Posted by Dr. Ronnie Mathew, 

Senior Consultant Surgeon, Colorectal Care Specialists (CRCS)

Fibre, probiotics, and exercise play an essential role in maintaining optimal gut health and preventing constipation. In this article, we’ll give you a breakdown on how this trio works together to improve gut health and overall digestive efficiency. 

Fibre: Your Gut’s Best Friend

What is Fibre?

Fibre (roughage) is the part of plant food that is not digested. It stays in your gut and is passed in the stools (faeces). Fibre adds bulk to the stools. This helps your bowels to work well and helps to prevent some bowel and anal conditions.

Why is fibre important in gut function?

Stools (faeces) are usually soft and easy to pass if you eat enough fibre and drink enough fluid. A diet with plenty of fibre may:

• Help to improve constipation and ease bowel movements.
• Help to manage conditions such as haemorrhoids (piles) and diverticular disease (wear and tear of your bowel), and anal fissure (a painful condition due to a cut in the anus/back passage).
• Help you lose or control weight. It is filling, but it has no calories and is not digested.
• Reduce the risk of developing colorectal cancer. 

Optimising  your fibre intake has also been shown to improve the population of helpful germs (bacteria) in your gut, known as the microbiome. An unhealthy microbiome has been linked with many conditions, in addition to serious conditions such as bowel cancer. It has been linked with the immune system, diabetes, mental health, inflammation, and obesity. We still don't know much about our microbiome's role in our health. However, we know that a high-fibre diet is important in ensuring our microbiome keeps us healthy.

How much fibre should we eat per day?

The general recommendation is that adults eat 30 grams (g) of fibre daily. However, your medical history and tolerance for fibre should be considered.

Types of fibre:

Fibre can generally be typified into two types — insoluble fibre and soluble fibre. 

• Soluble fibre: Found in foods like oats, beans, apples, and carrots, it dissolves in water and helps form a gel-like substance that softens stool.
• Insoluble fibre: Found in foods like whole grains, nuts, and vegetables, it doesn't dissolve in water and adds bulk to stool, speeding its passage through the intestines.

They work in different ways in the body. A combination of both types of fibre should form part of a healthy, balanced diet to keep your gut healthy. Many foods containing fibre will naturally contain both types. 

How does fibre help with reducing constipation?

Fiber plays a crucial role in alleviating constipation by promoting healthy bowel movements. Here's how it helps:

1. Adds bulk to stool: Fiber increases stool volume, making it easier to pass. It binds to water in the intestines, helping to soften and bulk up the stool, which reduces straining.
2. Speeds up digestion: Fiber speeds up the movement of food through the digestive system, preventing it from sitting too long in the intestines, which can contribute to constipation.
3. Increases stool water content: Some types of fibre (especially soluble fibre) absorb water, helping soften stool and making it easier to pass. This is especially important for preventing hard, dry stools, which often cause constipation.
4. Stimulates bowel movements: Insoluble fibre, found in whole grains, vegetables, and nuts, helps stimulate the muscles of the intestines, encouraging regular contractions (peristalsis) that move stool along the digestive tract.
5. Supports gut health. Fibre feeds beneficial gut bacteria, which can improve overall digestive health and help maintain regular bowel movements.

Note: Drinking plenty of water is essential when increasing fibre intake. Fibre absorbs water and hence it is important to be well hydrated when taking fibre. In fact, there is a risk that without adequate hydration, any additional fibre intake may cause hardening of stools and constipation. Lack of hydration may also  cause discomfort or bloating. 

Gradually incorporating a balanced amount of fibre into your diet can help prevent or relieve constipation over time.

Probiotics: Good Bacteria, Great Digestion

What are Probiotics, and what do they do?

Probiotics are good bacteria that can help keep your gut healthy. A healthy gut supports your immune system, protects against illness, and helps your body function normally.

The gut refers to your entire digestive system, from mouth to anus, also known as your digestive tract. In your gut, you have thousands of different types of bacteria and other microorganisms. Scientists call this your gut microbiome. Probiotics are the bacteria that support important bodily functions and your overall health.

Your gut microbiome plays a key role in your immune system and many daily operations of the human body, and so the evidence suggests that addressing an imbalance of bad and good bacteria may help protect against several diseases and health problems.

What are the benefits of taking probiotics?

There is little evidence that taking probiotics through food or dietary supplements can benefit healthy people. Research even suggests that many people's gut microbiomes don't change when they consume probiotics and that most actually pass right out of the body. Yet, probiotics may be worth trying if you have a problem linked to your digestive health.

There's evidence that taking probiotics may help:

• Relieve the symptoms of irritable bowel syndrome (IBS)
• Reduce occurrences of diarrhoea, constipation, bloating, and excess flatulence (gas in your intestines)
• Improve lactose intolerance symptoms
• Manage blood sugar levels in people with type2 diabetes
• Help those who take a prolonged course of bacteria-destroying medications - such as antibiotics.

Does probiotics help with constipation?

Yes, probiotics can help with constipation, especially if it's related to an imbalance in the gut microbiome. Probiotics are live beneficial bacteria that can support gut health and promote regular bowel movements when consumed in adequate amounts. Here's how they can help:

1. Improves Gut Microbiome Balance

• Gut bacteria balance: Probiotics help restore and maintain a healthy balance of beneficial bacteria in the gut, which can improve digestion and bowel regularity.
• Fermentation and short-chain fatty acids (SCFAs): Some probiotics help ferment dietary fiber, producing short-chain fatty acids (like butyrate), which nourish colon cells and promote healthy bowel movements.

2. Increases Bowel Motility

• Enhanced peristalsis: Certain strains of probiotics, such as Bifidobacterium and Lactobacillus, can stimulate bowel movements by improving intestinal motility (the movement of food through the intestines). 

3. Improves Stool Consistency

• Soften stools: Probiotics can help increase the water content of stool, making it softer and easier to pass. This is particularly beneficial for people with dry, hard stools associated with constipation.

4. Supports Digestive Health

• Enhances digestion: By maintaining a healthy balance of gut bacteria, probiotics can improve overall digestive health, reducing bloating, gas, and discomfort that often accompanies constipation.
• Improved stool transit time in the intestines: Probiotics can also help regulate the time it takes for food to move through the digestive system, reducing the feeling of "backed up" intestines and promoting more regular bowel movements.

5. Reduces Inflammation

• Gut inflammation: Chronic constipation is sometimes linked to mild inflammation in the gut. Probiotics may help reduce this inflammation, allowing the intestines to function more efficiently and alleviate constipation.

Which Probiotics are effective for constipation?

