernia surgery considered a major surgery?

Hernia surgery is generally considered a routine and safe procedure, but it depends on the type of hernia, the surgical method, and the patient’s overall health.

How do I know if I need hernia surgery?

Surgery is typically recommended if the hernia is causing symptoms such as pain and discomfort, growing in size, or causing complications such as incarceration (trapped tissue) or strangulation (cut-off blood supply), which require emergency surgery.

How long does hernia surgery take?

Most hernia surgeries take 60 minutes to two hours, depending on the complexity and type of repair needed. Patients can often return home the same day for minor hernias, although some may require an overnight hospital stay.

Are there any risks or complications associated with hernia surgery?

As with any surgery, hernia repair carries risks such as infection at the surgical site, bleeding, or bruising. These risks can be minimised by following post-operative care instructions, such as avoiding strenuous activities, keeping the incision site clean, and attending follow-up appointments with the surgeon. Contact your surgeon immediately if you experience any complications or severe pain after hernia surgery.

Can a hernia come back after surgery?

Hernia recurrence is not common and may happen if post-surgery precautions are not followed, such as heavy lifting. Using a mesh reinforcement during surgery lowers the risk of recurrence.

References

Cleveland Clinic. (n.d.). Hernia. Retrieved from https://my.clevelandclinic.org/health/diseases/15757-hernia
Healthline. (n.d.). Strangulated hernia: Symptoms, causes, and treatment. Retrieved from https://www.healthline.com/health/strangulated-hernia
Olanrewaju, O. A., Saleem, A., Ansah Owusu, F., Pavani, P., Ram, R., & Varrassi, G. (2023). Contemporary Approaches to Hernia Repair: A Narrative Review in General Surgery. Cureus, 15(12), e51421. Retrieved from https://doi.org/10.7759/cureus.51421
Lopes, T. C., Coelho, J. C. U., da Costa, B. P., de Souza, G. R., & de Oliveira, J. P. (2022). Hernia surgery: Current concepts and future perspectives. Annals of Medicine and Surgery, 75, 103365. Retrieved from https://doi.org/10.1016/j.amsu.2022.103365
Ministry of Health Singapore. (n.d.). MediSave. Retrieved from https://www.moh.gov.sg/managing-expenses/schemes-and-subsidies/medisave
Ministry of Health Singapore. (n.d.). MediShield Life. Retrieved from https://www.moh.gov.sg/managing-expenses/schemes-and-subsidies/medishield-life/medishield-life

Why More and More Young People in Singapore are Being Diagnosed with Colon Cancer

Is Colon Cancer an “Old Person’s Disease”?

The recent cancer diagnosis of Catherine, the 42-year-old Princess of Wales, has highlighted the alarming global increase in certain cancers among those below the age of 50. Not only is the news a stark reminder that cancer can strike anyone regardless of age, but this phenomenon of young-onset cancer is also prevalent in Singapore. Although many types of cancer are common in Singapore, this blog article will focus solely on colon cancer, the second leading cause of death in both men and women locally.

Contrary to popular belief, colon cancer is certainly not an “old person’s disease”. In fact, gastrointestinal specialists have noticed a worrying rising trend in the number of young people, particularly millennials, being diagnosed with colon cancer in Singapore. This shift has turned colon cancer into a significant medical concern that requires immediate attention and action. The alarming increase poses serious societal implications, including elevated healthcare costs, increased emotional and financial burdens on families, and a potential decrease in workforce productivity.

Locally, we notice the problematic trend of young Singaporeans going under the radar for colon cancer screening since they have not met the age recommendation. Although the Ministry of Health Singapore (MOH) recommends routine screening for colon cancer for those from age 50 onwards, that is merely a general guideline that does not factor in other individual risk factors. This blog article will feature a more nuanced screening guideline for colon cancer.

What is Colon Cancer?

Colon cancer, which is also called bowel cancer or colorectal cancer, begins as a polyp on the inner lining of the large intestine or rectum. While the polyps start as noncancerous (benign) growths of cells, they can grow out of control and develop into colon cancer if left untreated.

Has There Been a Higher Incidence of Colon Cancer Among Young People in Singapore Lately?

According to the Singapore Cancer Society, the incidence of cancer (including colon cancer) among individuals under 50 rose by 10.4%, from 11,416 cases in the period between 2008 and 2012 to 12,600 cases in the period between 2017 and 2021. In particular, more and more millennials, those who are aged 28 to 43 in 2024, are being diagnosed with cancer. This staggering increase has prompted gastrointestinal experts to investigate the underlying causes behind the rising cases of young-onset colon cancer. At the moment, it is not fully known what has been driving this upward trend, as more conclusive research findings are yet to be found. However, we do understand the causes of colon cancer, as the research behind this is well-established.

What are the Causes of Colon Cancer?

The development of colon cancer can be attributed to a multitude of factors spanning lifestyle, environment and genetic predisposition. These changes cause cells to overproduce uncontrollably. When cells in the colon grow and divide without regulation, polyps can form, which might become cancerous if not removed.

