Senior Consultant Colorectal Surgeon
MBBS, MMed , FAMS, FRCSEd
Dr Tan Wah Siew was senior consultant surgeon at the Department of Colorectal Surgery, Singapore General Hospital prior to her move to private practice. She was the first female consultant colorectal surgeon in the history of SGH, and was one of the earliest female surgeons in Singapore to be trained in robotic colorectal surgery.
She graduated from the Faculty of Medicine, National University of Singapore in 2003 and completed her Advanced Surgical Training in General and Colorectal Surgery at SGH in 2011. In 2013, she completed a one year Ministry of Health sponsored Healthcare Manpower Development Plan Fellowship at St. James University Hospital in Leeds, United Kingdom. While there, she trained in minimally invasive and robotic colorectal surgery for colorectal cancer, surgery for inflammatory bowel disease as well as treatment of locally advanced rectal cancers and recurrent pelvic cancers requiring removal of multiple organs and/or pelvic exenterations.
To date, she has performed more than 500 major colorectal resection surgeries for both colorectal cancer andbenign colorectal conditions. In addition, since 2016, she has been part of the multi-disciplinaryInflammatory Bowel Disease Team at SGH. As one of the IBD surgeons in the team, she has performed manylife-saving surgeries for patients with both ulcerative colitis and crohns disease.
Two Problems One Solution
Using Metamucil® and drinking lots of water will clear up most anal fissures and hemorrhoids. Metamucil bulks up, or softens, the stool, and drinking water moves the stool through faster. Then you just sit on the toilet and go theres no strain. When stool comes out easily, bleeding is less likely.
The best part about Metamucil is that it helps with diarrhea-related issues as well. So you can take it if your stools are hard or loose.
If bleeding continues despite using fiber and water or if you cant think of any cause for the bleeding then you need to see a doctor. An evaluation and colonoscopy exam will rule out polyps, cancer, inflammatory bowel disease or other problems that require treatment.
How Are Hemorrhoids Diagnosed
Your healthcare provider diagnoses hemorrhoids based on symptoms and a physical exam. You may also have:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum to feel for swollen veins.
- Anoscopy: Your provider uses an anoscope to view the lining of the anus and rectum.
- Sigmoidoscopy: Your provider uses a sigmoidoscope to view inside the lower part of the colon and rectum. Procedure types include flexible sigmoidoscopy and rigid sigmoidoscopy .
These tests may be uncomfortable but arent painful. They typically take place in a doctors office or outpatient center without anesthesia. You go home the same day.
Your provider may perform a colonoscopy to confirm findings from other tests or check for signs of colon cancer. This outpatient procedure requires anesthesia.
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When Do I Need To See A Health Care Provider For Hemorrhoids
You should see your health care provider if you
- Still have symptoms after 1 week of at-home treatment
- Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn’s disease, ulcerative colitis, colorectal cancer, and anal cancer. So it’s important to see your provider to find the cause of the bleeding.
Classification Of Internal Hemorrhoids:
- Grade 1 – A hemorrhoid is present but only visualized by a doctor with ansocopy or colonoscopy. The hemorrhoid does not extend out the anus.
- Grade 2 – The hemorrhoid extends out of the anus with a bowel movement or with straining. After your BM, the hemorrhoid goes back inside on its own.
- Grade 3 – The hemorrhoid extends out of the anus with a bowel movement or with straining. You have to manually push the hemorrhoid back inside the anus. If you have this, you should seek medical attention, but it is not urgent.
- Grade 4 – A hemorrhoid extends outside the anus and are not able to be manually pushed back inside. If you have this seek medical attention immediately. There are significant potential complications.
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Diagnosis For Bleeding Hemorrhoids
A licensed healthcare professional can help diagnose bleeding hemorrhoids. To get the diagnosis, your doctor may have you undergo a physical examination and:
- Rectal examination, where a doctor uses a gloved finger to check inside your rectum.
- Anoscopy, where a doctor inserts a lighted scope into your rectum to examine the anal canal.