While different probiotic strains have varying effects, the following have shown promise in studies related to constipation:

• Bifidobacterium lactis
• Lactobacillus acidophilus
• Bifidobacterium infantis
• Lactobacillus reuteri

Considerations:

• Not all probiotics are the same: The effectiveness of probiotics for constipation can vary depending on the strain, and different strains may have different effects on digestion.
• Consult a doctor: If you have chronic or severe constipation, consult a healthcare provider before starting probiotics, especially if you have any underlying conditions (such as IBS, Crohn's, or a weakened immune system).

In summary, probiotics can be an effective additional natural remedy for constipation by improving gut health, supporting bowel motility, and enhancing digestion. However, they are most effective when combined with other healthy lifestyle habits, such as a balanced diet with adequate fibre and regular exercise.

Exercise for a Well-functioning Gut

Exercise can significantly help with constipation by promoting regular bowel movements and improving overall digestive health. Here’s how:

1. Stimulates Intestinal Motility

• Increased movement: Physical activity stimulates the muscles of the digestive tract, particularly the colon, encouraging peristalsis (the wave-like contractions that move stool through the intestines). This leads to more efficient movement of stool through the gut.
• Faster transit time: Regular exercise helps food move more quickly through the stomach and intestines, reducing the time waste material spends in the digestive system, which prevents constipation.

2. Reduces Stress

• Stress relief: Stress and anxiety can slow down digestion and contribute to constipation. Exercise, particularly aerobic activities like walking, jogging, or yoga, can lower stress levels, allowing the body to relax and improve gut function.
• Hormonal balance: Exercise can help regulate hormones like cortisol, which, when elevated due to stress, can negatively affect digestion.

3. Improves Muscle Function

• Strengthens abdominal muscles: Strong abdominal muscles help support the intestines and promote effective bowel movements. Exercises that engage the core muscles, like Pilates or yoga, can enhance your body’s ability to push stool out.
• Improves pelvic floor health: Exercises such as pelvic floor exercises (Kegels) can strengthen the muscles involved in bowel movements, which is particularly useful for people who have difficulty "bearing down" or coordinating their muscles to pass stool.

4. Increases Blood Flow

• Better circulation: Regular physical activity improves blood flow throughout the body, including to the digestive organs. This increased blood circulation helps the intestines function more effectively, which may help relieve constipation.

5. Promotes Regularity

• Consistent routine: Engaging in regular physical activity, even a brisk walk every day, can create a routine that helps you establish more regular bowel movements. The body's internal rhythms, including the digestive system, tend to work better with a predictable daily routine.

6. Improves Gut Flora

• Better microbiome health: Exercise has been shown to positively impact the gut microbiome, which plays a role in digestive health and bowel regularity. A healthy microbiome supports smoother digestion and can reduce symptoms of constipation.

What types of exercises are good for constipation relief?

• Aerobic exercise, such as Walking, jogging, swimming, cycling, or dancing, can help stimulate the digestive tract and reduce constipation.
• Strength training: Lifting weights or performing bodyweight exercises strengthens muscles, including those involved in bowel movements.
• Yoga: Certain yoga poses, such as twists and forward bends, are known to help massage the abdominal organs and promote digestion.
• Pilates: Pilates focuses on core strength and posture, both of which support better bowel movements.

Tips:

• Aim for at least 30 minutes of moderate exercise most days of the week to help improve constipation.
• Stay hydrated. Exercise can lead to fluid loss through sweat, which could exacerbate constipation if you don’t drink enough water.

Incorporating regular physical activity into your daily routine is an effective, natural way to help prevent and relieve constipation over time.

Important: Exercise can reduce the risk of cancer: Regular physical activity can help reduce the chance of developing cancer. It roughly halves the chance of developing oesophageal (food pipe/gullet) or colorectal (large intestine) cancer.

Do I need to see a doctor before I start any physical activity?

Not usually. However, a sports doctor or physiotherapist might be a good source of advice for someone intending to start a very vigorous physical activity programme. Someone worried that increasing physical activity might worsen a joint or back problem might consult with a physiotherapist. Generally, it is good to see a doctor for those people who are not used to physical activity or are planning to significantly increase their physical activity.

People with the following conditions should speak to a general practitioner or a specialist doctor urgently:

• People with chest pains, particularly if chest pain is brought on by exercise.
• People who have had falls due to becoming dizzy or blacking out.
• People who become very breathless on mild exertion. This might be due to a lack of conditioning and improvement by exercise, but there are other conditions that can cause this.

If you have any questions regarding constipation or what to do about it, then do get in touch with us today to have them answered. https://www.thecrcs.com

Important Disclaimer: The information provided here is not specific and is meant for general information only. It does not constitute guidance for managing or treating any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.

Imagine noticing a persistent change in your bowel habits or spotting blood in your stool. At first, you might brush it off as something minor — stress, diet or assume it is just a fleeting issue. However, such symptoms could be early warning signs of colorectal cancer, a condition that often begins silently but has significant implications if left unaddressed. In fact, the most common stage for colorectal cancer presentation is advanced stages (III and IV), with a significant portion of patients presenting with stage IV disease. (For explanation regarding the various stages, please see the table below)

Colorectal cancer develops in the colon or rectum, often starting as small, non-cancerous growths called polyps. While many polyps remain harmless, some can slowly turn into cancer. As such, this progression highlights the importance of awareness, early detection, and timely intervention.

Understanding colorectal cancer is not just about managing the disease; it is about empowering yourself with the knowledge to prevent it or catch it in its earliest stages when treatment is most effective. Whether through regular screenings, healthy lifestyle choices or recognising subtle symptoms, proactive steps can make all the difference.

In this guide, we will delve into the key aspects of colorectal cancer, from its causes, and risk factors to diagnosis, treatment, and prevention strategies. By understanding the disease and its nuances, you take the first step toward safeguarding your health, and that of your loved ones.

What is Colorectal Cancer?

Colorectal cancer refers to cancers that begin in the colon or rectum, which are integral parts of the digestive system. These cancers typically develop over time from polyps. Polyps starts as small non-cancerous growths in the inner lining of the colon or rectum. If these polyps are left untreated, some can transform into malignant tumours. Thus, making early detection immensely crucial.

Colorectal cancer is a significant health concern in Singapore, where it remains as the most commonly diagnosed cancers for men and women combined, particularly among adults over 50. According to the Singapore Cancer Registry [1], it accounts for about 17% of all cancer cases in men and 13% in women. With these statistics underscoring its prevalence, public awareness and timely intervention are vital.