Lifestyle Factors Contributing to Colon Cancer

Unhealthy Diets

One of the primary lifestyle factors that makes people more prone to getting colon cancer is an unhealthy diet. The modern diet, particularly in urban areas like Singapore, often includes a high intake of foods with the following nutritional properties:

High Fat and Low Fibre: Diets rich in fat and limited in fibre, namely fast food, can lead to constipation and other gastrointestinal issues. This is because fatty foods take longer to digest than other types of foods, resulting in slower bowel movements and potentially constipation. In a similar vein, inadequate consumption of vegetables can contribute to harder, more difficult-to-pass stools due to the lack of dietary fibre. Therefore, such diets may lead to prolonged contact of carcinogens with the colon lining, increasing the risk of cancer.
High Sugar: Sugary foods can lead to obesity, which is a known risk factor for many cancers, including colorectal cancer.
Preservatives and Additives: Processed foods, such as bread, cheese, and canned vegetables, may contain preservatives and additives with carcinogenic properties.

Sedentary Lifestyles

Another significant lifestyle risk factor for colon cancer is inadequate physical exercise. Many young people in Singapore spend a substantial amount of time sitting, whether at work, school, or home, often engaging in screen-based activities like watching TV, playing video games, or using computers and smartphones. Lack of exercise can lead to obesity, which is associated with a higher risk of colon cancer. Physical activity is beneficial for regulating hormone levels and enhancing immune function, both of which can reduce cancer risk.

Obesity and Metabolic Conditions

Unwholesome diets coupled with insufficient physical exercise typically lead to obesity, an important risk factor for colon cancer. Excess body weight, particularly around the abdomen, can promote cancer cell growth due to the following reasons:

Insulin Resistance: Obesity often leads to insulin resistance, where the body's cells do not respond well to insulin. This condition can cause higher levels of insulin and glucose in the blood, creating an environment that encourages cancer growth.
Chronic Inflammation: Obesity is associated with chronic inflammation, which can cause DNA damage and promote the development of cancer cells.

Stress

Additionally, a stressful lifestyle can contribute to the development of colon cancer. While the exact mechanisms are not entirely clear, chronic stress is believed to impact cancer risk through several pathways:

Immune Suppression: Chronic stress can weaken the immune system, reducing its efficacy in detecting and destroying cancer cells.
Hormonal Changes: Stress may lead to hormonal imbalances that promote the growth of cancer cells.

Environmental Factors Contributing to Colon Cancer

Carcinogens present in polluted air and food can initiate mutations that lead to cancer development.

Air Pollution: Emerging research suggests a positive association between prolonged exposure to certain air pollutants and suffering from colon cancer. While Singapore generally maintains good air quality, periods of haze can significantly increase pollution levels and pose health risks to the colon.
Industrial Chemicals: Certain chemicals used in food manufacturing and agriculture, such as pesticides and herbicides, have been linked to a heightened risk of colorectal cancer.

Hereditary Factors Contributing to Colon Cancer

Genetics play a paramount role in the risk of developing colon cancer. People with a family history of colorectal cancer are at a higher risk. Specific hereditary conditions, such as Lynch syndrome and familial adenomatous polyposis (FAP), significantly raise the likelihood of having colorectal cancer at a younger age.

Lynch Syndrome: This genetic condition, also called hereditary nonpolyposis colorectal cancer (HNPCC), increases the risk of colorectal cancer and other cancers. People with Lynch syndrome often develop cancer at a younger age.
Familial Adenomatous Polyposis (FAP): FAP is a condition that causes hundreds to thousands of polyps to form in the colon and rectum. If left untreated, these polyps are likely to become cancerous.

How Does Colon Cancer Screening Work?

Colorectal cancer screening is a critical tool in the early detection and prevention of cancer, and the process is as follows:

1. Undergo Preliminary Testing

At-risk groups, especially people 50 and older, are typically encouraged to do yearly screenings by collecting stool samples. They can opt for either a Guaiac Faecal Occult Blood Test (gFOBT) or a Faecal Immunochemical Test (FIT), which are both preliminary tests that can detect gastrointestinal abnormalities.

2. Schedule an Appointment with a Colorectal Surgeon in Singapore

Patients with positive stool test results will typically be referred to a colorectal specialist who will conduct further testing to confirm the preliminary results. Colorectal specialists are medical doctors who specialise in the diagnosis and surgical treatment of gastrointestinal disorders. Depending on your medical history and the extent of the positive FOBT result, your colorectal specialist may recommend that you go through a more sensitive test, namely a colonoscopy.

3. Follow Pre-colonoscopy Procedures, Relax During the Colonoscopy, and Follow Post-Colonoscopy Guidelines

In order to prepare for your colonoscopy, you have to adhere to some pre-colonoscopy procedures for a successful and stress-free colonoscopy.

During a colonoscopy, a long, flexible and thin tube with a miniature camera and attached light (colonoscope) is inserted into the rectum to examine the colon for polyps or cancerous growths. The minimally invasive procedure typically takes less than 15 minutes and is often performed with mild sedation to reduce discomfort.

After the colonoscopy, you need to rest for about an hour to recover from the sedative used during the procedure. Our experienced staff from Alpine Surgical Practice will monitor you to ensure that you are waking up safely and not experiencing any immediate complications.

What are the Benefits of Screening for Colon Cancer in Singapore?

As pre-cancerous polyps and early-stage colon cancer tend to be asymptomatic, at-risk groups have to attend routine screenings even if they are feeling perfectly fine. Detecting abnormalities early usually leads to an improved prognosis as preventive action like removing polyps can be done.