- Colonoscopy, where a doctor places a long flexible tube with a tiny camera into your rectum to examine the entire colon.
There are two types of hemorrhoids:
- Internal hemorrhoids: Hemorrhoids hidden inside the rectum are called internal hemorrhoids. These are usually painless but can cause bleeding when you use the bathroom.
- External hemorrhoids: Hemorrhoids that you can see or feel are called external hemorrhoids. These are usually more painful because the skin becomes irritated and eroded.
A health care provider will help you determine what kind of hemorrhoids you have and discuss the best treatment options.
- Fibersupplements to help soften your stool
- Laxatives to help you make healthy stools
- Sitz bath to improve blood flow and relax the muscle around the anus
Over-the-counter creams and rectal suppositories may be another option to treat a bleeding hemorrhoid. These can help relieve pain, itching, and inflammation temporarily:
Minimally invasive treatments
In other cases, your doctor might recommend sclerotherapy. Sclerotherapy is when a doctor injects a chemical solution into a hemorrhoid, causing it to break down and scar.
How Do You Treat A Bleeding Hemorrhoid
A bleeding hemorrhoid can refer to a thrombosed external hemorrhoid, where a blood clot has formed or possibly burst, or the common side effect of an internal hemorrhoid, which is painless rectal bleeding.
Both can be treated by eating high fiber foods, taking a fiber supplement, and maintaining healthy bathroom habits, like not sitting on the toilet for too long.
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Questions To Ask Your Doctor
- Why do I have hemorrhoids?
- Are there any lifestyle changes I can do that can relieve or prevent hemorrhoids?
- I saw blood on toilet paper. Is this serious?
- Are having hemorrhoids a sign of another health condition?
- Will I always have hemorrhoids?
- Is there medicine I can take for hemorrhoids? Are there side effects?
The Trusted Specialist In Singapore
Dr Bernard Lim is an accredited and reputable Surgeon of Bernard Lim Specialist Surgery in Mount Elizabeth Novena Hospital.
Dr Lim has extensive experience especially dealing with Haemorrhoid and Piles conditions, using surgical and non-surgical approach. He is empathetic towards his patients and treats them with utmost care.
Dr Lim was trained in the Department of Colorectal Surgery at the Singapore General Hospital, where he was a Consultant Surgeon. He has performed hundreds of colon and rectal surgeries in both laparoscopic and open techniques.
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The Best And Worst Things You Can Do For Hemorrhoids
Sameet Shah, D.O. contributes to topics such as Gastroenterology.
Near the top of the list of health issues people avoid talking about is hemorrhoids, even to doctors. Theyre uncomfortable, theyre unattractive, they bleed, and they make going to the bathroom a challenge. Theyre also very common. In fact, about half of people have had a bout with hemorrhoids by the time they reach 50 years old.
How To Tell If You Have Bleeding Hemorrhoids
The most obvious indicator of bleeding hemorrhoids is blood in the stool. There are additional indicators that let you determine whether it is blood from hemorrhoids or something else.
First, look at the blood and determine its color. Is the blood red, brown, or black? Blood from a bleeding hemorrhoid will always be red because it is fresh. If the blood is brown or black, it could be a more serious condition and you should see your doctor right away.
Never ignore or brush off rectal bleeding, even if it is due to a bleeding hemorrhoid. In all cases of rectal bleeding, see a doctor. This is because it could be a sign of a more serious condition, such as, anal fissures, torn tissue, or an infection. The doctor will use a scope to examine your rectum and colon in order to determine the origin of the bleeding.
Doctors can confirm whether the blood is in fact coming from a bleeding hemorrhoid or something more. They will also let you know if the treatment you are using is effective.
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Who Removes Hemorrhoids Treatment
Treating enlarged hemorrhoids is important, because they tend to get worse over time. Hemorrhoids are treated with a variety of measures including diet, over-the-counter medicine like
- anti-inflammatory pain killers,
and various treatment options are available, like
Who Removes Hemorrhoids?