Understanding Colorectal Cancer

To fully understand colorectal cancer, it is essential to grasp the anatomy of the colon, and rectum, which form the final part of the digestive system. The colon absorbs water, and nutrients from digested food, while the rectum stores waste before elimination. Together, they play a critical role in digestive health.

Colorectal cancer begins when cells in the colon or rectum grow uncontrollably. This process typically starts with benign polyps that may develop into cancer over years due to genetic changes. Adenocarcinomas are the most common type of colorectal cancer, accounting for over 95% of cases [2]. Meanwhile, less common forms include carcinoid tumours, and gastrointestinal stromal tumours.

Genetics, and cell mutations also play a pivotal role. Hereditary conditions like Lynch syndrome, and familial adenomatous polyposis significantly increase the risk of colorectal cancer. These conditions cause mutations in specific genes that regulate cell growth, and repair. However, most cases of colorectal cancer are sporadic, meaning they result from acquired mutations rather than inherited ones. As a result, this complexity further highlights the importance of understanding individual risk factors.

What are the risk factors for Colorectal Cancer?

Colorectal cancer is influenced by various risk factors, ranging from lifestyle choices to genetic predispositions, and environmental influences. While some risks can be modified through lifestyle changes, others, like age, and genetics, require vigilant monitoring, and proactive measures. Understanding these risks is crucial for prevention, and early intervention.

Lifestyle-Related Risks

• Diet – a diet high in red or processed meats [3], and low in fibre increases the likelihood of colorectal cancer. Such foods may produce harmful compounds during digestion, while fibre aids in healthy bowel movements, and reduces toxin exposure in the colon.
• Physical Inactivity – sedentary lifestyles are linked to slower digestion, and increased cancer risk [4]. Engaging in regular exercise has been linked to lowering the risk of cancer as it boosts metabolic health, and helps maintain a healthy weight.
• Obesity – excess body fat, particularly around the abdomen, is associated with higher levels of insulin, and inflammatory markers, which can promote cancer cell growth [5].
• Smoking – tobacco contains carcinogenic chemicals that can damage the lining of the colon, and rectum. In fact, long-term smokers have a significantly higher risk [6] of colorectal cancer.
• Alcohol Consumption – excessive alcohol intake is associated with increased cancer risk due to its effect on liver function [7], and DNA repair processes.

Genetic and Hereditary Factors

• Family History – individuals with close relatives who have had colorectal cancer are at a higher risk, especially if the relative was diagnosed before age 50 [8].
• Hereditary Syndromes – conditions like Lynch syndrome [9], and familial adenomatous polyposis [10] are caused by inherited genetic mutations that significantly raise cancer risk. In such cases, early screening, and preventive surgeries are often recommended for affected individuals. 

Environmental and Other Factors

• Age – the risk of colorectal cancer increases with age, particularly after 50 [11], due to cumulative cell damage over time.
• Ethnicity – some ethnic groups, such as individuals of East Asian descent [12], may have unique genetic or dietary factors contributing to higher susceptibility.
• Occupational Hazards – long-term exposure to chemicals or toxins, such as in manufacturing industries, can elevate cancer risk [13].

What are the symptoms of Colorectal Cancer?

Recognising the symptoms of colorectal cancer is critical for timely diagnosis, and treatment. While early-stage symptoms are often subtle, and easily dismissed, advanced stages produce more noticeable signs. 

As such, by understanding these symptoms, it will help empower individuals to seek medical attention before the disease progresses.

Likely Initial Symptoms

• Changes in Bowel Habits – persistent diarrhoea, constipation, or changes in stool consistency may indicate abnormal colon activity.
• Blood in the Stool – this may appear as bright red streaks or darker, tar-like stools, signalling bleeding in the colon or rectum.
• Unexplained Fatigue – blood loss, even in small amounts, can cause anaemia, leading to chronic fatigue, and weakness.

Advanced-Stage Symptoms

• Persistent Abdominal Pain – cramping or discomfort in the lower abdomen can result from tumour growth obstructing the digestive process.
• Unintended Weight Loss – a sudden, unexplained drop in weight could indicate cancer interfering with nutrient absorption or increased metabolic activity.
• Bowel Obstruction Symptoms – severe constipation, bloating, or nausea may occur if a tumour blocks the colon.

When to Seek Medical Attention

It is crucial not to dismiss these symptoms as minor issues, particularly if they persist for a few weeks or more. Early medical evaluation can lead to early detection, which significantly improves treatment outcomes. As a matter of fact, colorectal cancer is one of the most preventable, and treatable cancers provided the polyps are detected early – before it becomes malignant.

How is Colorectal Cancer diagnosed?

One of the reasons early detection is crucial is because colorectal cancer often begins without noticeable symptoms. By identifying the disease at an early stage, it improves survival rates [14], and prevents progression. In contrast, delaying seeking medical attention raises several risks, including:

Risks of Colorectal Cancer Detection Delays

• Missed Early-Stage Detection – early-stage colorectal cancer may present with no symptoms, causing individuals to delay screening. Without early detection, the cancer can progress to more advanced stages, reducing the chances of successful treatment.
• Overlooking Subtle Symptoms – common but mild symptoms like changes in bowel habits or minor rectal bleeding may be dismissed as unrelated conditions, thereby delaying diagnosis. However, recognising these as potential warning signs is critical for timely intervention.
• Avoidance of Screening Due to Fear or Discomfort – many avoid screening procedures like colonoscopy due to fear or perceived discomfort, which increases the risk of undetected polyps developing into cancer. 

Screening and Diagnostic Methods

Diagnosing colorectal cancer accurately, and early is key to effective treatment, and improved survival rates. Screening not only detects cancer but can also identify precancerous polyps, which can be removed before they develop into cancer. Some of the available diagnostic methods include:

• Colonoscopy – considered the gold standard, a colonoscopy allows doctors to visually examine the colon, and rectum for abnormalities. During the procedure, polyps can be removed for further testing. And a biopsy can be done for any bigger growth or suspected cancer.
• Stool-Based Tests – tests like the Faecal Immunochemical Test (FIT) detect hidden blood in stool samples. These are minimally invasive, and widely available, with free FIT kits offered to eligible individuals in Singapore. However, they may miss smaller polyps or lesions.
• Imaging Tests – advanced imaging methods, such as CT colonography, provide detailed visuals of the colon. Although Colonoscopy is the gold-standard method for undertaking colon and rectal assessment, a CT colonography (non-invasive technique) may be used when colonoscopy is unsuitable to be done for certain individuals.
• Biopsy – when abnormalities are detected, a biopsy may be performed. This involves removing a small tissue sample for microscopic analysis, which confirms the presence of cancer, and its type.