Early Detection: Identifying cancer early allows for less invasive treatments and a stronger likelihood of speedy recovery.
Polyp Removal: Removing polyps or other growths during a colonoscopy can prevent them from turning into cancer.

Why Do Young People Delay Colorectal Screening?

Despite the clear benefits, young people may avoid screenings due to various barriers:

Anxiety about Colonoscopy: Some may repeatedly delay attending their colonoscopy appointments due to worries that the process is painful. Rest assured, you will be sedated to minimise discomfort, and most patients report that the procedure was pain-free.
Misinterpretation of Symptoms: Symptoms such as changes in bowel habits or abdominal discomfort are often attributed to less serious conditions, such as irritable bowel syndrome, leading to delays in seeking medical advice.
Lack of Awareness: Some young adults are unaware of the importance of colorectal cancer screening and the availability of procedures like colonoscopy.

Should Young People Undergo Colonoscopies?

Colon cancer may affect younger individuals as well as older people. Despite the majority of colon cancer patients falling within the 55 to 65 age range, a significant number of cases seen by doctors today involve young adults. A 2022 study from the Hematology/Oncology Clinics of North America even projects that by 2030, roughly 15% of colon cancer cases will be diagnosed in younger adults.

Moreover, younger patients often face delayed diagnosis compared to older individuals because colorectal cancer is commonly perceived as rare in this age group. By the time most younger patients are accurately diagnosed, many are already in the advanced stages (stage 3 or 4) of cancer.

While colonoscopy is typically recommended for average-risk patients from age 50 onwards, Alpine Surgical Practice advises scheduling one if you have:

A first-degree relative with colon cancer or polyps.
Two relatives with colon cancer or polyps, regardless of degree.
A personal history of inflammatory bowel disease, namely Crohn's disease or ulcerative colitis.
A personal history of colon polyps.

According to the American Cancer Society, as many as 33 % of patients who develop colorectal cancer have family members who have also suffered from the illness.

Summary

Old age is but one of the many risk factors for the development of colon cancer. That is, those below age 50 can still be prone to cancer, especially if they have other risk factors, like a family history of colon cancer. Therefore, colon cancer is certainly not an "old person's disease".

The rising rates of colon cancer among young people in Singapore highlight the urgent need for increased awareness and proactive health management. Annual screenings, such as those available at Alpine Surgical Practice, can play a crucial role in early detection and prevention, potentially saving lives. It is advisable for individuals to maintain a healthy lifestyle and undergo regular screenings to optimise colon health.

Visit Alpine Surgical Practice

In order to book a colonoscopy screening or specialist consultation with Dr Aaron Poh, Alpine Surgical Practice’s Consultant General Surgeon and Medical Director, please get in touch with us. Dr Poh is an experienced general surgeon with a subspeciality in colorectal surgery. He has conducted numerous colonoscopies, enabling patients to gain clarity about their condition and effectively treating them.

At Alpine Surgical Practice, our specialist clinic in Singapore provides a colonoscopy screening package with the following components:

Pre-screening Consultation
Colonoscopy including Polypectomy & Histology
Post-screening Clinical Evaluation
Specialist Report & Recommendation

Take charge of your colorectal health by scheduling a screening today.

References

1. Pooja Dharwadkar, Zaki TA, Murphy CC. Colorectal Cancer in Younger Adults. Hematology/Oncology Clinics of North America. 2022;36(3):449-470. doi:https://doi.org/10.1016/j.hoc.2022.02.005

‌2. Colorectal Cancer Risk Factors | Hereditary Colorectal Risk Factors. www.cancer.org. https://www.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-factors.html#:~:text=Most%20colorectal%20cancers%20are%20found

The Straits Times: Looks Good But Tastes Bad? The Science Behind Food Poisoning

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From Screen Time to Screenings: Addressing the Spike of Colon Cancer Among Young Adults in Singapore

Colon cancer is emerging as a critical health crisis in Singapore and is particularly evident in the escalating incidence rates across the globe [1]. This type of cancer, which develops in the colon or rectum, is notably insidious, often presenting no symptoms until it has advanced to a more severe stage. The result is a condition that, although highly treatable when caught early, becomes more challenging to manage later.

The situation is particularly alarming in Asia, where changing lifestyles and dietary habits seem to intersect with genetic predispositions to significantly affect colon cancer rates. Singapore, for instance, has seen a stark rise in colon cancer cases [2]. According to statistics by the National Cancer Centre Singapore [3], the number of colon cancer patients has been increasing steadily, which makes it one of the most common cancers in the nation. This trend is mirrored in neighbouring countries, which suggests a broader regional health shift that demands immediate attention.

The rising number of colon cancer cases in Singapore is more than just a statistic; it signals a pressing need to explore the underlying causes of this trend. Factors such as increased urbanisation, adoption of Western diets, and stress-related lifestyle changes contribute to this rise. In this blog, we aim to analyse the trends contributing to the increase in colon cancer cases and review effective prevention strategies. Our objective is to raise awareness of colon cancer in Singapore and provide individuals with the knowledge they need to take action to prevent colon cancer.

Colon cancer singapore — Colon cancer begins in the colon or rectum, parts of the large intestine, and is characterised by the growth of tumours in the inner lining of these organs.

What is colon cancer, and how does it affect the body?