Most hemorrhoid complaints begin with a trip to a family doctor. Your doctor will then refer you to a specialist: either a gastroenterologist or a proctologist . Proctologists specialize in surgical treatments, while gastroenterologists are experts in digestive diseases.
If You Need Any Assistance Call Our Patient Assistance Helpline At 6475 5512
KH Ng Surgery is a colorectal clinic located at Gleneagles Medical Centre that specializes in the diagnosis and treatment of piles and haemorrhoids. The clinic is headed by Dr Ng Kheng Hong, an established specialist with more than 20 years experience in treating piles successfully.
Gleneagles Medical Centre, 6 Napier Road, #03-13, Singapore 258499
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What Are The Symptoms Of Hemorrhoids
Internal hemorrhoids rarely cause pain unless they prolapse. Many people with internal hemorrhoids dont know they have them because they dont have symptoms.
If you have symptoms of internal hemorrhoids, you might see blood on toilet paper, in stool or the toilet bowl. These are signs of rectal bleeding.
Signs of external hemorrhoids include:
- Itchy anus.
- Hard lumps near the anus that feel sore or tender.
- Pain or ache in the anus, especially when you sit.
- Rectal bleeding.
Prolapsed hemorrhoids can be painful and uncomfortable. You may be able to feel them bulging outside the anus and gently push them back inside.
How Do Doctors Treat Hemorrhoids
Doctors treat hemorrhoids with procedures during an office visit or in an outpatient center or a hospital.
Office treatments include the following:
- Rubber band ligation. Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal hemorrhoids. A doctor places a special rubber band around the base of the hemorrhoid. The band cuts off the blood supply. The banded part of the hemorrhoid shrivels and falls off, most often within a week. Scar tissue forms in the remaining part of the hemorrhoid, often shrinking the hemorrhoid. Only a doctor should perform this procedureyou should never try this treatment yourself.
- Sclerotherapy. A doctor injects a solution into an internal hemorrhoid, which causes scar tissue to form. The scar tissue cuts off the blood supply, often shrinking the hemorrhoid.
- Infrared photocoagulation. A doctor uses a tool that directs infrared light at an internal hemorrhoid. Heat created by the infrared light causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
- Electrocoagulation. A doctor uses a tool that sends an electric current into an internal hemorrhoid. The electric current causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
Outpatient center or hospital treatments include the following:
Sometimes complications of hemorrhoids also require treatment.
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Maintaining A Healthy Weight
Being overweight is another factor that may contribute to the development of haemorrhoids. You can lose weight by exercising regularly, eating a low-fat diet and moderating your alcohol intake.
More information about food and nutrition is available in our healthy eating section and from the Nutrition Australia website.
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How Are Bleeding Hemorrhoids Treated
A bleeding hemorrhoid is usually a sign of irritation or damage to the wall of the hemorrhoid. This should resolve on its own over time, but there are several things you can do at home to speed up the process and soothe any discomfort.
However, if there is no clear source of bleeding or if the bleeding doesnt go away within a week, see your doctor. Experts note that hemorrhoids are often self-diagnosed, which can be dangerous. Many medical conditions, including cancer and inflammatory bowel disease , can have similar symptoms. Its important to receive a proper diagnosis from your doctor.
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How To Heal Hemorrhoids: Over
Products used to treat hemorrhoids are available as
- foams, and
When used around the anus, ointments, creams, and gels should be applied as a thin covering. When applied to the anal canal, these products should be inserted with a finger or a “pile pipe.” Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion. Suppositories or foams do not have advantages over ointments, creams, and gels.
Medical Procedures For Hemorrhoids
If your symptoms are severe or aren’t getting better after a couple of weeks, your doctor may suggest a procedure to shrink or remove the hemorrhoids. Many can be performed in their office.
Injection. Your doctor can inject an internal hemorrhoid with a solution to create a scar and close off the hemorrhoid. The shot hurts only a little.