What are the stages of Colorectal Cancer?

Colorectal cancer staging is based on the TNM system, which assesses tumour size (T), lymph node involvement (N), and metastasis (M). These factors determine how far the cancer has spread.

Stages range from 0 to IV:

Stage 0	At this stage, the cancer is confined to the innermost layer of the colon or rectum. Treatment typically involves surgical removal of abnormal cells or polyps, which is often curative. Additionally, the 5-year survival rate for Stage 0 is nearly 100% [15].
Stage I	In this stage, the cancer has grown into the inner layers of the colon or rectum but has not spread beyond the wall. Surgery is often recommended to remove the tumour, and is often curative. However, the 5-year survival rate for Stage I is approximately 90% [16].
Stage II	Stage II cancer has grown through the wall of the colon or rectum, and may have spread to nearby tissues but not to the lymph nodes. Surgery is the primary treatment, sometimes followed by chemotherapy. While the 5-year survival rate ranges from 70% to 85% [17], curability is possible with effective treatment, particularly for Stage IIA.
Stage III	At this stage, the cancer has spread to nearby lymph nodes but not to distant organs. Treatment involves a combination of surgery, chemotherapy, and sometimes radiation therapy. The 5-year survival rate is approximately 50% to 70% [18], depending on the extent of lymph node involvement. While curability becomes more challenging, aggressive treatment can lead to long-term remission for some patients.
Stage IV	Stage IV cancer has metastasized to distant organs such as the liver, lungs, or other sites. Treatment often focuses on palliative care, though surgical resection of metastases combined with chemotherapy or targeted therapies can occasionally lead to long-term survival. The 5-year survival rate is about 10% to 15% [19], and curability is rare.  However, advancements in treatment continue to improve outcomes for select cases, with an increase in the 5 yr survival rates to up to 30%..

What are the treatment options for Colorectal Cancer?

Treating colorectal cancer requires a personalised approach based on the cancer’s stage, location, and the patient’s overall health. This section introduces treatment methods, outlines their associated risks, and highlights symptoms managed during the process.

Surgical Treatments

Surgery is often the first line of defence, with options include:

• Polypectomy – removal of polyps during a colonoscopy. However, this procedure is only effective for early-stage cancers.
• Colectomy – partial or full removal of the colon, sometimes paired with lymph node dissection.
• Minimally Invasive Surgeries – techniques like laparoscopic surgery or robotic surgery may offer reduced recovery time, and lower complication rates.

Chemotherapy and Radiation

• Chemotherapy – chemotherapy uses drugs to kill cancer cells or prevent them from multiplying. It is often combined with other treatments to maximise effectiveness.
• Radiation Therapy – radiation therapy targets, and shrinks tumours before surgery or manages symptoms in advanced cases. Due to its potential side effects, patients are closely monitored to ensure these side effects are managed effectively.

Targeted, and Immunotherapies

• Targeted Therapy – targeted therapy includes drugs like monoclonal antibodies block specific proteins that fuel cancer growth.
• Immunotherapy – immunotherapy activates the body’s immune system to attack cancer cells, offering hope for advanced or resistant cases.

Holistic and Supportive Therapies

These address the physical, and emotional challenges of treatment.

• Nutrition – a balanced diet helps manage treatment side effects, and supports recovery.
• Physiotherapy – improves mobility, and strength after surgery or prolonged treatment.
• Psychological Support – counselling services assist in managing stress, and emotional health.

Living With Colorectal Cancer

A colorectal cancer diagnosis marks a significant life challenge, impacting physical health, emotional well-being, and daily life. However, with proper care, a supportive network, and practical strategies, individuals can navigate this journey and improve their quality of life. 

Coping with the Diagnosis

The emotional impact of a cancer diagnosis can be overwhelming. Feelings of fear, anxiety, and sadness are common, and natural responses. With that in mind, seeking professional help from counsellors or psychologists can provide valuable coping mechanisms, such as mindfulness techniques, and cognitive behavioural therapy (CBT).

Meanwhile, support groups offer another vital resource. Speaking with others who share similar experiences can foster a sense of belonging, and reduce feelings of isolation. In Singapore, organisations like the Singapore Cancer Society provide counselling services, peer support, and workshops for both patients, and families.

Lifestyle Adjustments During Treatment

Treatment for colorectal cancer often requires significant changes in daily routines to manage side effects, and maintain strength:

• Dietary Modifications – a balanced diet rich in nutrients can support recovery, and overall health. Foods that are high in fibre, such as fruits, vegetables, and whole grains, help regulate digestion. On the other hand, avoiding processed foods, spicy dishes, and alcohol can also minimise discomfort. 
• Physical Activity – light to moderate exercise, such as walking or yoga, helps reduce fatigue, improve mood, and strengthen the body. However, activities should be tailored to individual abilities, and approved by doctors.
• Managing Side Effects – side effects like nausea, fatigue, or bowel irregularities are common during treatment. It is important to remember that open, and honest communication you’re your doctor can help identify effective medications or therapies to alleviate discomfort.

Support Systems and Survivorship

A robust support system is essential during and after treatment. Family, friends, and caregivers provide emotional reassurance, and practical help with daily tasks. In Singapore, resources like cancer support groups, and survivorship programmes [20] encourage individuals to share experiences and advice.

Survivorship begins when active treatment ends, and life gradually returns to normal. Regular follow-ups, a healthy lifestyle, and stress management play critical roles in preventing recurrence, and improving long-term well-being. Many survivors find renewed purpose in life, engaging in advocacy or education to support others facing similar challenges.

How can I prevent Colorectal Cancer?

Preventing colorectal cancer requires proactive measures to reduce risk factors, and promote early detection. By adopting a healthy lifestyle, staying vigilant about screening, and considering preventive options, individuals can significantly lower their chances of developing this disease.

Regular Screening and Early Detection

Screening is the most effective way to detect, and prevent colorectal cancer. This is because early detection allows for the identification, and removal of polyps before they become cancerous.

• Age Guidelines – in Singapore, individuals aged 50 years old, and older are encouraged to undergo regular screenings. However, those with a family history of colorectal cancer or hereditary conditions may need to start earlier as they have a higher risk of developing the disease. It is important to also note that over the last decade, there has been a steady increase in earlier onset of colorectal cancer in people in younger ages of between 30-50 years. 
• Methods – colonoscopy remains the gold standard, providing a comprehensive view of the colon and enabling the removal of polyps during the procedure. The FIT is widely available, and offered for free in certain Singaporean programmes. However, because FIT has limitations, regular follow-ups are vital.