Colon cancer, also known as colorectal cancer, is a type of cancer that begins in the colon or rectum, which are key components of the digestive system. The colon, also known as the large intestine, absorbs water and nutrients from digested food and forms solid waste (stool). The rectum, the final segment of the large intestine, stores stool until it is expelled from the body.

This form of cancer typically starts as small, benign clumps of cells called polyps that form on the inner lining of the colon or rectum. Over time, some of these polyps can become cancerous. The progression from benign polyp to cancer can take many years, which is why screening and early detection [4] are crucial in preventing and effectively treating colon cancer.

The body parts primarily affected by colon cancer are:

Colon: divided into four sections (ascending colon, transverse colon, descending colon, and sigmoid colon); cancer can develop in any part but is most commonly found in the sigmoid colon and the rectum.
Rectum: located at the end of the colon, the rectum is a common site for cancer to develop, especially in its lower sections.

Understanding the stages of colon cancer is critical for determining treatment and prognosis. The stages of colon cancer are categorised as follows:

Stage 0: also known as carcinoma in situ, the cancer is in a very early stage where it has not grown beyond the inner layer of the colon or rectum.
Stage I: cancer has grown into the next layer of tissue but has not reached the outer walls of the colon or rectum or spread outside the colon.
Stage II: cancer has spread through the muscle layer of the colon or rectum but has not spread to nearby lymph nodes.
Stage III: cancer has invaded nearby lymph nodes but is not affecting other parts of the body.
Stage IV: cancer has metastasised to distant organs, such as the liver or lungs.

Each stage of colon cancer not only suggests the extent of the disease and guides the treatment strategy but also impacts the prognosis. Early detection significantly increases [5] the chances of successful treatment, highlighting the importance of regular screenings, especially for those over 50 or with risk factors for the disease.

colon cancer stages singapore — The stages of colon cancer range from Stage 0, indicating cancer in situ, to Stage IV, where the cancer has spread to distant organs.

Why is the incidence of colon cancer rising in Singapore?

Colon cancer rates have been rising in Singapore and around the world, which presents a significant public health concern. This increase is evident across various age groups and geographical regions, which prompts a closer look at the underlying causes and risk factors contributing to this trend.

Recent data [6] indicate that colon cancer is no longer a disease predominantly affecting the older population. Increasingly, individuals under 50 are being diagnosed, a group previously considered at low risk. Geographical variations [7] also show that higher rates of colon cancer are found in developed regions, such as North America, Europe, and parts of Asia, including Singapore. These regions have seen a steady climb in cases over the past few decades.

Historical data comparison further underscores the rise. For instance, over the last 20 years, colon cancer incidence in young adults has increased by more than 2% per year [8] in the United States alone. Similarly, countries [9] like Japan and South Korea, which traditionally had lower incidence rates, have witnessed a rapid increase, aligning more closely with Western figures.

Research [10] suggests that this uptick may be linked to a combination of factors, including dietary habits, increased sedentary lifestyles, and environmental influences. The Westernisation of diets [11] across the globe—characterised by high consumption of red and processed meats, refined sugars, and fat, along with low intake of fibre—has been closely associated with higher colon cancer risks. Urbanisation has also led to more sedentary lifestyles [12], further elevating the risk.

Key risk factors for developing colon cancer in Singapore include:

Age: while traditionally more common in older adults, rising cases in younger age groups are concerning.
Genetics: a family history [13] of colon cancer significantly increases risk.
Diet: diets [14] high in red meat and processed foods and low in fruits, vegetables, and fibre are linked to higher incidence.
Smoking and alcohol consumption: smoking and heavy alcohol use [15]are notable risk factors for colon cancer.
Obesity: being overweight [16] or obese increases the likelihood of developing colon cancer.
Modern lifestyle contributions: the shift towards more sedentary jobs, less physical activity [17], and poor dietary choices have contributed significantly to the rise in colon cancer rates. Modern diets are often deficient in essential nutrients and fibres that help protect against colon cancer.

colon cancer risks — A sedentary lifestyle coupled with a diet rich in fats and low in fibre is linked to colon cancer.

What are the first signs of colon cancer?

Identifying the early signs of colon cancer is crucial for timely intervention, which significantly enhances the chances of successful treatment and survival. Colon cancer often begins silently, without symptoms, but as it progresses, several key indicators can signal the presence of this disease. The initial symptoms of colon cancer can be subtle and easily mistaken for less serious health issues, which makes regular screening and awareness of these signs vital. Common symptoms of colon cancer include:

Changes in bowel habits: sudden alterations such as constipation, diarrhoea, or a change in the consistency of stool that lasts for more than a few days can be an early sign of colon cancer.
Rectal bleeding or blood in stool: the appearance of bright red or very dark blood in the stool is one of the most noticeable signs of colon cancer.
Persistent abdominal discomfort: abdominal discomfort, like cramps, gas, or pain that does not go away, might indicate the presence of a tumour.
Feeling of incomplete bowel movement: a sensation that the bowel does not empty completely after a bowel movement can also be a warning sign of colon cancer.
Weakness or fatigue: unexplained weakness or fatigue can occur if cancer causes blood loss, leading to anaemia.
Unintended weight loss: losing weight without a change in diet or exercise habits is often a sign of cancer, as the body and appetite are affected by the disease’s metabolic demands.

rectal bleeding singapore — Rectal bleeding can be a sign of colon cancer when it occurs persistently.

