Capsule colonoscopy is a non-invasive medical procedure to monitor and diagnose gastrointestinal (GI) health. In Singapore, this technique is gaining traction for its ability to examine the colon and intestines in a non-invasive manner compared to other types of colonoscopies.
In Singapore, common gastrointestinal (GI) conditions [1] include colorectal cancer, irritable bowel syndrome (IBS),inflammatory bowel disease (IBD), and gastrointestinal infections. These issues often develop due to factors such as dietary habits, sedentary lifestyles, and genetic predisposition.
Colonoscopy plays a vital role in diagnosing and preventing GI conditions. It allows for early detection of polyps, cancers, and other abnormalities, enabling timely treatment. Regular screenings are essential, especially for individuals at higher risk, to maintain GI health.
Keep reading to find out what exactly a capsule colonoscopy is, the advantages it offers, and what patients can expect from the procedure.
What is Capsule Colonoscopy?
Capsule colonoscopy, sometimes known as capsule endoscopy, is a diagnostic tool [2] that involves the patient swallowing a pill-sized capsule that has been embedded with a tiny camera. This capsule moves through the digestive tract, capturing thousands of images which are then transmitted to a recorder worn by the patient. These images are later viewed and analysed by a specialist or doctor to detect abnormalities such as polyps, inflammation, bleeding, or signs of colorectal cancer.
The capsule is about the size of a vitamin pill, measuring about 11 mm by 26 mm. It is designed to be swallowed easily with a sip of water, and the process is typically painless. The camera inside the capsule takes high-quality images as it moves through the digestive system, offering a comprehensive view of the colon's interior without the need for invasive procedures.
How does Capsule Colonoscopy work?
The procedure is relatively straight-forward. Here's how a typical capsule colonoscopy works:
Preparation: Before the procedure, patients are required to follow a special diet consisting of clear liquids for a day or two. They may also be instructed to take a bowel-cleansing solution to ensure that the colon is clear of any residue so that the capsule camera can capture accurate and clear images.
Swallowing the capsule: On the day of the procedure, the patient swallows the capsule with water. Once ingested, the capsule starts moving through the digestive tract. It is equipped with a light source, a camera, and a wireless transmitter that sends images to a data recorder worn by the patient.
Image capturing: As the capsule moves through the intestines, it captures images at a rapid rate. These images provide a detailed view of the inner walls of the colon and intestines, helping doctors to detect any anomalies.
Completion: The capsule is naturally excreted from the body, usually within 8 to 72 hours, depending on the patient's digestive system. No retrieval is needed as the images are transmitted in real-time to the external recording device.
Analysis: After the capsule has passed through the entire digestive tract, the data recorder is returned to the medical facility. A specialist then analyses the captured images for any signs of abnormalities, which can help in diagnosing conditions like colorectal cancer, Crohn's disease, ulcers, or polyps.
Capsule colonoscopy involves swallowing a small capsule that’s roughly the size of a vitamin pill.
Advantages of Capsule Colonoscopy
Capsule colonoscopy offers several advantages over traditional colonoscopy methods, including:
Non-Invasive: One of the most significant benefits is that it is non-invasive. Unlike traditional colonoscopy, which requires inserting a flexible tube with a camera through the rectum, capsule colonoscopy is as simple as swallowing a pill. This reduces discomfort and anxiety for many patients.
No Sedation: Traditional colonoscopy often requires sedation, meaning that patients have to arrange for transportation and take time off from work or daily activities. Capsule colonoscopy does not require sedation and allows for patients to go about their day with minimal disruption.
Reduced complication risk: Traditional colonoscopy carries a slight risk [3] of perforating the colon. Capsule colonoscopy eliminates this risk because the capsule is tiny and does not damage or impact the colon.
Comfort: The procedure is painless, with no discomfort from invasive instruments and no recovery time. This factor is particularly appealing to patients who may avoid traditional colonoscopy due to fear of pain or discomfort after the procedure.
Clear views: Capsule colonoscopy provides a thorough examination of the entire digestive tract, including areas that may be difficult to reach with traditional colonoscopy, such as the small intestine.
Limitations of Capsule Colonoscopy
While capsule colonoscopy has numerous advantages, there are also limitations compared to other traditional methods. These include:
While capsule colonoscopy is a valuable screening tool, it has limitations:
No biopsy or treatment: Capsule colonoscopy cannot take tissue samples or remove polyps, requiring follow-up procedures if abnormalities are found.
Incomplete views: Certain areas of the colon may not be fully visualised, which may lead to missing lesions.
Cost: Often more expensive than traditional colonoscopy.
Common digestive problems in Singapore include polyps and irritable bowel syndrome. Capsule colonoscopy can help to rule out more serious conditions.
Who is a Candidate for Capsule Colonoscopy in Singapore?
With an emphasis on early detection and preventive care, many specialists in Singapore now offer capsule colonoscopy as an option for patients seeking a less invasive way to monitor their gastrointestinal health. Capsule colonoscopy is suitable for those in Singapore seeking a non-invasive alternative to traditional colonoscopy or have certain limitations.
Ideal candidates include those who:
Have had incomplete or unsuccessful colonoscopies.
Are unable to tolerate sedation or invasive procedures due to health conditions.
Require screening for gastrointestinal bleeding or inflammatory bowel disease.
Prefer a minimally invasive option for colorectal cancer screening.
Are at higher risk of complications from traditional methods.
Have a family history of colorectal cancer, previous history of polyps, or chronic inflammatory bowel conditions.
If you are interested in a capsule colonoscopy, it is necessary to consult a doctor to assess suitability. Dr. Bhavesh Kishor Doshi, the founder of Gastrohealth Singapore, is an experienced gastroenterologist with a patient-centered approach who focuses on minimally invasive diagnostic methods.
Compared to traditional colonoscopy, capsule colonoscopy allows for more convenience as the patient can carry on with their normal activities and will not have to be sedated.