Lifestyle Modifications

Lifestyle choices have a profound impact on colorectal cancer risk. Here are some key modifications to adopt:

• Healthy Diet – a diet rich in fibre, fruits, vegetables, and whole grains can lower the risk of colorectal cancer. Additionally, avoiding red, and processed meats, as well as excessive fat, and sugar, is equally important. By replacing these with plant-based proteins, and lean meats, it helps to promote digestive health.
• Exercise – regular physical activity, such as walking, cycling, or swimming, helps maintain a healthy weight, and reduces inflammation, both of which lower cancer risk. The World Health Organization (WHO) recommends at least 150 minutes of moderate activity [21] per week.
• Avoidance of Carcinogens – smoking, and excessive alcohol consumption are significant risk factors for colorectal cancer. Quitting smoking and limiting alcohol intake can drastically reduce the likelihood of developing cancer.

Role of Preventive Medications and Supplements

There is no conclusive evidence that medications/supplements can prevent the development of colorectal cancer. However, there are some studies and evidence that certain medications, and supplements may lead to reducing colorectal cancer risk, particularly in high-risk individuals:

• Aspirin – few studies suggest that low-dose aspirin can lower the risk [22] of developing colorectal cancer by reducing inflammation. However, it is crucial to consult a doctor before starting aspirin therapy, as it may have side effects.
• Calcium [23] and Vitamin D – these nutrients may play a role in maintaining colon health. Including calcium-rich foods, like dairy products and leafy greens, and getting adequate sunlight for vitamin D [24] can provide added protection. On the other hand, supplements may be recommended for those with deficiencies.

Conclusion

It goes without saying that colorectal cancer is a significant health concern. However, with early detection, effective treatments, and lifestyle modifications, the prognosis can be improved – especially with early detection. In fact, understanding the risk factors, symptoms, and screening methods empowers individuals to take proactive steps towards prevention, and early diagnosis. This, combined with advances in medical technology, such as minimally invasive surgeries, continues to enhance treatment outcomes, and the patients’ quality of life.

Remember, regular screenings, and a healthy lifestyle are key factors in reducing the risk of colorectal cancer. By staying informed, and proactive, you can protect your health, and that of your loved ones. 

References

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7. Alcohol and Cancer Risk Fact Sheet - NCI. (2021). In www.cancer.gov. https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet 
8. Henrikson, N. B., Webber, E. M., Goddard, K. A., Scrol, A., Piper, M., Williams, M. S., Zallen, D. T., Calonge, N., Ganiats, T. G., Janssens, A. C., Zauber, A., Lansdorp-Vogelaar, I., van Ballegooijen, M., & Whitlock, E. P. (2015). Family history and the natural history of colorectal cancer: systematic review. Genetics in medicine : official journal of the American College of Medical Genetics, 17(9), 702–712. https://doi.org/10.1038/gim.2014.188 
9. Shall, S., & Stein, W. D. (1979). A mortalization theory for the control of the cell proliferation and for the origin of immortal cell lines. In Journal of theoretical biology (Vol. 76, Issue 2, pp. 219–231). Journal of theoretical biology. https://doi.org/10.1016/0022-5193(79)90371-0 
10. Chaves, J. J., Chaves-Cabezas, V., Parra-Medina, R., & Chaves-Chamorro, J. O. (2022). Familial Adenomatous Polyposis: Case Report and Literature Review. Cureus, 14(11), e31609. https://doi.org/10.7759/cureus.31609 
11. Zaki, T. A., Singal, A. G., May, F. P., & Murphy, C. C. (2022). Increasing Incidence Rates of Colorectal Cancer at Ages 50-54 Years. Gastroenterology, 162(3), 964–965.e3. https://doi.org/10.1053/j.gastro.2021.10.039 
12. Chen, Z., Guo, X., Tao, R., Huyghe, J. R., Law, P. J., Fernandez-Rozadilla, C., Ping, J., Jia, G., Long, J., Li, C., Shen, Q., Xie, Y., Timofeeva, M. N., Thomas, M., Schmit, S. L., Dez-Obrero, V., Devall, M., Moratalla-Navarro, F., Fernandez-Tajes, J., … Zheng, W. (2024). Fine-mapping analysis including over 254,000 East Asian and European descendants identifies 136 putative colorectal cancer susceptibility genes. In Nature Communications (Vol. 15, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1038/s41467-024-47399-x 
13. Oddone, E., Modonesi, C., & Gatta, G. (2014). Occupational exposures and colorectal cancers: a quantitative overview of epidemiological evidence. World journal of gastroenterology, 20(35), 12431–12444. https://doi.org/10.3748/wjg.v20.i35.12431 
14. Li, J., Li, Z. P., Ruan, W. J., & Wang, W. (2024). Colorectal cancer screening: The value of early detection and modern challenges. World journal of gastroenterology, 30(20), 2726–2730. https://doi.org/10.3748/wjg.v30.i20.2726 
15. – 19 Redirect Notice. (n.d.). In www.google.com. Retrieved January 15, 2025, from https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.healthline.com/health/colorectal-cancer-survival-rate%23:~:text%3DEarly%2520stage%2520colorectal%2520cancer%2520that,lymph%2520nodes%2520is%252071.1%2520percent.&ved=2ahUKEwidwJOfsviKAxV_V2wGHeIELowQ-tANegQIRRAW&usg=AOvVaw0pf7XyW1OEjPQHzVXPXJrR 
16. Colorectal Cancer Survival Rate: Understanding What It Means for You. (2018). In Healthline. https://www.healthline.com/health/colorectal-cancer-survival-rate#prognosis
17. Colorectal Cancer Survival Rate: Understanding What It Means for You. (2018). In Healthline. https://www.healthline.com/health/colorectal-cancer-survival-rate#prognosis 
18. Colorectal Cancer Survival Rate: Understanding What It Means for You. (2018). In Healthline. https://www.healthline.com/health/colorectal-cancer-survival-rate#prognosis 
19. Colorectal Cancer Survival Rate: Understanding What It Means for You. (2018). In Healthline. https://www.healthline.com/health/colorectal-cancer-survival-rate#prognosis 
20. Loh, K. W., Ng, T., Choo, S. P., Saw, H. M., Mahendran, R., Tan, C., Chang, G. C. Y., Ong, Y. J., Yee, A. C. P., Chan, A., & Soo, K. C. (2018). Cancer Supportive and Survivorship Care in Singapore: Current Challenges and Future Outlook. Journal of global oncology, 4, 1–8. https://doi.org/10.1200/JGO.17.00117 
21. Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J. P., Chastin, S., Chou, R., Dempsey, P. C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., Lambert, E., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955 
22. Works Cited Burn, J., Sheth, H., Elliott, F., Reed, L., Macrae, F., Mecklin, J.-P., Mslein, G., McRonald, F. E., Bertario, L., Evans, D. G., Gerdes, A.-M., Ho, J. W. C., Lindblom, A., Morrison, P. J., Rashbass, J., Ramesar, R., Seppl, T., Thomas, H. J. W., Pylvninen, K., … Side, L. (2020). Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial. In The Lancet (Vol. 395, Issue 10240, pp. 1855–1863). Elsevier BV. https://doi.org/10.1016/s0140-6736(20)30366-4 
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Posted by Dr. Ronnie Mathew, 