Can colon cancer be cured?

The possibility of curing colon cancer depends mainly on the stage at which the cancer is detected and treated. Early detection and intervention significantly increase the likelihood of a cure, which emphasises the need for regular screening and awareness of symptoms.

Early stages (I and II): in these stages, colon cancer is often localised to the lining of the colon or has just begun to penetrate the walls. Surgical removal of the cancerous section of the colon, known as a colectomy, is typically very effective. The cure rate is relatively high if the cancer is detected and treated at these stages. The 5-year survival rate [18] for stage I colon cancer can exceed 90%, while stage II has a survival rate of about 85% to 89% [19], depending on the extent of cancer spread within the walls.
Stage III: at this stage, colon cancer has spread to nearby lymph nodes but not to distant sites. Treatment often involves surgery followed by adjuvant chemotherapy to kill any remaining cancer cells and reduce the risk of recurrence. The 5-year survival rate for stage III colon cancer is around 65% [20], again dependent on the extent of spread and response to treatment.
Stage IV: this is the most advanced stage, where the cancer has spread to distant organs such as the liver, lungs, or other parts of the body. Cure rates at this stage are lower because the cancer is more challenging to eliminate.

The key to curing colon cancer lies in early detection through screening. Procedures like colonoscopies not only detect cancer at its earliest and most treatable stages but can also prevent cancer by allowing for the removal of polyps before they develop into cancer. For individuals at average risk, screening should begin at age 45. Those with additional risk factors, such as a family history of colon cancer or genetic predisposition, may need to start colon cancer screening earlier.

How can you prevent colon cancer in Singapore?

Colon cancer is a formidable health challenge, but it is also one of the most preventable types of cancer. A combination of dietary and lifestyle modifications, regular screenings, and advancements in treatment options can significantly reduce risk and improve patient outcomes.

Diet: dietary choices play a crucial role in colon cancer prevention. High-fibre diets [21] rich in fruits, vegetables, and whole grains are associated with a reduced risk of developing colon cancer. Conversely, diets high in red and processed meats have been linked to an increased risk. Limiting alcohol consumption and avoiding tobacco use also contribute to lower cancer risk.
Physical activity: regular physical activity is another effective measure. Engaging in moderate to vigorous exercise for at least 150 minutes per week has been shown [22] to significantly decrease the likelihood of developing colon cancer. Exercise helps to reduce inflammation, regulate hormones, and improve gut health, all of which play a role in cancer prevention.
Weight management: maintaining a healthy weight is critical. Obesity [23] increases the risk of colon cancer, particularly in men. Efforts to manage weight through diet and exercise can also help reduce this risk.
Regular screenings and medical check-ups: screening [24] is the most powerful tool for preventing colon cancer or catching it in its earliest stages when it is most treatable. Colonoscopies, in particular, can detect precancerous polyps, which can be removed before they become cancerous. Beyond colonoscopies, other screening tests, such as stool-based tests, are available and can be done more frequently. Regular medical check-ups also help manage other risk factors, such as diabetes and high cholesterol, which can indirectly influence the risk of colon cancer.

Fibre-rich diet singapore — A high-fibre diet helps reduce the risk of colon cancer by promoting healthy bowel movements and enhancing gut health.

How have recent advances improved treatment for colon cancer?

The treatment of colon cancer has evolved significantly, with several advanced options now available that improve outcomes and offer hope even in more advanced stages. The choice of treatment typically depends on the cancer stage, the patient's overall health, and specific cancer characteristics. Here’s an overview of the current mainstays in colon cancer treatment:

Surgery

Surgery is the most common treatment for localised colon cancer and may range from minimally invasive techniques to more extensive resections:

Polypectomy: this is a proc e dure used during a colonoscopy to remove polyps before they potentially turn into cancer.
Local excision: if the cancer is very small and located on the surface, it can sometimes be removed without cutting through the abdominal wall.
Partial colectomy: removing part of the colon that contains the cancer along with a margin of normal tissue on either side. This procedure can often be done laparoscopically, using small incisions.

Chemotherapy

Chemotherapy is used to kill cancer cells and is typically employed when cancer has spread beyond the original tumour or to reduce the risk of recurrence:

Adjuvant chemotherapy: adjuvant chemotherapy is used after surgery to eliminate any remaining cancer cells. This therapy can prevent the cancer from coming back.
Neoadjuvant chemotherapy: neoadjuvant chemotherapy is given before surgery to shrink tumours, making them easier to remove and sometimes allowing for less extensive surgery.

Radiation therapy

Radiation therapy uses high-energy rays to target and kill cancer cells. While more common in rectal cancer, it is sometimes used in colon cancer for shrinking tumours before surgery or to relieve symptoms of advanced cancer.

Targeted therapies

Targeted therapies focus on specific abnormalities within cancer cells. By blocking these abnormalities, targeted drugs can cause cancer cells to die. Some of the targeted therapies for colon cancer include:

Anti-angiogenesis drugs: anti-angiogenesis drugs [25] stop tumours from making new blood vessels, starving the tumour of the nutrients it needs to grow.
EGFR inhibitors: epidermal growth factor reception or EGFR drugs [26] help block the growth of new cells, which is particularly effective against colon cancers that express the EGFR protein.