Rubber band ligation. This procedure is often done on prolapsed hemorrhoids, internal hemorrhoids that can be seen or felt outside. Using a special tool, the doctor puts a tiny rubber band around the hemorrhoid, which shuts off its blood supply almost instantly. Within a week, the hemorrhoid will dry up, shrink, and fall off.
Coagulation or cauterization. With an electric probe, a laser beam, or an infrared light, your doctor will make a tiny burn to remove tissue and painlessly seal the end of the hemorrhoid, causing it to close off and shrink. This works best for prolapsed hemorrhoids.
Surgery. For large internal hemorrhoids or extremely uncomfortable external hemorrhoids, your doctor may recommend surgery.
- Hemorrhoidectomy. The most effective technique is to completely remove the hemorrhoids. But recovery is painful and can take several weeks.
- Hemorrhoid stapling. This technique cuts blood flow to internal hemorrhoids and moves prolapsed tissue back in place. Recovery is easier, but thereâs a greater chance of the hemorrhoids coming back.
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What Are The Types Of Hemorrhoids
Hemorrhoids can happen inside or outside the rectum. The type depends on where the swollen vein develops. Types include:
- External: Swollen veins form underneath the skin around the anus. Your anus is the canal where poop comes out. External hemorrhoids can be itchy and painful. Occasionally, they bleed. Sometimes they fill with blood that can clot. This is not dangerous, but can result in pain and swelling.
- Internal: Swollen veins form inside the rectum. Your rectum is the part of the digestive system that connects the colon to the anus. Internal hemorrhoids may bleed, but they usually arent painful.
- Prolapsed: Both internal and external hemorrhoids can prolapse, meaning they stretch and bulge outside of the anus. These hemorrhoids may bleed or cause pain.
Possible Complications And Side Effects
If you have a bleeding hemorrhoid, you might consider it a small problem, but it can still be a very painful experience. Seeing blood after we use the bathroom can be scary, but youre not alone.
There are a lot of different ways to treat a bleeding hemorrhoid and in some cases, its best to seek medical attention sooner rather than later if:
- Youre experiencing rectal bleeding or see blood on your toilet paper
- You have pain in and around your anus
- Youve tried over the counter treatments for a week with no change in symptoms
- Your bowel movements look maroon or tarry in color
If your doctor recommends surgery to treat a bleeding hemorrhoid, there are some possible complications to be aware of like :
- Injury to the anus
- Narrowing of the anus
Other treatments and medications may have different side effects. Consult your healthcare provider about possible complications of any medications you might take for a bleeding hemorrhoid.
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When To Seek Medical Advice
See your GP if you have persistent or severe symptoms of haemorrhoids. You should always get any rectal bleeding checked out, so your doctor can rule out more potentially serious causes.
The symptoms of haemorrhoids often clear up on their own or with simple treatments that can be bought from a pharmacy without a prescription . However, speak to your GP if your symptoms don’t get better or if you experience pain or bleeding.
Your GP can often diagnose haemorrhoids using a simple internal examination of your back passage, although they may need to refer you to a colorectal specialist for diagnosis and treatment.
Some people with haemorrhoids are reluctant to see their GP. However, theres no need to be embarrassed, because GPs are very used to diagnosing and treating haemorrhoids.
Read more about diagnosing haemorrhoids.
Can Hemorrhoids Bleed Without A Bowel Movement
Yes, hemorrhoids can bleed without a bowel movement. Bleeding can occur when an external hemorrhoid forms a blood clot, resulting in a thrombosed hemorrhoid.
The blood clot can burst, resulting in bleeding around the anal area.
If you have a thrombosed hemorrhoid, do not attempt to try to “pop” the blood clot open or you could put yourself at risk of getting an infection or causing complications.
If you find that you are bleeding from the anal area, contact your doctor, regardless of whether or not you have hemorrhoids, rectal bleeding can be a sign of another complication or gastrointestinal disorder.
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