Conclusion
Capsule colonoscopy is a patient-friendly colonoscopy method that provides a non-invasive alternative to traditional colonoscopy, making it easier for patients to undergo critical screening and diagnostic procedures. While it may not replace traditional methods entirely due to certain limitations, it offers a valuable option for early detection of GI conditions, particularly for those who may avoid or cannot undergo conventional procedures. For those in Singapore concerned about their gastrointestinal health but are unable to undergo other methods, capsule colonoscopy offers a suitable option in preventive healthcare.
References
1. Low, D., Swarup, N., Okada, T., & Mizoguchi, E. (2022). Landscape of inflammatory bowel disease in Singapore. Intestinal research, 20(3), 291–296. Retrieved from: https://doi.org/10.5217/ir.2021.00089
3. Waddingham, W., Kamran, U., Kumar, B., Trudgill, N. J., Tsiamoulos, Z. P., & Banks, M. (2023). Complications of colonoscopy: common and rare—recognition, assessment and management. BMJ Open Gastroenterology, 10(1), e001193. Retrieved from: https://doi.org/10.1136/bmjgast-2023-001193
Complete Guide on Colonoscopy Procedure in Singapore
Table of Contents
Introduction
Colonoscopy is a medical procedure that helps in the early detection and prevention of several colorectal conditions, including colorectal cancer. In Singapore, where cases of colorectal cancer [1] are high, a colonoscopy plays a crucial role in safeguarding public health, which is why it is one of the main health screenings advised by the Ministry of Health (MOH).
Regular colonoscopy screenings are suitable for everyone and can significantly prevent colorectal cancer while improving overall digestive health. The procedure is highly recommended not only for those with symptoms such as rectal bleeding or persistent abdominal pain but also as part of routine health checks.
Keep reading to find out everything you need to know about a colonoscopy in Singapore, from understanding the procedure to choosing the right doctor.
What is a Colonoscopy?
A colonoscopy allows doctors to visually examine [2] the inner lining of the large intestine (colon) and rectum using a flexible tube with a camera. This procedure helps in identifying and removing polyps, which are potential precursors to cancer, as well as diagnosing other gastrointestinal issues such as Crohn’s disease and diverticulitis.
This medical examination involves the use of a long, flexible tube called an endoscope, which is fitted with a tiny camera at its tip. This device is inserted through the rectum to allow doctors to visually inspect the interior of the large intestine (colon) and rectum. The procedure provides real-time images of the colon, which helps doctors diagnose and sometimes treat issues in the gastrointestinal tract.
The endoscope transmits high-definition images of the colon’s lining to a monitor. If abnormalities such as polyps (small growths) or other suspicious lesions are found, they can often be removed during the procedure.
A colonoscopy helps your doctor visualise and examine the colon while treating issues such as removing polyps, if required.
Who Needs a Colonoscopy?
A colonoscopy is an important procedure for anyone, but particularly those who are at risk of colorectal cancer and those experiencing gastrointestinal symptoms. Early detection can significantly reduce the risk of severe conditions and prevent cancer. In Singapore, specific groups are encouraged to undergo this screening for optimal health outcomes. However, anyone at any age can undergo a colonoscopy, especially if it has been recommended by your doctor.
Individuals aged 50 and above: Recommended for routine colorectal cancer screening.
High-risk individuals: Those with a family history of colorectal cancer or a personal history of polyps.
Symptomatic patients: Anyone experiencing symptoms such as unexplained rectal bleeding, persistent abdominal pain, or changes in bowel habits should consult a doctor regarding a colonoscopy.
Benefits of Colonoscopy
Colonoscopy is a highly effective procedure for identifying and treating colorectal issues before they become severe. Key benefits include:
Cancer prevention: Detecting and removing polyps early can prevent them from turning into cancer [3].
Polyps removal: Small colorectal polyps can often be removed during the colonoscopy, reducing the risk of future complications.
Routine preventive screening: Anyone can undergo a colonoscopy as a preventive measure to ensure they are healthy and have no underlying colorectal issues.
A colonoscopy is recommended for those above 45 to detect colorectal cancer in the early stages or other gastrointestinal conditions.
Preparing for a Colonoscopy
Preparing for a colonoscopy is a crucial step to ensure the procedure's effectiveness and accuracy. Speak to your doctor if you have any concerns about how you can prepare for the procedure. Here’s a general guide on what to expect before a colonoscopy is booked.
Consultation: Before a colonoscopy, you will have a consultation with your doctor to discuss your medical history, current medications, and any symptoms. Your doctor will also provide instructions on how to prepare for the procedure.
Pre-procedure guidelines: Typically, you will need to follow a clear liquid diet for a few days before the procedure and take a prescribed laxative to clean out the colon for clear visibility during the exam.
What to expect before the procedure: On the day of the colonoscopy, you will be asked to arrive at the clinic or hospital in comfortable clothing. The procedure is usually done under sedation, meaning you won’t feel discomfort or remember much of it.
Colorectal polyps can be detected and removed during a colonoscopy, which can turn into cancer if left untreated.
The Colonoscopy Procedure
A colonoscopy is considered a minimally invasive procedure as it still requires internal access to the colon. However, the procedure is typically done under sedation, so most patients experience little to no discomfort during the exam. Although there are potential risks, such as bleeding or perforation of the colon, these complications are rare, and the benefits of early detection and prevention of colorectal conditions often outweigh the risks.
Here’s a brief guide on what to expect during a colonoscopy. However, bear in mind that some people react differently to sedation and recovery.
Step-by-Step Process of Colonoscopy:
Preparation: A day before the procedure, you'll follow a liquid diet and take a prescribed laxative to clean out the colon.
Sedation: Upon arrival at the clinic or hospital, you'll be sedated to ensure comfort during the procedure.
Procedure: A flexible tube with a camera is gently inserted into the rectum and advanced through the colon.
Examination and treatment: The doctor examines the colon’s lining, and any polyps or abnormalities are removed or biopsied if necessary.
Post-procedure: After 30-60 minutes, you'll rest as the sedation wears off, and can typically go home the same day.
Recovery: After the colonoscopy, you will rest for about an hour as the sedation wears off. You may experience mild discomfort, bloating, or gas. It's advisable to have someone accompany you home, as the sedation may impair your ability to drive.
Persistent abdominal pain or bloating can be a cause for concern. A colonoscopy can help rule out or diagnose serious gastrointestinal issues.