Senior Consultant Surgeon, Colorectal Care Specialists (CRCS)

Constipation is a common problem that affects people of all ages. It can mean that you’re not passing stools regularly or you’re unable to completely empty your bowel. Constipation in adults can affect the quality of life. It also may be associated with haemorrhoids, anal fissures, and serious underlying causes, such as colorectal cancer. There is some evidence that constipation may be associated with a modest reduction in survival.

What is Constipation?

Constipation is common and can occur at any age. The word may mean different things to different people, as bowel habits (and the words they use to describe them) differ greatly between people. For some, it might mean not going to the toilet as often as usual; for others, it means their stools are very hard or painful to pass. This might mean people strain to force the stool out. For others, it might feel like they haven't emptied completely, and for some people, they only believe they are constipated when they have several of these symptoms at the same time. Sometimes, it occurs because of your body’s condition: Your large intestine might be sluggish and need help expelling waste, or perhaps the bowel muscles don't work effectively. Otherwise, it occurs because of another medical condition or medicines that you are taking. 

A commonly used medical definition of constipation is having fewer than three spontaneous bowel movements per week. 

Symptoms of Constipation

The severity of constipation varies from person to person. Many people experience it only for a short time, but for others, it can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life. Chronic constipation means the problem has been present for at least 12 weeks out of the past 6 months. 

If you are constipated, it may cause one or more of the following: 

• Stools (faeces) become hard and difficult or painful to pass.
  
  
• The time between each bowel motion increases compared with your usual pattern. There is a large range of normal bowel habits. Some people usually go to the toilet to pass stools 2-3 times daily. For others, 2-3 times per week is normal. It is a change from your usual pattern that may mean you are constipated. Passing a soft stool at least three times a week is considered normal.
  
  
• Sometimes, crampy pains occur in the lower part of your tummy (abdomen). You may also feel bloated and feel sick if you have severe constipation.
  
  
• It does not feel like you have emptied your bowels or 'finished' after going to the toilet to pass a stool. 

What are the causes of Constipation?

Some causes are known to lead to constipation, including the following: 

• Not eating enough fibre (roughage) can lead to constipation. Fibre is the part of plant food that is not digested. It remains in your gut. It adds bulk to the stools (faeces) and helps your bowels to work well. Foods high in fibre include fruit, vegetables, bran cereals, whole-meal bread, oats, etc.  A daily intake of 30 g of fibre per day is recommended. However, you should consider your medical history and how well you can tolerate fibre.
  
  
• Not drinking enough may lead to or worsen constipation. If you eat enough fibre and drink enough fluid, your stool is usually soft and easily passed. However, some people need more fluids than others to avoid constipation. For example, if you live in a hot country, spend most of your time outdoors, or exercise a lot, you may need more fluids.
  
  
• Being less active for various reasons, for example:
  • Illness or injury. 
  • Disability.
  • Frailty, or old age. 
  • Depression.
  • Work patterns. 
  • Obesity.
    
    
• Some medicines can cause constipation as a side effect. Examples are painkillers (particularly those with codeine/morphine based), some antacids, some antidepressants (including amitriptyline), and iron tablets. These are only a few examples, and there are many others. If in doubt, check the medication label and its side effects.
  
  
• Various medical conditions can cause constipation. For example: An
  • underactive thyroid gland.
  • Irritable bowel syndrome.
  • Diverticular disease. 
  • Colon and Rectal cancer.
    
    
• Pregnancy. About one in five pregnant women will become constipated. This is due to the hormonal changes that slow down gut movements during pregnancy. In later pregnancy, it can simply be due to the baby taking up a lot of room in the tummy and pushing the bowels to one side.
  
  
• Unknown cause (idiopathic) Some people can get constipated despite having a good diet, drinking a lot of fluids, not having a disease, and not taking any medication that can cause constipation. Their bowels are said to be underactive. This is quite common and is sometimes called functional constipation or primary constipation. Most cases occur in women. This condition starts in childhood or early adulthood and persists throughout life.
  
  
• Personal Toileting habits might also predispose to constipation. For example, people may develop the long-term habit of withholding or ignoring the urge to defecate. This can be due to a lack of access to the toilet at home or work or an avoidance of using public toilets. Issues of cleanliness and lack of privacy can also lead to these. People may also feel hurried or disturbed when trying to defecate.
  
  
• Anxiety, depression, cognitive impairment, or an eating disorder. There are multiple causes of constipation, including over 30 factors. Sometimes, it can be a combination of these. This blog is unable to cover them all. If you need to seek a healthcare specialist assessment for personal health reasons, it is recommended that you seek one.
  

Can you improve your Constipation on your own?

There are several things that can be done to improve constipation symptoms. 

• Adequate dietary fibre: This includes fruits and vegetables. Certain fruits may especially help, but this can vary from person to person. Some of these fruits are prunes, kiwi fruit, papaya, pineapple, dragon fruit, and banana. You may need to adjust according to the seasons. Prunes, for example, don’t go out of season, as they are dried and usually available all year round.
  
  
• Stay hydrated: Drink at least 8-10 glasses of liquids daily. This is even more important when you take fibre, as it needs liquid to help it bulk up and become soft. Otherwise, it can become hard. This is especially true in hot climates, if you exercise more, etc.
  
  
• Stay active. Regular exercise and staying active are important to avoid constipation.
  
  
• Probiotics. There is evidence that probiotics may help with reducing the risk of constipation.
  
  
• Maintain good toilet habits: Go to the toilet when you need to, without delay. Some people also find the correct position helps while you are on the toilet.
  
  
• Manage any stress, anxiety, or eating disorders. Learn and use relaxation techniques to manage stress. Seek expert help as required, including for eating disorders.

When should you seek expert professional help and treatment for Constipation?

