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Lower Gastrointestinal (GI) Tract Disorders

  • What are common conditions affecting the lower gastrointestinal (GI) tract?

    lower gastrointestinal tract disorders

    The lower gastrointestinal (GI) tract begins at the midsection of the small intestine, extending throughout the large intestine till the anus.

    Common conditions associated with the lower GI tract include diverticular disease, polyps, irritable bowel syndrome (IBS), cancer, or Crohn's disease, and usually require prompt clinical care by a gastroenterologist or a colorectal surgeon. Find out more about these conditions, the symptoms, diagnosis methods, and treatment options available.

    Don't let digestive disorders cause you to miss out on another good meal. Please call +65 6812 3770 to make an appointment with a specialist doctor today.

  • What is irritable bowel syndrome (IBS)?

    irritable bowel syndrome ibs

    What is irritable bowel syndrome (IBS)?

    Irritable bowel syndrome (IBS) is a chronic disorder that affects the colon (large intestine). It affects the normal functioning of the colon, and causes discomfort and pain, changes in bowel habits (constipation or diarrhoea), gas and bloating. Irritable bowel syndrome is not life-threatening as it does not lead to permanent damage to the colon or serious complications such as cancer.

    What are the causes of irritable bowel syndrome (IBS)?

    There is no exact cause for irritable bowel syndrome but people suffering from the disease tend to report one of the following conditions:

    • Food passing through the bowel quickly and forcefully, leading to diarrhoea
    • Food passing very slowly through the bowel, leading to constipation
    • Sensitive muscles and nerves in the bowel. Excessive contraction of these muscles when you eat can lead to cramps in the abdomen (belly)

      Risk factors that increase the chance of IBS include:

      • Being young
      • Having a family history of irritable bowel syndrome
      • Leading a stressful life
      • Suffering from infection or inflammation of the gut

    What are the symptoms of irritable bowel syndrome (IBS)?

    The symptoms of irritable bowel syndrome can vary greatly between affected individuals. Your symptoms can range from mild to disabling, and these include:

    • Changes to your stools (small hard pellets or loose stools)
    • Changes to your bowel habits (diarrhoea or constipation)
    • Feeling that your bowel doesn’t empty completely
    • Finding mucus in the stools
    • Excess gas and bloating
    • Having pain or cramps in the abdomen

    These symptoms are similar to that of colon cancer, and you need to get your condition evaluated by your doctor.

    There are also less common symptoms of irritable bowel syndrome such as general tiredness, backache, headache, sweating, nausea, vomiting and pain when going to the toilet.

    How is irritable bowel syndrome (IBS) treated?

    There is no cure for irritable bowel syndrome. Treatment options consist of treating your symptoms and avoiding the risk factors that trigger the onset of your irritable bowel syndrome. Your doctor will suggest a treatment plan that works best for you, and it may include a combination of the following:

    • Activities and medication to keep your stress in check
    • Dietary changes such as:
      • Avoiding alcohol, fatty foods, chocolate and caffeinated drinks
      • Increasing or reducing your intake of fibre, depending on your condition
      • Eating small meals
      • Medication to help alleviate your constipation, diarrhoea, or abdominal pain and cramps

  • What is diverticular disease?

  • diverticular disease colon

    What is diverticular disease?

    Diverticular disease occurs when small pockets or bulges (diverticula) develop within the lining of the large intestine (colon). It is a common condition with most people having no or few symptoms. In the absence of symptoms, the condition is called diverticulosis. When symptoms, such as lower abdominal pain is present, it is called diverticular disease.

    In some people with diverticular disease, the diverticula tear and become infected or inflamed, a condition known as diverticulitis. Diverticula is usually associated with inadequate fibre intake or ageing and is caused by hard stools passing through the large intestine.

    What are the causes of diverticular disease?

    The exact cause of diverticular disease is not known, however, it has been linked to several factors, such as: 

    • Age. The walls of the large intestine become weaker with age. This may lead to the formation of diverticula from the pressure of hard stools passing through the intestines.
    • Diet and lifestyle. Lack of fibre in the diet, smoking, being overweight or obese, having a history of constipation, and long-term regular use of painkillers increase the risk for diverticular disease.
    • Genetics. Having a family history of diverticular disease increases the chances of a person developing the condition.

    What are the symptoms of diverticular disease?

    Common symptoms of diverticular disease include: 

    • Abdominal pain often occurring on the lower left side of the abdomen and tends to happen intermittently. However, it has been noted that pain on the right side may be present among people of Asian descent. The pain gets worse during or shortly after eating.  
    • Constipation, diarrhoea, or both 
    • Occasional bloody stool 

    How is diverticular disease diagnosed?