Risks and Complications of a Colonoscopy
While colonoscopy is generally safe, it carries some risks [4], especially if polyps are removed during the procedure.
Side effects: These include mild abdominal discomfort, bloating, or cramping. You may also experience slight rectal bleeding if a biopsy was taken.
Potential risks: In rare cases, complications like perforation of the colon, infection, or adverse reactions to sedation can occur.
Complications: If you experience severe pain, excessive bleeding, or fever after the procedure, contact your doctor immediately.
Costs of Colonoscopy in Singapore
The cost of a colonoscopy in Singapore varies depending on the type of facility (public vs private), the complexity of the procedure, and whether sedation or polyp removal is involved.
In public hospitals, the cost typically ranges from SGD 1,200 to SGD 1,800, while private hospitals and clinics may charge between SGD 3,000 and SGD 6,000. Some insurance plans and Medisave can cover part of these costs. It's advisable to check with your insurance provider regarding coverage for colonoscopy, especially if it’s for preventive screening.
Choosing the Right Doctor for a Colonoscopy
Choosing a qualified and experienced doctor is key to a successful colonoscopy. Look for board-certified gastroenterologists who specialise in digestive health and have ample experience in performing colonoscopies. Read reviews, ask for referrals, and consider the doctor’s reputation, experience, and areas of specialisation. Some doctors may also have specific expertise in removing complex polyps or managing high-risk patients.
Dr. Bhavesh Doshi is a highly experienced gastroenterologist based in Singapore with over 25 years in the field. As the founder and medical director of Gastrohealth Centre for Digestive and Liver Care located in Gleneagles Hospital and Mount Alvernia Hospital, he specialises in advanced endoscopic procedures, including gastroscopy, colonoscopy (both basic and complex), endoscopic ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP). Additionally, he offers expertise in bowel cancer screening, endoscopic mucosal resection, and stenting.
For invasive procedures such as a colonoscopy, it’s best to go with an experienced doctor who you feel comfortable with. Dr. Doshi has performed over 15,000 scopes and is fluent in English, Hindi, Indonesian, and Malay, making him accessible to a diverse range of patients. Book an appointment to find out more.
Post-Colonoscopy: What to Expect
After a colonoscopy, it’s essential to adhere to your doctor's follow-up instructions, particularly if any biopsies were taken or polyps were removed. The results of these procedures typically arrive within a few days, and your doctor will discuss the findings with you during a follow-up appointment. If polyps were discovered and removed, you may need to make dietary or lifestyle adjustments to promote better colon health. Incorporating a diet rich in fibre[5] and low in processed foods can significantly contribute to maintaining a healthy digestive system and preventing future issues. Regular monitoring and a proactive approach to diet can help ensure long-term well-being.
After a colonoscopy, you may be advised to follow a diet rich in fibre to maintain a health digestive system.
Conclusion
In conclusion, colonoscopy is a vital procedure in Singapore for the early detection and prevention of colorectal cancer, and to treat other gastrointestinal issues that may become severe. With rising cancer rates, regular screenings are essential for individuals aged 50 and above, as well as those at higher risk. The procedure, while minimally invasive, provides crucial insights into colon health and allows for the removal of precancerous polyps. By prioritising colonoscopy and adhering to follow-up care and lifestyle adjustments, individuals in Singapore can significantly enhance their digestive health and reduce the risk of serious conditions.
Frequently Asked Questions
Is colonoscopy painful? The procedure is typically painless due to sedation, but some may experience mild discomfort afterward.
What can I eat after a colonoscopy? You can resume a normal diet after the procedure, starting with light meals.
What are the risks of colonoscopy? Risks include bleeding, perforation of the colon, and reactions to sedation, although these are rare.
Will my insurance cover a colonoscopy? Many insurance plans do cover colonoscopy, particularly if it's for screening purposes. Always check with your provider beforehand.
What happens if the doctor finds polyps? If polyps are found, they may be removed during the procedure and sent for biopsy to check for cancer.
Ioniță Mindrican, C. B., Ziani, K., Mititelu, M., Oprea, E., Neacșu, S. M., Moroșan, E., Dumitrescu, D. E., Roșca, A. C., Drăgănescu, D., & Negrei, C. (2022). Therapeutic Benefits and Dietary Restrictions of Fiber Intake: A State of the Art Review. Nutrients, 14(13), 2641. Retrieved from: https://doi.org/10.3390/nu14132641
Can Healthier Lifestyle Choices Prevent Colon Cancer?
The digestive system plays a pivotal role in your overall health as it breaks down foods into their simplest form to allow the body to absorb nutrients, be used for energy, and repair cells. The digestive system comprises several organs essential for digestion, including the large intestine, better known as the colon [3]. It is a vital part of the digestive system, some of its key functions are to absorb water, and electrolytes from undigested food, to form and store excrement, and to facilitate waste removal in the body.
The colon is one of the four parts that make up the large intestine.
Considering its significance, it goes without saying that colon health is of utmost importance, especially when certain lifestyle behaviour choices can severely damage your colon, so much so that they breed a host of colon diseases that impact your overall health.
Colon Diseases: Colorectal Cancer and Colon Polyps
Unfortunately, colorectal cancer [4], or colon cancer, is one of the most common types of cancer [5] in Singapore, with approximately 1,500 new cases diagnosed annually. In fact, an individual has a 5.6% chance of being diagnosed with colorectal cancer in his or her lifetime. Although doctors are uncertain what actually causes colorectal cancer, colon polyps [6] that are formed in the inner lining of the colon carry the risk of becoming cancerous in the future. Most colon polyps are benign. However, adenomatous colon polyps have a higher possibility of becoming cancerous if they are given enough time to grow.
You must be asking, “Who is more likely to get colon polyps or colorectal cancer?”
Genetic factors, such as a family history of colorectal-related diseases and environmental factors like ageing, can increase the likelihood of developing colon polyps or colorectal cancer.
But what you may not be aware of is that some of your lifestyle and behaviour choices can actually increase the risk of developing adenomatous colon polyps and colorectal cancer.
How Are My Choices and Habits Harming My Colon Health?