It is not possible to be certain when to seek a review from a healthcare expert. Below are some of the general considerations when it is important to seek a health review for constipation: 

• Your constipation lasts longer than 14 days without improvement
• You have a sudden change in your bowel habits
• A feeling of incomplete bowel evacuation (you feel you have not passed all the stool even though you have gone to the toilet to do so)
• You have blood in your stool or black stools
• You have unexplained weight loss
• You are over 40 years old
• You have a family history of colon cancer
• You have persistent tiredness
• It makes it difficult to do everyday activities
• You have stomach pain that doesn't stop
• You have abdominal (tummy) bloating
• You're vomiting stool or bile
• You're taking medicine that's causing constipation
  

Important: Irrespective of the above general factors, seeking professional help is good practice when unsure or worried.

What are the possible investigations and treatment options for Constipation?

The list of investigations and management options is too vast and detailed to be included in this blog. This also considers the multiple causes of constipation, including over 30 factors. Sometimes, it can be a combination of these. It is enough to mention that some may need lifestyle changes, while others require more detailed investigations and treatment. The direction of the management approach is based on the likely causative factors. What is important is that you seek help from a specialist healthcare provider. 

If you have any questions regarding constipation or what to do about it, then do get in touch with us today to have them answered. 

Important Disclaimer: The information provided here is not specific and is meant for general information only. It does not constitute guidance for managing or treating any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.

Acknowledgments and References, for further reading: 

• patient.info/digestive-health/constipation 
• Attaluri A, Donahoe R, Valestin J, et al; Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011 Apr;33(7):822-8. doi:
• A Guide to Refractory Constipation: Diagnosis and Evidence-Based Management; British Society of Gastroenterology, 2020 - updated November 2021 
• Diaz S, Bittar K, Mendez MD; Constipation
• Constipation; NICE CKS, January 2024 
• Cho YS, Lee YJ, Shin JE, et al; 2022 Seoul Consensus on Clinical Practice

Guidelines for Functional Constipation. J Neurogastroenterol Motil. 2023 Jul 30;29(3):271-305. doi: 10.5056/jnm23066.

• Ford AC, Talley NJ; Laxatives for chronic constipation in adults. BMJ. 2012 Oct 1;345:e6168. doi: 10.1136/bmj.e6168. 
• Krogh K, Chiarioni G, Whitehead W; Management of chronic constipation in adults. United European Gastroenterol J. 2017 Jun;5(4):465-472. doi: 10.1177/2050640616663439. Epub 2016 Aug 2. 
• Lacy BE, Levenick JM, Crowell M; Chronic constipation: new diagnostic and treatment approaches. Therap Adv Gastroenterol. 2012 Jul;5(4):233-47. doi: 10.1177/1756283X12443093. 

Written by Dr. Ronnie Mathew, Senior Consultant Surgeon, CRCS

What is Heartburn, and how does it occur?

Heartburn is a burning sensation that rises from the stomach or lower chest towards the neck. It is essentially due to gastro-oesophageal reflux disease (GERD), also called reflux oesophagitis. 

The mouth and the stomach are connected by the oesophagus (food pipe).  At the end of the oesophagus, where the stomach connects, there is a valve called the lower oesophagus sphincter (LES). The LES is a circular muscle that only opens when you swallow, burp, or have hiccups. It closes again to prevent the stomach acid from coming back up again. Acid reflux occurs when the LES weakens or relaxes, such as after a heavy meal. While the LES usually relaxes temporarily, GERD happens when the LES is weakened. 

GERD is usually a chronic condition in which stomach contents (particularly acid, bile, and pepsin) reflux back into the oesophagus (food pipe) and irritate the lining of the lower end of the oesophagus. The predominant symptoms are heartburn and acid regurgitation. Atypical oropharynx and/or respiratory tract symptoms may occur, such as hoarseness, cough, asthma, and dental erosions.

How common is Heartburn?

GERD affects 10-30% of the adult population in developed countries. Although heartburn/GERD can occur at any age, its prevalence increases with age, especially after age 40. It is slightly more common in women. 

What causes Heartburn or GERD? 

A certain amount of gastro-oesophageal reflux of acid is normal, and there is a natural protective mechanism of the lower oesophagus. Gastro-oesophageal reflux disease (GERD) describes prolonged or excessive reflux that may cause the breakdown of this protection with inflammation of the oesophagus (oesophagitis).

Several factors can predispose to reflux, including:

• Increased intra-abdominal pressure
• Smoking, alcohol, fat, chocolate, coffee
• Pregnancy
• Obesity
• Stress and anxiety
• Tight clothes
• Big meals
• Surgery in achalasia of the cardia
• Systemic sclerosis
• Hiatus hernia (this is a weakening of the sphincter at the lower end of the oesophagus/food pipe)
• Family history
• Drugs (examples include alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nonsteroidal anti-inflammatory drugs, nitrates, theophyllines, and tricyclic antidepressants

Most of these predisposing factors increase intra-abdominal pressure. A fatty meal delays gastric emptying. The above-listed drugs and smoking relax the tone of the sphincter at the lower end of the oesophagus (also called the lower oesophageal sphincter or cardiac sphincter). Note that there is no proven relationship between Helicobacter pylori infection (which affects the stomach, causes gastritis, etc.) and GERD.

Bile is particularly caustic, and reflux of duodenal contents is more troublesome than reflux of gastric contents alone. There is little correlation between the severity of symptoms and findings on endoscopy.

What are the symptoms of Gastro-oesophageal Reflux Disease?

You may have GERD if you have experienced the following symptoms:

• Heartburn
• Backwash of food in the throat
• Sensation of a lump in the throat
• Nausea
• Difficulty swallowing
• Backwash
• Breathing symptoms: chronic cough, shortness of breath, wheezing
• Laryngitis
• Sore throat
• Chest pain not related to the heart
• Upper abdominal pain/discomfort

How is GERD diagnosed?

A specialist (e.g., general surgeon/intestinal surgeon/gastroenterologist) will need to undertake a full assessment of symptoms and relevant history, followed by a physical examination. They then may decide to undertake diagnostic procedures like:

• Upper gastrointestinal endoscopy (Oesophago-Gastro-Duodenoscopy, OGD): This diagnostic procedure involves inserting an endoscope through the mouth to examine the inside of the oesophagus, stomach, and part of the duodenum more closely.

• Barium Swallow: This type of X-ray involves swallowing a chalky liquid (barium) and taking pictures of the oesophagus as you swallow.

• Oesophageal manometry: This procedure uses pressure sensors planted in a nasogastric tube to measure the muscle activities in the oesophagus and determine whether the LES is functioning properly.

• Oesophageal pH test: measures the acid content in the oesophagus.