Immunotherapy

Immunotherapy is a type of treatment that uses the body's immune system to fight cancer. It is particularly effective in patients whose tumours have specific genetic markers such as high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR):

Checkpoint inhibitors: checkpoint inhibitors [27] help the immune system recognise and attack cancer cells. They have been a significant breakthrough in treating advanced colon cancer in Singapore.

Precision medicine

Precision medicine [28] tailors treatment to the individual characteristics of each patient's cancer based on genetics, biomarkers, and other diagnostic tests. It allows doctors to select treatments that are most likely to help patients based on a genetic understanding of their disease.

These treatment options, used alone or in combination, offer comprehensive approaches tailored to the individual patient’s condition, which aims not only to treat the cancer but also to maintain quality of life through and beyond treatment. The ongoing advancements in medical research continue to enhance these treatment strategies, which offer new hope to patients facing colon cancer.

Conclusion

The increasing incidence of colon cancer globally, particularly noted in regions like Asia and among younger demographics, emphasises the critical importance of awareness, early detection, and proactive prevention measures.

By understanding the risk factors, recognising early symptoms, and utilising the latest advancements in treatment, individuals can significantly enhance their chances of preventing or successfully managing colon cancer.

It is essential to maintain a healthy lifestyle, participate in regular screening programmes, and stay informed about the developments in cancer care to combat this prevalent but curable disease effectively.

References

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Li, D. (2018). Recent advances in colorectal cancer screening. Chronic Diseases and Translational Medicine, 4(3), 139–147. https://doi.org/10.1016/j.cdtm.2018.08.004
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Wong, M. C., Ding, H., Wang, J., Chan, P. S., & Huang, J. (2019). Prevalence and risk factors of colorectal cancer in Asia. Intestinal Research, 17(3), 317–329. https://doi.org/10.5217/ir.2019.00021
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M.D, D. C. H. W. (2023, June 29). Precision cancer medicines for colon cancer. CancerConnect. https://news.cancerconnect.com/colon-cancer/precision-cancer-medicines-for-colon-cancer

The Crucial Role of Upper Endoscopy in Managing Stomach Cancer

Delayed Detection of Stomach Cancer

Are you aware that stomach cancer claims the lives of 300 to 500 people in Singapore annually? Even though the local incidence of stomach cancer has declined compared to the post-war years, partly because of heightened public awareness about the cancer, stomach cancer continues to be prevalent in Singapore.

Stomach cancer, also known as gastric cancer, is a condition defined by the development of malignant cancer cells (or tumours) in the stomach lining, leading to a range of symptoms and physiological implications which can be potentially deadly if left untreated.

Stomach cancer tends to remain asymptomatic during its initial stages. Consequently, two-thirds of stomach cancer cases remain undiagnosed until the cancer has become advanced, reducing the chances of effective treatment and speedy recovery.

Nevertheless, a recent discovery in diagnostic research conducted by Duke-NUS Medical School, National University Hospital (NUH), and the National University of Singapore’s Yong Loo Lin School of Medicine, offers the potential for earlier detection of stomach cancer. The breakthrough, highlighted in a December 2023 Straits Times article, unveiled a crucial genetic factor linked to changes in the stomach’s mucous lining. To be precise, individuals with intestinal metaplasia, a cellular change in the stomach's mucous membrane often resulting from chronic gastritis (inflammation of the stomach lining), have a sixfold increased risk of developing stomach cancer.

In light of this discovery, doctors are encouraged to order genetic tests, such as straightforward and cost-effective blood tests, to identify individuals at a significantly high risk of getting stomach cancer. This advancement holds the promise of enabling at-risk patients to receive an earlier confirmed diagnosis and timelier treatment, leading to accelerated recovery and an overall enhancement in their quality of life. It provides valuable clinical data that could aid precision prevention (preventing diseases with a highly targeted and individualised approach) and precision treatment (tailoring treatment by considering factors such as a person's genetic makeup, lifestyle, and environment) of stomach cancer.

Risk Factors for Stomach Cancer

Aside from the aforementioned risk factor of preexisting stomach conditions such as chronic gastritis, there are other key risk factors which have proven to contribute to its development:

Family History of Stomach Cancer: People with a family history of stomach cancer or specific genetic inclinations may face an elevated risk. Genetic counselling and screening initiatives are vital for identifying and effectively managing this heightened risk.
Helicobacter pylori infection: Another complication of frequent consumption of salted and processed foods is an elevated risk of H. pylori exposure. This bacterium significantly increases the risk of stomach cancer as it weakens the cellular lining of the stomach.
Dietary Habits: Smoked, salted, or pickled foods are commonly found throughout Singapore. Frequent consumption of such foods allegedly contributes to an elevated risk for the development of stomach cancer.
Tobacco and Alcohol Consumption: Smoking and excessive alcohol use are well-established risk factors, prompting public health campaigns in Singapore to raise awareness about their dangers.

Red Flags that Could Indicate Stomach Cancer

Stomach cancer is often labelled as a ‘silent enemy’ as it typically goes unnoticed until it reaches advanced stages, posing significant risks to its patient’s health. Understanding the signs of stomach cancer is crucial for early detection:

Prolonged indigestion
Unexpected weight loss
Abdominal pain and nausea
Long-term acid reflux and heartburn
Difficulty swallowing

According to General Surgeon Dr Aaron Poh who has a subspeciality in Colorectal surgery, the presence of these symptoms does not necessarily mean that you have stomach cancer, as some patients in Singapore do not have these symptoms upon their diagnosis. As such, if you are experiencing persistent issues with your stomach, such as chronic gastritis, you need to identify the root cause of your issues and treat them promptly.