Some lifestyle choices and behavioural habits are actually harming your colon, as they cause chronic inflammation, which can lead to colon polyps or colorectal cancer.
Surprising as it may be, it is true! You could unintentionally be jeopardising your colon health through these lifestyle choices, and behavioural habits:
Unhealthy Diet
One of the most common risk factors that are associated with colorectal cancer, and colon polyps is an unhealthy diet [7]. As it turns out, researchers have identified that a diet that is rich in processed meats, high in sugar and animal fat, but low in fruits and fibre has been linked to an increased risk of developing colorectal cancer, and precancerous colon polyps. The food we consume can actually cause inflammation – which is a predisposing factor for colon cancer – in the large intestine. In fact, researchers discovered that animal fats, along with processed meats like hot dogs, bacon, and salami, can lead to chronic inflammation. What is even more shocking is that a person who consumes processed meat four (or more) times a week, is 20% more likely [8] to develop colorectal cancer compared to those who consume processed meat twice a week.
Obesity
Our unhealthy eating habits and poor diet can result in obesity [9]. Much like the food we eat, excessive fat deposits can result in chronic inflammation, which increases the risk of precancerous colon polyps, and colorectal cancer. However, the effects of excess body fat [10], especially visceral fat, do not stop there. Being overweight, or obese can result in higher levels of insulin, as well as insulin-like growth factor, and sex hormones. As a result, these changes can increase the chances of developing colorectal cancer, and colon polyps.
Sedentary Lifestyle
We are certain you have heard that a sedentary lifestyle can risk your overall health and well-being. So, it is unsurprising that sedentary lifestyles, coupled with a lack of regular exercise, have been associated with obesity [11], which can lead to colorectal cancer and precancerous colon polyps. This is because a sedentary lifestyle and a lack of physical activities encourage insulin resistance, and chronic inflammation in the colon.
Smoking
Smoking poses a significant risk factor for many diseases, including the development of colorectal cancer. The carcinogens contained in tobacco smoke [12], like aromatic amines, polycyclic aromatic hydrocarbons, and nitrosamines, can enter the bloodstream, and reach the colon. This is a call for concern as these carcinogens can induce DNA damage in the cells lining the colon, which can cause mutations that speed up the development of colorectal cancer, and precancerous colon polyps. To top it all off, smoking has been known to cause chronic inflammation [13], and oxidative stress throughout the body, including the colon. Chronic inflammation combined with oxidative stress creates a microenvironment that stimulates tumour growth by interfering with normal cellular processes and promoting the multiplication, and survival of cancerous cells. As if that is not bad enough, smoking has also been linked to alterations in the gut microbiota [14], thereby influencing the balance of beneficial, and harmful bacteria in the colon. This potentially exacerbates the risk of colon cancer and precancerous colon polyps.
Excessive Alcohol Consumption
Meanwhile, alcohol consumption has been consistently linked to an increased risk of precancerous colon polyps, and colorectal cancer. When alcohol is consumed, it is metabolised by enzymes in the liver, leading to the production of a carcinogen that promotes cancerous growth [15]. However, the adverse side effects of excessive alcohol consumption do not end there. Excessive alcohol consumption can further exacerbate the risk of precancerous colon cancer, and colorectal cancer because alcohol may interfere with the absorption of essential nutrients, like folate, which plays a role in DNA repair.
If you are feeling overwhelmed by the information overload, relax!
We understand that it can be daunting knowing that our poor lifestyle choices and behavioural habits can risk our health. But we do have some good news: you can lower the risks of developing colorectal cancer, and precancerous colon polyps!
Making Lifestyle Changes to Lower Risk Factors of Colon Diseases
Exercising can greatly lower your risk of developing colorectal cancer, and colon polyps.
Although it is impossible to prevent genetic mutations that often lead to precancerous colon polyps, and colorectal cancer, you can take charge of your health by adopting healthier lifestyle choices to lower the risk of colorectal cancer, and precancerous colon polyps.
So, where do you start? Here are some of our suggestions:
Healthy Diet
Right off the bat, it is important to adopt a healthier diet [16], which entails a diet that is rich in fruits, vegetables, and whole grains. You do not have to completely forget processed meat, or fat. The key here is to eat a wholesome, and balanced diet that is jam-packed with essential vitamins, minerals, and antioxidants that support your overall health, and bolster the body’s defences against cancerous cells. We understand that changing your diet can be a tall order. So, to help you out, here is a simple guideline [17] you can refer to:
Eat more:
Fruit: apples, berries, bananas, pears, oranges, and melons. When it comes to fruits, it is always best to opt for the whole fruit, rather than fruit juices.
Vegetables: broccoli, carrots, eggplants, tomatoes, and salad greens. Did you know that all vegetables have cancer-preventive properties? Well, now that you do, it is time to boost your vegetable intake.
Whole grains: oats, grains, barley, lentils, beans, black rice, and quinoa. As they are high in fibre, they have an abundance of substances that can protect against colorectal cancer and colon polyps.
Eat less:
Red meat: meats like beef, lamb, and pork can increase the risk of colorectal cancer, and colon polyps. That is why it is recommended to eat about 500 grammes (or less!) of red meat weekly.
Processed meat: sausages, bacon, hot dogs, and cold cuts, is yummy to eat. But sadly, they contain high levels of carcinogens that stimulate cancerous cell growth. So, it is best to keep the processed meat to a minimum.
Alcohol: since excessive alcohol consumption increases the risk of colorectal cancer and precancerous colon polyps, you should limit your alcohol intake to 1 drink per day.
Watching Your Weight
Maintaining a healthy weight is one of the most effective ways to lower the risk of developing colon polyps, and colorectal cancer. On top of adopting a healthier diet, you can also incorporate regular exercises into your fitness regime to maintain a healthy weight or shed extra pounds. While the frequency of exercises, types, and intensity have yet to be properly determined, studies have found that physical activities can prevent roughly 15% [18] of all colon cancers. But what is more important is that exercising helps to regulate insulin levels, reduce obesity, and combat inflammation – all of which delay the progression of colon polyps, and colorectal cancer.