    Following a thorough review of your medical history, your doctor may perform a physical examination with one or more of the following tests:

    • Blood tests to test for infection, inflammation or anaemia. 
    • Computerised tomography (CT) scan to diagnose diverticular disease and diverticulitis. In this procedure, a combination of x-rays and computer technology is used to visualise the gastrointestinal tract. 
    • Colonoscopy, which uses a long, flexible, narrow tube with a camera attached to its end to have a good view of the insides of the rectum and colon. This procedure may be done to confirm a diagnosis of diverticular disease or diverticulitis and rule out other conditions. 
    • Barium enema. This procedure utilises x-rays and a liquid called barium to examine the large intestine. The large intestine is filled with barium using a flexible tube inserted through the anus. The barium will make the large intestine more visible on an x-ray. 

    How is diverticular disease treated?

    For mild cases, your doctor may prescribe antibiotics and recommend lifestyle or dietary changes such as a diet high in fibre, or probiotics. For severe cases of diverticulitis or diverticular bleeding, surgical treatment may be required.

    Lifestyle changes

    Those with diverticular disease should consume a diet that is rich in fibre, such as fruits and vegetables, beans and pulses. Drink plenty of fluids to prevent bloating and wind. For diverticulitis, a fluid-only diet may be recommended for a few days until symptoms improve followed by a high-fibre diet upon recovery.

    Medicine

    Painkillers such as paracetamol can be used to relieve pain in diverticular disease. A bulk-forming laxative helps to ease constipation or diarrhoea. Antibiotics and stronger painkillers are usually prescribed for diverticulitis. More severe cases of diverticulitis may need to be treated in the hospital.

    Surgery

    Surgery may be needed to treat rare cases of serious complications of diverticulitis such as fistulas (an abnormal connection between two organs), peritonitis (infection of the abdominal cavity), or blockage in the intestines. The surgery is called bowel resection which involves the removal of diseased segments of the intestine and then reconnecting the healthy segments. If it’s not possible to reconnect the colon and the rectum, a colostomy will be performed.
  • What are colon polyps?

    polyps colon

    What are colon polyps?

    Polyps are abnormal growths, usually forming on the lining of the colon (large intestine). Whilst the majority of polyps are non-cancerous, certain types may eventually become cancerous. Due to the risk of polyps developing into cancer, it is recommended to go for regular screenings and to seek treatment promptly, especially if one has any of the following risk factors: Family history, obesity, smoking, or certain gastrointestinal disorders such as Crohn's disease.

    There are 2 main types of polyps: 

    • Hyperplastic. This type is unlikely to become cancer.
    • Adenoma. Most colon cancer begin as this type, but not all adenomas will become cancerous. Adenomas are further divided into four types, tubular, villous, sessile, and serrated based on their growth patterns. 

    What are the causes of colon polyps?

    While the exact causes of colon polyps are not known, chances of developing them are higher in those: 

    • Over the age of 50 
    • With a personal or family history of colon polyps or cance
    • Who have an inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease
    • Who are overweight or smoke 

    What are the symptoms of colon polyps?

    Most polyps do not cause any symptoms unless of a certain size, which is why regular screening is important. Symptoms that can be caused by polyps include: 

    • Blood in the stools, which may indicate bleeding in the colon 
    • Changes in bowel habits such as constipation or diarrhoea that lasts longer than a week.
    • Abdominal pain
    • Fatigue, shortness of breath, or anaemia, which are indications of chronic bleeding 
    Screening for colorectal cancer is recommended from the age of 50 years and earlier for patients who are at risk. A person is at high risk for colorectal cancer if they have a family history of polyps or colorectal cancer. Follow-up screening is recommended in 10 years if no polyps are found and within shorter intervals if polyps are observed and depending on the characteristics of the polyps. If you have any of the above symptoms, consult a gastroenterologist or colorectal surgeon. Early detection can prevent future complications.

    How are colon polyps diagnosed?

    A colonoscopy is usually prescribed to detect polyps. A colonoscopy is a simple outpatient procedure whereby your doctor will examine your colon. If polyps are found, this procedure will remove the polyps at the same time. Your doctor may also recommend the following tests:

    • Faecal occult blood testing
    • Barium enema

    How are colon polyps treated?

    Removal of polyps is usually performed during the colonoscopy procedure. Dietary and lifestyle changes may also be recommended. Talk to your doctor to understand the treatment options available.

  • What is Crohn's disease (inflammatory bowel disease)?

    Crohn's disease and IBD

    What is Crohn's disease (inflammatory bowel disease)?

    Crohn's disease is a chronic (long-term) inflammatory disease that primarily affects the small and large intestines.

    Crohn’s disease causes inflammation of the digestive tract, which can result in abdominal pain, severe diarrhoea, fatigue, weight loss, and malnutrition. The inflammation can involve different areas of the digestive tract and often spreads deep into the layers of the affected bowel tissues. The disease can be painful and debilitating and may lead to serious complications.

    What are the causes of Crohn's disease?