Precision Prevention Through Timely Detection of Stomach Cancer

Also known as EGD (Esophagogastroduodenoscopy) and upper endoscopy, gastroscopy facilitates the early detection of stomach cancer. Gastroscopy is a medical procedure involving a gastrointestinal specialist who evaluates the oesophagus (the tube linking the throat and stomach), stomach, and small intestine (duodenum). This safe, minimally invasive examination is conducted using a slender and flexible device known as an endoscope.

The following points highlight the various capabilities of gastroscopy in managing stomach cancer.

Detecting Precancerous Lesions and Stomach Cancer

Gastroscopy allows for the direct visualisation of the stomach lining, enabling the identification of precancerous lesions such as intestinal metaplasia or high-grade dysplasia or carcinoma-in-situ. Detecting these early warning signs offers a window of opportunity for intervention before any tumour develops.

Out of the existing screening technologies currently available, gastroscopy also stands out as being the most sensitive test for detecting stomach cancer. This means that it excels in accurately identifying individuals with gastric cancer (true positives) while minimising the chance of false negatives.

Screening High-Risk Individuals

Precision prevention involves tailoring screening advice based on individual risk profiles. Your colorectal surgeon may recommend that patients with the aforementioned risk factors or any history of chronic stomach issues undergo regular upper endoscopy screenings. This targeted screening approach allows surgeons to monitor high-risk individuals closely and detect stomach abnormalities at their earliest stages, while lowering the risk of unnecessary screenings for those with low risk.

Creating Tailored Surveillance Programmes

Utilising clinical data from upper endoscopy, colorectal surgeons can design personalised monitoring plans for those at high risk of developing stomach cancer, advising more frequent surveillance for such patients.

Precision Diagnostics and Treatment

Treatment for non-cancerous polyps or ulcers: If a polyp is detected, your colorectal surgeon may choose to perform a biopsy or remove the polyp during the endoscopic procedure. Polypectomy, Electrocautery, or laser-based treatments are some of the common procedures used to remove polyps.

Localised treatment of early-stage cancer

When stomach cancer is detected at an early stage, upper endoscopy can be used as a precise tool for localised treatment. Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) can be performed to remove small, localised tumours without the risks involved in invasive surgeries. Localised treatments also allow for a faster postoperative recovery period in comparison to traditional invasive surgeries.

Visit Alpine Surgical Practice

If you are grappling with persistent stomach issues such as indigestion, unexplained weight loss, or chronic discomfort, taking action now can make a significant difference. Early detection and understanding of the root cause of your symptoms can pave the way for effective management and improved gut well-being. Contact Alpine Surgical Practice today to schedule a consultation with Consultant General Surgeon Dr Aaron Poh, who has double subspecialties in Colorectal and Trauma Surgery.

Alpine Surgical Practice offers a comprehensive gut health screening package that would help you understand more about your gut health and the underlying causes of your stomach issues.

References

Gupta R, Reddy DN. Endoscopic stent placement combined with tumor ablation therapy. Gastrointestinal Intervention. 2015;4(1):27-30.
doi:https://doi.org/10.1016/j.gii.2015.05.001
Information NC for B, Pike USNL of M 8600 R, MD B, Usa 20894. What Happens during a Gastroscopy? Institute for Quality and Efficiency in Health Care (IQWiG); 2015.
https://www.ncbi.nlm.nih.gov/books/NBK310264/
Sitarz R, Skierucha M, Mielko J, Offerhaus J, Maciejewski R, Polkowski W. Gastric cancer: epidemiology, prevention, classification, and treatment. Cancer Management and Research. 2018;Volume 10:239-248.
doi:https://doi.org/10.2147/cmar.s149619
Tan J. Local research on stomach cancer makes breakthrough in potential early detection. The Straits Times.
https://www.straitstimes.com/singapore/local-research-on-stomach-cancer-makes-breakthrough-in-potential-early-detection. Published December 20, 2023. Accessed January 2, 2024.

What to Do if My Stool Test (FOBT/ FIT) is Positive?

A stool test, such as the Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT), is a non-invasive kit available in Singapore that can detect hidden blood in the stool often unidentifiable by the naked eye. It is a prevalent method used to screen for colorectal cancer or other fundamental issues that result in bleeding within the digestive system.

Receiving a positive FOBT/FIT result can be a scary moment for some people. However, it's essential to understand that a positive result does not necessarily indicate a dire medical condition like colon cancer. In this article, we'll focus on the crucial next steps to take in Singapore if your FOBT/FIT stool test result comes back positive, guiding you through the process and providing clarity during this potentially worrisome time.

What types of stool tests exist in Singapore?

There are two types of FOBT stool tests which can detect gastrointestinal abnormalities:

1. Fecal Immunochemical Test (FIT or iFOBT): the FIT utilises a spatula or brush to gather a specimen of your stool, which is then enclosed within a container for subsequent laboratory analysis.

2. Guaiac Fecal Occult Blood Test (gFOBT): the gFOBT entails applying a stool sample to the designated test card using an applicator, followed by sealing the card within a container for subsequent laboratory evaluation.