Quit Smoking
After learning how smoking can speed up the progression of colorectal cancer, do you still need some persuasion to put those cigarettes down? If you feel that it is too late for you to stop smoking due to your age, do not be discouraged! The health benefits of quitting smoking [19] can occur at any age, regardless of whether you are a social smoker or a chain smoker. So, if you smoke, then it is time to quit.
Taking Control of Your Colon Health
Improve your colon health by going on a colon cleanse by drinking detox juices.
Now that you are aware of what increases the risk of developing colorectal cancer, and colon polyps, along with the preventative steps to take, it is time to take control over your colon health.
But taking care of your colon goes beyond living, and eating healthier. It also includes going for routine colorectal screening. Going for routine screenings, especially colonoscopies, can help detect, and remove colon polyps before they become cancerous [20]. Colonoscopies will also be able to detect colorectal cancer in its earlier stages, which increases the possibility of better treatment outcomes.
Do you know if your family has a family history of colorectal cancer or colon-related diseases? If you do not, then it is time to have a chat with your parents and find out your family’s medical history. By being armed with all the relevant, and necessary information pertaining to your health, it will be that much easier to get ahead of colorectal cancer, and colon polyps. Because genetics is a known risk factor [21] for colon-related diseases, you are at an increased risk of developing adenomatous colon polyps, and colorectal cancer.
Finally, flushing out your colon [22] will do wonders for your colon! Staying hydrated is one way to keep your digestive system functioning properly, and help reduce the risk of colon polyps, and colon cancer. You can even give home remedies for a colon detox juice a shot if you are up for it! Cleansing your colon will aid in weight loss and management, remove toxins from the body, improve your immune and digestive systems, and ultimately, lower the risk of colon polyps, and colorectal polyps. So, in a time when self-love is encouraged: love yourself, by showing your colon some attention and care.
References
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[2] Your digestive system & how it works - niddk. (n.d.) National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works (Accessed: 29 April 2024).
[3] Large Intestine (Colon) (2021) Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/body/22134-colon-large-intestine (Accessed: 29 April 2024).
[4] Colorectal (Colon) Cancer (2022) Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/14501-colorectal-colon-cancer (Accessed: 29 April 2024).
[5] Singapore Cancer Registry Annual Report 2021 (2023). National Registry of Diseases Office. Available at: https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-ar-2021-web-report.pdf?sfvrsn=591fc02c_0 (Accessed: 29 April 2024).
[6] Colon Polyps (2023) Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/colon-polyps/symptoms-causes/syc-20352875 (Accessed: 29 April 2024).
[7] Mohammad, N.M. et al. (2022). Association between diet-related behaviour and risk of colorectal cancer: A scoping review. Journal of Cancer Prevention, 27(4), pp. 208–220. doi:10.15430/jcp.2022.27.4.208.
[8] Bradbury, K.E., Murphy, N. and Key, T.J. (2019). Diet and colorectal cancer in UK Biobank: A prospective study. International Journal of Epidemiology, 49(1), pp. 246–258. doi:10.1093/ije/dyz064.
[9] Obesity: What You Need To Know (2020) Healthline. Available at: https://www.healthline.com/health/obesity (Accessed: 2 May 2024).
[10] Obesity and Cancer (2023) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/cancer/obesity/index.htm (Accessed: 2 May 2024).
[11] Inactivity and Cancer Risk: The Latest Research (2014). American Institute for Cancer Research. Available at: https://www.aicr.org/news/inactivity-and-cancer-risk-the-latest-research/ (Accessed: 2 May 2024).
[12] Chao, A. (2000). Cigarette smoking and colorectal cancer mortality in the cancer prevention study II. Journal of the National Cancer Institute, 92(23), 1888–1896. https://doi.org/10.1093/jnci/92.23.1888
[13] Hosseinzadeh, A., Thompson, P. R., Segal, B. H., & Urban, C. F. (2016). Nicotine induces neutrophil extracellular traps. Journal of Leukocyte Biology, 100(5), 1105–1112. https://doi.org/10.1189/jlb.3ab0815-379rr
[14] Antinozzi, M., Giffi, M., Sini, N., Gallè, F., Valeriani, F., De Vito, C., Liguori, G., Romano Spica, V., & Cattaruzza, M. S. (2022). Cigarette smoking and human gut microbiota in healthy adults: A systematic review. Biomedicines, 10(2), 510. https://doi.org/10.3390/biomedicines10020510
[15] Rossi, M., Jahanzaib Anwar, M., Usman, A., Keshavarzian, A., & Bishehsari, F. (2018). Colorectal Cancer and Alcohol Consumption-Populations to Molecules. Cancers, 10(2), 38. https://doi.org/10.3390/cancers10020038
[16] What To Eat To Lower Your Risk of Colon Cancer (2023). Cleveland Clinic. Available at: https://health.clevelandclinic.org/the-best-diet-to-lower-your-colon-cancer-risk-2 (Accessed: 4 May 2024).
[17] Ryan-Harshman, M., & Aldoori, W. (2007). Diet and colorectal cancer: Review of the evidence. Canadian family physician Medecin de famille canadien, 53(11), 1913–1920.
[18] Oruç, Z., & Kaplan, M. A. (2019). Effect of exercise on colorectal cancer prevention and treatment. World journal of gastrointestinal oncology, 11(5), 348–366. https://doi.org/10.4251/wjgo.v11.i5.34s
[20] Zheng, S., Schrijvers, J. J. A., Greuter, M. J. W., Kats-Ugurlu, G., Lu, W., & de Bock, G. H. (2023). Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis. Cancers, 15(7), 1948. https://doi.org/10.3390/cancers15071948
[21] Colorectal cancer risk factors: Hereditary colorectal risk factors. Hereditary Colorectal Risk Factors | American Cancer Society. (n.d.). Available at: https://amp.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-factors.html (Accessed: 7 May 2024).
[22] WebMD. (n.d.). Colon cleanse: Benefits, methods, Risks & Health Implications. WebMD. Available at: https://www.webmd.com/balance/natural-colon-cleansing-is-it-necessary (Accessed: 7 May 2024).
Are colon polyps a cause for concern?