    The exact cause of Crohn’s disease remains unknown. An abnormal immune response and a family history of the disease are among the factors that have been suggested to play a role in causing the disease in an individual. 

    Risk factors for Crohn’s disease:  

    • Age. Crohn’s disease is more likely to develop in young people, usually around the age of 30 years.
    • Family history. Having a close relative, i.e. parents, siblings, or children with the disease increases the risk of developing the disease.
    • Smoking. Cigarette smoking is the most important controllable risk factor for Crohn’s disease
    • Non-steroidal anti-inflammatory medicines. These drugs may lead to inflammation of the bowel, which exacerbates the disease. 

    What are the symptoms of Crohn's disease?

    Crohn’s disease can cause inflammation in any part of the gastrointestinal tract from the mouth to the anus. However, it is most commonly seen in the small intestine and the beginning of the large intestine. Common symptoms of Crohn's disease include: 

    • Weight loss
    • Cramps and abdominal pain
    • Diarrhoea
    Symptoms are largely dependent on the location and severity of the inflammation. They may be constant or happen intermittently, and usually develop gradually but may sometimes happen suddenly without any warning signs. 

    If you have any of the above symptoms, consult a gastroenterologist or colorectal surgeon. Early detection can prevent future complications.

    How is Crohn's disease diagnosed?

    Your doctor may enquire about your family history and perform a physical examination. Additional tests may be prescribed such as:


    How is Crohn's disease treated?

    Treatment for Crohn’s disease is for long term with the goal of reducing inflammation and preventing future flare-ups. They are dependent on disease site, pattern, and severity. Treatment options include medicines, bowel rest, and surgery. 

    Medicines 

    • Anti-inflammatory drugs are often used as the first step of IBD treatment. They include corticosteroids and oral 5-aminosalicylates. 
    • Immune system suppressors are drugs that reduce inflammation by targeting the immune system. They may be used individually or in combination. Examples include azathioprine and mercaptopurine, and methotrexate. 
    • Biological medicines are stronger may be used when other medications are not effective in relieving symptoms. They include infliximab, adalimumab, certolizumab pegol, natalizumab, vedolizumab, and ustekinumab. 
    • Antibiotics are used to reduce the amount of drainage and may also heal fistulas and abscesses. 
    • Other medications may be used to manage other symptoms of Crohn’s disease, such as anti-diarrhoeals, pain relivers, iron supplements, vitamin B-12, calcium and vitamin D supplements. 

    Nutrition therapy

    • Nutrition therapy may be prescribed to allow the bowel to rest, which can reduce inflammation in the short term. This is done with a liquid diet administered via a feeding tube (enteral nutrition) or injected into a vein (parenteral nutrition). A low-fibre diet may be recommended to reduce the risk of intestinal blockage if there is bowel narrowing. 

    Surgery

    • Surgery is recommended if diet and lifestyle changes and medications are not successful in relieving symptoms. This may involve removing the damaged portion of the digestive tract and reconnecting the healthy sections, closing fistulas, or draining abscesses. Following surgery with medications is the best approach to improve treatment outcomes and minimise the chances of disease recurrence. Talk to your doctor to understand your treatment options.


    • References:
    • Colon polyps. American College of Gastroenterology. http://patients.gi.org/topics/colon-polyps
    • Overview of the medical management of mild to moderate Crohn's disease in adults. http://uptodate.com
  • What is ulcerative colitis?

    Ulcerative Colitis

    What is ulcerative colitis?

    Ulcerative colitis occurs in the colon (large intestine) when there is continuous inflammation and, if severe, ulceration of the colon, typically at the innermost lining. The inflammation can be of varying extents, starts in the rectum, and may affect the entire colon. The more affected the colon is, the worse the symptoms will be.

    Common symptoms of ulcerative colitis include:

    • Abdominal pain and cramping
    • Bloating or distension
    • Blood or mucus in the stools
    • Loss of appetite
    • Persistent diarrhoea
    • Fever and fatigue
    • Unintended weight loss
    • Inflammation of the skin, eyes or joints

    If you have any of the above symptoms, consult a gastroenterologist or colorectal surgeon. Early detection can prevent future complications.

    How is ulcerative colitis diagnosed?

    Your doctor may run some diagnostic tests to identify the cause of your symptoms. These tests may include:

    • Blood and stool tests
    • CT scans and MRI
    • Gastroscopy and colonoscopy

    How is ulcerative colitis treated?

    Treatment of ulcerative colitis depends on the severity of the disease and its responsiveness to available therapies. For example, a mild case of ulcerative colitis may be controlled with anti-inflammatory medication. But for more severe cases, immunosuppressives such as corticosteroids may also be required.

    In severe cases where the disease isn’t responding to medication or where the patient’s life is in danger, surgery may be necessary as the last resort.

    Speak to a gastroenterologist to find the best treatment option for your condition.