FOBT vs FIT: What is the difference?

The FOBT is a general umbrella term that encompasses the FIT and gFOBT. Both are stool tests that serve as effective initial screening tools to identify potential gastrointestinal issues. However, FIT is more sensitive and specific compared to gFOBT, thus the former is generally more accurate.

Are the results from the FIT accurate?

The FIT reportedly has a moderate to high accuracy in detecting digestive disorders. Its efficacy as a first-stage screening tool has been backed up by robust clinical studies such as population-based randomised trials. For example, a 2013 study published in the reputable Singapore Medical Journal supports the finding that using the FIT can decrease mortality from colorectal cancer. This is because it contributes to the early detection of colorectal cancer, which often leads to more successful treatment outcomes.

In the study, 8% out of the 8,156 active participants received positive FIT results. After which, 494 of them underwent further diagnostic screening. Close to half of them were diagnosed with a digestive disorder following colonoscopy, which alligns with their positive FIT results.

Main takeaway: the FIT serves as a moderately accurate first-stage screening tool for colorectal abnormalities.

Where can I get the FIT stool test in Singapore?

As colon cancer is the most prevalent cancer in Singapore, the Singapore Cancer Society distributes free FIT stool test kits to encourage people to get screened. Singaporeans and Permanent Residents above 50 years old can conveniently collect FIT kits from designated pick-up points.

What does a positive FOBT stool test indicate?

When blood is detected in your stool, you get a positive FOBT result. This could be an early indicator for a range of gastrointestinal conditions, including anal fissures, ulcers, polyps, haemorrhoids, and potentially colorectal cancer.

What happens after a positive FOBT test?

1. Do not panic and worry

If you have a positive FOBT result, remember that it is not an immediate cause for alarm. Since FOBT solely identifies the existence of blood, further examinations will be necessary to pinpoint the origin of the bleeding. FOBT may yield false-positive results because of non-cancer-related conditions causing gastrointestinal bleeding. In a similar vein, it can also lead to false negatives if your cancer or polyps do not bleed. Hence, it would be best to remain calm as further testing is required before a proper diagnosis can be made.

2. Book an appointment with a colorectal specialist

Contrary to common belief, you do not necessarily require a GP referral letter to see a colorectal specialist in a Singapore private clinic. If you would like to streamline the consultation process, you can book an appointment with a colorectal specialist directly after you get your positive FOBT results.

A colorectal specialist, also known as a colorectal surgeon or proctologist, is a medical doctor who specialises in the diagnosis as well as surgical treatment of gastrointestinal and digestive disorders. Hence, colorectal surgeons should be your go-to doctors for FOBT and colon cancer concerns.

3. Attend the colorectal specialist consultation

Depending on your health history and the extent of the positive FOBT result, your colorectal surgeon may recommend further tests with higher sensitivity. A common recommendation is a colonoscopy, the gold standard for detecting colorectal cancer, which enables direct visualisation of the colon.

If you are worried about your upcoming colonoscopy, actively asking questions about the details of the procedure during the consult can allay your anxiety since it may reduce your fear of the unknown. Although the fear of colonoscopy is common, it is actually a safe and straightforward procedure. Regardless of age or underlying medical problems, most patients can undergo colonoscopy safely.

4. Prepare for your colonoscopy

You need to adhere to some pre-colonoscopy procedures for a successful and stress-free colonoscopy. Adhere closely to the guidance of your colorectal surgeon. Staying compliant with these directions is essential for obtaining accurate diagnostic insights.

5. Attend your colonoscopy and book the next colonoscopy

Rest assured that colonoscopy is not painful. Patients undergoing colonoscopy will be given sedative drugs to minimise discomfort. The sedative drugs also have some amnesia effect to minimise memories of the event.

After the examination, it typically takes approximately one hour to initiate the recovery process from the sedative. As the complete effects of the sedative may persist for up to a day, it is necessary to arrange for someone to accompany you home. Refrain from driving, making significant decisions, or returning to work for the remainder of the day.

Finally, remember to book your next routine colon cancer screening appointment. For a colonoscopy performed with a well-cleansed colon and adequate polyp removal, the next scope can be performed in 5 years.

Visit Alpine Surgical Practice

A positive FOBT result serves as a stepping stone toward proactive healthcare. It is meant to be an initial screening tool rather than cause immediate worry. The stool test kit result is insufficient for a diagnosis of colon cancer. Thus, follow-up tests with higher sensitivity are necessary.

For a safe and effective colonoscopy, book an appointment with colorectal surgeon Dr Aaron Poh, the Medical Director at Alpine Surgical Practice. He is a trusted colorectal specialist with a proven track record of doing colonoscopies.

References

Cleveland Clinic. Fecal Occult Blood Test (FOBT). Cleveland Clinic. 2023. https://my.clevelandclinic.org/health/diagnostics/24227-fecal-occult-blood-test-fobt#:~:text=What%20does%20a%20positive%20fecal,to%20talk%20about%20next%20steps. Accessed August 22,
Mayo Clinic. Colonoscopy. Mayo Clinic. 2021. https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569 Accessed August 22, 2023.
Singapore Med J 2013; 54(4): 220-223 doi: 10.11622/smedj.2013077 Accessed August 23, 2023.