The diagnosis of colon polyps, also known as colorectal polyps, often strikes panic in patients. Colon polyps are abnormal growths that develop in the lining of your colon. These growths vary in size and shape and typically start as small, benign clumps of cells on the inner surface of the colon.
Colon polyps are small lumps of cells that grow in the lining of the colon.
Frequently affiliated with cancer, colon polyps are usually detected during routine colonoscopy screening or when patients actively seek remedies for issues such as bloating, rectal bleeding, changes in bowel habits, and stool colour. In this article, we take a deep dive into colon polyps and whether the concern surrounding the subject is warranted.
Myth 1: Colon Polyps = Colorectal Cancer
The common misconception is that colon polyps will inevitably progress into colorectal cancer. Whilst 95% [1] of colon cancer begins with colon polyps, only an estimated 5% [2] will eventually progress into colorectal cancer [3]. Nonetheless, given that colorectal cancer is the predominant cancer in Singapore [4], it is unsurprising that many Singaporeans are concerned about polyps.
Unbeknownst to many, the actual determinant of colon polyps becoming cancerous is the size of the polyps [5] during discovery. Below, we discuss the estimated prevalence of cancerous polyps out of 550,811 polyps studied.
Polyp size Percentage of cancer
1–5 mm 0.6%
6–9 mm 2.1%
10 mm+ 13.4%
** It has been noted from prior studies [6] that polyps of size 30 mm or more have the highest risks of cancer progression.
The size of a colon polyp determines the likelihood of the growth progressing into colon cancer.
Additionally, the type of polyps is another factor that significantly determines the likelihood of cancer progression. There are two primary categories of colon polyps: adenomatous [7] and hyperplastic [8].
Adenomatous polyps, specifically, tend to raise concern as they have a higher likelihood of cancer progression. These are further divided into three subtypes:
Tubular adenomas:tubular adenomas [9] are the most commonly occurring polyps and tend to have a lower risk of developing into cancer.
Villous adenomas: villous adenomas [10] are less common but more likely to become cancerous.
Tubulovillous adenomas:tubulovillous adenomas [11] are a mix of tubular and villous features with a moderate risk of malignancy.
Hyperplastic polyps, on the other hand, are typically benign and rarely become cancerous. They often occur on the left side of your colon and do not raise concern. The most promising preventative care one can practice is to detect and remove polyps regardless of the type of polyp. This sentiment is echoed unanimously [12] by medical professionals in Singapore.
Myth 2: Only symptomatic patients should be screened
This myth is not only inaccurate but rather dangerous. Most patients with colon polyps are asymptomatic, so if you are stalling screening because there are no concerning signs at sight yet, you may be missing the opportunity to introduce intervention at early stages. As mentioned, when polyps grow to a certain size, the risk of cancer progression increases concurrently. Thus, conducting health screening at the prescribed frequency is in your best interest.
Regular screening allows for detecting and removing colon polyps at early stages.
Additionally, patients tend to consider their risk factors less. Where risk factors are present, the standard recommendations will no longer apply. It is recommended to discuss screening and surveillance with your doctor, depending on your risk factors.
Myth 3: Colon polyps are only prevalent among older men
While colon polyps are more prevalent in men than women (66.2% vs 33.8%) [14] and are generally of higher concern in seniors [15], this statement is not necessarily true. Children, too, may be at risk of polyp growth, known as juvenile polyposis [16]. These are usually detected when children present symptoms such as rectal bleeding.
In some Asian countries, the prevalence of colon polyps in younger age groups has been growing [17]. For instance, in India, one out of six people [18] over 40 has a polyp, increasing the risk of colorectal adenoma fivefold after age 40. A recent study [19] also projected an increased incidence rate for colon and rectal cancers by 90% and 124%, respectively, for patients between 20 and 34 years of age based on increased findings of colon polyps in younger adults.
The verdict
So, should colon polyps be a cause for concern? The studies mentioned above indicate that more adults may have colon polyps. Additionally, even younger age groups adults are now vulnerable to colon polyp growth. Given the pervasiveness, we can safely deduce colon polyps growth is not an unusually unique health concern.
Yes, colon polyps do increase the risk of cancer. However, patients are not doomed to have cancer in their lifetime invariably. The takeaway from the recent statistics about colon polyp growth signals an immediate need for change in lifestyle and proactiveness in health. Patients must take more accountability for their health where risk factors are present.
Stay tuned for the next article, where we discuss lifestyles and behaviours that increase the risks of colon polyps and colorectal cancer, ways to prevent them, and how to retake autonomy of your health.
Calva, D. and Howe, J. (2009) Juvenile polyposis - cancer syndromes, National Library of Medicine . Available at: https://www.ncbi.nlm.nih.gov/books/NBK51310/ (Accessed: 10 October 2023).
Pan, J. et al. (2020) Prevalence and risk factors for colorectal polyps in a Chinese population: A retrospective study, Nature.com. Available at: https://www.nature.com/articles/s41598-020-63827-6 (Accessed: 10 October 2023).
Bailey, C.E. et al. (2014) Increasing Disparities in the Age-Related Incidences of Colon and Rectal Cancers in the United States, 1975-2010, JAMA Surgery. Available at: https://jamanetwork.com/journals/jamasurgery/fullarticle/1920838 (Accessed: 10 October 2023).
Is it IBS, or just an upset tummy? Here’s how to tell
Stomach pains can hit you at any moment; unfortunately, it usually happens when you least expect it. Whether your stomach pains are caused by food poisoning, irritable bowel syndrome, or just regular stomach aches, it is inconvenient and often embarrassing.
But it is important to understand the cause of your stomach pains; having an upset tummy, though inconvenient, is curable and not long-term. On the other hand, irritable bowel syndrome (IBS) is a chronic condition that, while not curable, is treatable through the management of symptoms.
Stomach pains can sometimes be ambiguous, with causes ranging from food poisoning, lactose intolerance, to irritable bowel syndrome.
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome, commonly referred to as IBS, is a gastrointestinal disorder that is relatively common, affecting 6-18% of people worldwide [1]. Although IBS comprises a variety of symptoms that affect the gastrointestinal tract, a recent study conducted in 2022 found that it does not increase your risk of gastrointestinal cancer [2].
IBS is a functional gastrointestinal disorder or a disorder of the gut-brain interaction. This means there is a problem with how the gut and brain work together, causing the gastrointestinal tract to be highly sensitive, thus affecting the contraction of the bowel muscle, resulting in bloating, constipation, abdominal pain, and diarrhoea.
The main cause of IBS is still unknown and poorly misunderstood. However, several factors have been linked to the development of IBS. These are:
Intestinal muscle contraction: individuals with IBS tend to have altered intestinal muscle contractions.
Visceral hypersensitivity: visceral organs, which consist of the organs in your chest, abdomen, and pelvic region, are more sensitive to pain in individuals with IBS. This stems from issues in the nervous system that overreact when the gastrointestinal tract moves and stretches during digestion.
Infection: a bacterial or viral infection that causes diarrhoea, also known as gastroenteritis, can cause IBS.
Inflammation: one of the persistent issues seen in individuals with IBS.
Stress: exposure to stress in the early stages of life can result in numerous IBS symptoms.
Irritable bowel syndrome occurs due to abnormal contractions in the gastrointestinal tract.
What are the symptoms of IBS?
IBS has many symptoms, but it varies from person to person. These symptoms include:
Abdominal pain or discomfort
Change in appearance of stools
Bloating
Change in frequency of stools (constipation or diarrhoea)
Acid reflux or heartburn
Headache
Muscle aches and pains
These symptoms come and go for varying durations. For example, bloating or gas tends to disappear after a bowel movement. Therefore, IBS is often misdiagnosed as other conditions, such as an upset tummy or even lactose intolerance.
Differences between IBS and upset tummy
While they may have some similar symptoms, there are a few clear-cut ways to tell if you have IBS or just an upset tummy.
Irritable bowel syndrome
Upset tummy
It happens frequently and with greater severity.
It occurs rarely, and symptoms are not as severe.
Pain does not wake you up at night.
Pain is more severe at night and can wake you up, especially in cases of food poisoning.
Pain may affect the whole gastrointestinal tract.
Pain is generalised.
Symptoms usually include constipation, diarrhoea, or both, and lower abdominal pain.
Symptoms usually include nausea, vomiting, and upper abdominal pain.
The intestinal lining appears normal.
The intestinal lining is inflamed.
There are no known causes, but they have been linked to several factors.
It is known to be caused by various bacteria, viruses, food, medication, etc.
IBS differs from an upset tummy in various ways, such as pain location – upper abdomen for IBS and lower abdomen for an upset stomach.
How is IBS diagnosed?
If you suspect that you might be experiencing IBS, you should consult with a gastroenterologist who will help you manage your symptoms. IBS is diagnosed if you fulfil the following criteria:
Unexplained persistent stomach pains that occur three or more times for at least three months in a row with no sinister symptoms
Pain or discomfort during bowel movements.
Change in frequency of bowel movements.
Change in appearance of stools.
The following diagnostic tests can be conducted if IBS is suspected:
Complete medical history: your gastroenterologist will ask you questions about your medical history, symptoms, foods that trigger your IBS symptoms, family history of IBS, etc.
Blood test: this helps to check for anaemia and rule out medical conditions such as coeliac disease.
Stool test: also done to rule out infections.
Colonoscopy: a colonoscopy is a procedure involving a thin and flexible tube with a camera and light attached at one end, which is inserted into the anus and led up through the rectum and large intestine for a proper examination.
Computed tomography scan (CT-scan): a CT-scan is a non-invasive diagnostic imaging tool that uses a combination of X-rays and computer technology to produce cross-sectional, horizontal, or axial images of our body. This helps your gastroenterologist to identify any abnormalities.
Gastroscopy: a gastroscopy is a procedure involving a thin and flexible tube with a camera and light attached at one end, which is inserted into the mouth and led down through the oesophagus, into your stomach and your small intestine for a proper examination.
A gastroscopy can be used to diagnose causes of abdominal pain.
What is the best treatment for IBS?
The best treatment for IBS depends on what works for you; IBS treatment for you may be different from IBS treatment for someone else. Here are some treatment options that you may try to help yourself with IBS:
Regular physical activity/exercise
Reduce or avoid caffeinated drinks
Consume small meals
Minimise stress by doing yoga or relaxation techniques
Try the low FODMAP diet (a diet plan that restricts carbohydrates)
Take probiotics to improve gut bacteria
Your gastroenterologist can prescribe several medications:
Antidepressants for patients with depression or anxiety
Medications to relieve constipation or diarrhoea
Pain medications to alleviate or manage pain
The first line of treatment for IBS would be remedies you can try at home, such as lifestyle changes. However, if severe symptoms persist, medications can be prescribed to help manage them.
In conclusion, IBS is very different from an upset tummy. IBS is a chronic, incurable condition, while an upset stomach is an acute, curable condition. There are no known causes of IBS, but several causes of an upset tummy, such as gastroenteritis, food poisoning, etc.
So, next time you have any stomach pains, remember when it happens, how frequently it happens, and what the symptoms are. If it happens again within the next few days, weeks, or months, you could be developing IBS.
If you suspect you have IBS, book an appointment with us today, and we can help you manage your symptoms.
References
Ami D Sperber, D. D.-Y. (2017). The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut, 1075-1082.
Shanshan Wu, C. Y. (2022). Irritable Bowel Syndrome and Long-Term Risk of Cancer: A Prospective Cohort Study Among 0.5 Million Adults in UK Biobank. The American Journal of Gastroenterology, 785-793.
Lactose intolerance versus milk allergy: What’s the difference?
Not many people know this, but lactose intolerance is not the same as a milk allergy – although they may sound the same. Lactose intolerance is not dangerous, but a milk allergy could be life-threatening. Read on to learn more about this modern-day conundrum.
Lactose intolerance and milk allergy are not the same thing.
What is lactose intolerance?
Lactose intolerance is an issue of the digestive system that occurs when an individual’s small intestine does not produce or does not produce enough lactase – an enzyme necessary for the breakdown of lactose. Lactose is a type of sugar specifically found in milk and other dairy products like chocolate, yoghurt, cheese, ice cream, and butter.
Digesting lactose does not pose any problem for most people because lactase breaks down lactose into glucose and glycogen, which are then absorbed into our bloodstream and transported to all body parts to be used as energy.
For people who are lactose intolerant, lactose cannot be broken down, so it travels down to the colon, where it gets fermented by bacteria, resulting in bloating, diarrhoea, and abdominal cramps.
Fortunately, although lactose intolerance is inconvenient and, at times, embarrassing, it is not a life-threatening condition.
What are the causes of lactose intolerance?
We already know that lactose intolerance is caused by insufficient or a complete lack of lactase. But why do some individuals lack this enzyme?
Congenital lactase deficiency: some individuals may produce little or no lactase since birth.
Injury: some medical conditions, such as Crohn’s disease or coeliac disease, cause injury or damage to the small intestine, resulting in reduced lactase production.
Lactase nonpersistence: this occurs when the small intestine slows down lactase production as time goes by — this is why some people only develop lactose intolerance when they are adults.
Premature birth: the small intestines in babies born prematurely may not produce enough lactase initially. This condition is known as transient lactose intolerance as it usually corrects itself as the baby grows older.
Premature babies have been found to be more prone to lactose intolerance than full-term babies.
What are the symptoms of lactose intolerance?
Symptoms of lactose intolerance usually appear 30-60 minutes after consuming dairy products; symptoms include:
Bloating
Diarrhoea
Abdominal cramping
Gassiness
Nausea
Vomiting
Gurgling or rumbling in the stomach
The severity of symptoms depends on two things:
How much dairy was consumed
How well your body can tolerate lactose (based on whether your body produces lactase at all or whether your body produces insufficient lactase)
These symptoms are brief and will be alleviated once the dairy products have been removed from your digestive system.
What is a milk allergy?
A milk allergy, like all types of allergies, is an issue of the immune system where the body over-reacts to one or more proteins present in milk and other dairy products. This results in an allergic reaction with symptoms ranging from mild (rashes) to severe/life-threatening (anaphylactic shock).
Milk allergies can affect anyone but are one of the most common allergies in children and babies, affecting approximately 0.5-2.5% of children [1],[2],[3],[4]. Milk allergies usually occur in response to dairy products that contain cow’s milk.
Milk allergy is an allergy to dairy products that contain cow’s milk.
What are the causes of a milk allergy?
For individuals with a milk allergy, their immune system recognises one or more proteins in milk as a foreign invader. As a response, the immune system releases the antibody – immunoglobulin E (IgE), which then signals the body to release histamine and other chemicals responsible for the allergic symptoms.
Two proteins in cow’s milk can trigger an allergic reaction:
Whey: the liquid that remains when milk curdles.
Caesin: the solid part of milk when it curdles and the most common trigger of milk allergies.
Your likelihood of developing a food allergy such as a milk allergy significantly increases if one or both of your parents have allergies to food or other particles [5].
Types of milk allergies and their symptoms
lgE-mediated
Non-IgE mediated
What is it
IgE is an antibody the immune system produces when it recognises milk protein as a foreign invader. It causes immediate symptoms.
Involves other aspects of the immune system other than IgE. Symptoms develop later and are usually confused with the symptoms of lactose intolerance.
Symptoms
Rashes or hivesWheezingCoughingBreathlessnessItching around the mouthSwelling of the lips, mouth, or tongue Vomiting
Apart from identifying your symptoms, diagnostic tests must be carried out to confirm if you have lactose intolerance or a milk allergy.
Testing must be conducted to identify whether your symptoms are due to lactose intolerance or a milk allergy.
Tests for lactose intolerance include:
Hydrogen breath test: a hydrogen breath test measures the amount of hydrogen in your breath after consuming dairy products. Elevated hydrogen levels in your breath may suggest digestive issues like lactose intolerance.
Lactose intolerance test: your blood sugar level is measured after consuming dairy products. Your blood sugar level will not rise if you have lactose intolerance since your body cannot break down lactose into glucose and glycogen which are then absorbed by the bloodstream.
Genetic testing: tests for any genetic causes of lactose intolerance.
Stool acidity test: most commonly used for babies where the acidity levels of their stool are tested. A lower pH level (more acidic) signals lactose intolerance.
Lactase activity at the jejunal brush border: this is an invasive but accurate test involving a biopsy of the jejunal brush border – part of your small intestine.
Tests for a milk allergy include:
Blood test: a blood sample will be taken and sent to a laboratory. Milk proteins are then introduced to your blood sample, and the levels of IgE are measured. High levels of IgE present signals a milk allergy.
Skin prick test: a part of your skin will be cleaned and pricked with a small amount of fluid containing milk proteins. After 15 minutes, the test area is examined to check for any skin discolouration, raised skin, or itchy skin. A reaction signals a milk allergy.
Graded oral challenge: a small amount of milk is ingested in a controlled environment. Your doctor will examine you for an allergic reaction.
Conclusion
Lactose intolerance and milk allergy are different, even down to the way each one is diagnosed. Lactose intolerance is a digestive system issue, while milk allergy is an immune system issue. The former is not life-threatening, while the latter can be.
Fortunately, both can be treated, and symptoms can be avoided simply by steering clear of dairy products. It is essential to get properly tested so you can live comfortably and healthily.
References
Julie D Flom, S. H. (2019). Epidemiology of Cow’s Milk Allergy. Nutrients, 1051.
AA Schoemaker, A. S.-P. (2015). Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort. Allergy, 963-972.
Junichiro Tezuka, 1. M. (2021). Possible association between early formula and reduced risk of cow’s milk allergy: The Japan Environment and Children’s Study. Clinical and Experimental Allergy, 99-107.
Rachel L Peters, J. J.-L. (2018). The Prevalence of Food Sensitization Appears Not to Have Changed between 2 Melbourne Cohorts of High-Risk Infants Recruited 15 Years Apart. The Journal of Allergy and Clinical Immunology in Practice, 440-448.
Kanika Kanchan, S. C. (2021). Current insights into the genetics of food allergy. The Journal of Allergy and Clinical Immunology, DOI:https://doi.org/10.1016/j.jaci.2020.10.039.