Can certain foods cause worsening of the acid reflux?

In the presence of weakened LES (valve at the lower end of the oesophagus), certain foods can cause acid reflux. These foods include:

• Certain beverages, like alcohol, coffee, carbonated beverages, and tea.
• Certain fruits and vegetables include pineapple, citrus fruits, tomatoes, garlic, and onions.
• High-fat foods 
• Spicy food.

What lifestyle changes can help to reduce the symptoms of heartburn/GERD?

Certain lifestyle changes could help the heartburn/GERD symptoms:

• Eat slowly and in smaller portions, but more frequently
• Reduce the intake of above-mentioned foods
• Elevating your head when you sleep. You can use additional pillows for this or raise the headend of your bed
• Wear loose clothes when you sleep, so that it doesn’t constrict your tummy
• Eat your last meal of the day at least three hours before you go to bed
• Maintaining a healthy weight. Lose weight if you are overweight
• Reduce alcohol intake 
• Quitting smoking

How is GERD usually managed and treated?

There are various broad management approaches to help treat GERD symptoms:

Lifestyle changes

As mentioned above, adopting positive lifestyle changes, such as healthy eating habits and reducing alcohol can help manage GERD symptoms. 

Medications

• Antacids: neutralizes the acid that is already present in your stomach
• Alginates: help create a barrier between the stomach acid and the oesophagus as the contents of the alginates float on top of the stomach acid.
• Proton pump inhibitors reduce acid secretion into the stomach.
• Histamine receptor antagonists (H2 blockers) reduce acid secretion into the stomach.
• Potassium-competitive acid blockers reduce acid secretion into the stomach.
• Baclofen: to reduce muscle spasms and the frequency of lower oesophageal sphincter relaxation, thereby reducing the occurrence of acid reflux.
• Prokinetics: to strengthen the lower oesophageal sphincter and help the stomach empty faster

Please note: Medications have side effects and also interactions with other medications. Please consult your healthcare provider before you take any medications.

Operative management

If lifestyle management along with medications are unable to control GERD symptoms, then surgery for gastro-oesophageal reflux disease (GERD) may be considered. Surgical options involve a few different procedures, including:

• Fundoplication: Operation where the top of the stomach is wrapped at the junction of the oesophagus and stomach. This creates a new valve-like mechanism that prevents stomach acid from flowing back into the oesophagus. This is often performed laparoscopically, which means through small incisions and with the aid of a video monitor. There are mainly three types of fundoplication:
  • Nissens fundoplication
  • Anterior/Dor fundoplication
  • Toupet fundoplication

• Transoral incisionless fundoplication (TIF): A procedure that reconstructs the valve between the stomach and oesophagus.

• LINX Reflux Management System: A minimally invasive procedure that involves placing a ring of magnetic beads around the lower oesophageal sphincter. The beads help keep the sphincter closed, preventing stomach contents from flowing back into the oesophagus.

If you have any questions regarding heartburn, acid reflux or GERD, then do get in touch with us today to have them answered. 

For further information on GERD: https://thecrcs.com/gerd/

Important: Please note: The information provided here is not specific and is meant for general information only. It does not constitute guidance for the management or treatment of any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.

Acknowledgement:

https://patient.info/doctor/gastro-oesophageal-reflux-disease

Further References:

1. Cheung KS, Leung WK; Long-term use of proton-pump inhibitors and risk of gastric cancer: a review of the current evidence. Therap Adv Gastroenterol. 2019 Mar 11;12:1756284819834511. doi: 10.1177/1756284819834511. eCollection 2019.
2. Endoluminal gastroplication for gastro-oesophageal reflux disease; NICE Interventional Procedure Guidance, July 2011
3. Feinle-Bisset C, Azpiroz F; Dietary and lifestyle factors in functional dyspepsia. Nat Rev Gastroenterol Hepatol. 2013 Mar;10(3):150-7. doi: 10.1038/nrgastro.2012.246. Epub 2013 Jan 8.
4. Garg SK, Gurusamy KS; Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev. 2015 Nov 5;(11):CD003243. doi: 10.1002/14651858.CD003243.pub3.
5. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management; NICE Clinical Guideline (Sept 2014 - last updated October 2019)
6. Gyawali CP, Yadlapati R, Fass R, et al; Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut. 2024 Jan 5;73(2):361-371. doi: 10.1136/gutjnl-2023-330616.
7. Laparoscopic Insertion of a Magnetic Ring for GORD; NICE UK Jan 2023
8. Liu L, Li S, Zhu K, et al; Relationship between esophageal motility and severity of gastroesophageal reflux disease according to the Los Angeles classification. Medicine (Baltimore). 2019 May;98(19):e15543. doi: 10.1097/MD.0000000000015543.
9. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al; ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. doi: 10.14309/ajg.0000000000001538.
10. Krause AJ, Walsh EH, Weissbrod PA, et al; An update on current treatment strategies for laryngopharyngeal reflux symptoms. Ann N Y Acad Sci. 2022 Apr;1510(1):5-17. doi: 10.1111/nyas.14728. Epub 2021 Dec 17.
11. Moayyedi P, Talley NJ; Gastro-oesophageal reflux disease. Lancet. 2006 Jun 24;367(9528):2086.
12. Nencioni M, Asti E, Saino G, et al; Magnetic oesophageal sphincter for the treatment of gastro-oesophageal reflux disease: results of a prospective clinical trial. Chir Ital. 2009 Mar-Apr;61(2):187-92.
13. Ness-Jensen E, Hveem K, El-Serag H, et al; Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016 Feb;14(2):175-82.e1-3. doi: 10.1016/j.cgh.2015.04.176. Epub 2015 May 6.
14. Sigterman KE, van Pinxteren B, Bonis PA, et al; Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2013 May 31;(5):CD002095. doi: 10.1002/14651858.CD002095.pub5.
15. Yuan LZ, Yi P, Wang GS, et al; Lifestyle intervention for gastroesophageal reflux disease: a national multicenter survey of lifestyle factor effects on gastroesophageal reflux disease in China. Therap Adv Gastroenterol. 2019 Sep 25;12:1756284819877788. doi: 10.1177/1756284819877788. eCollection 2019.

Written by Dr. Ronnie Mathew, Senior Consultant Surgeon, CRCS

What is the Gallbladder, and what does it do?

The gallbladder is a small, pear-shaped organ in the upper right side of the abdomen. Think of your gallbladder as a little storage pouch for bile, a digestive fluid made by your liver. When food is eaten, the stomach releases a hormone that causes the gallbladder to contract and release bile into the small intestine. The bile fluid helps break down fats in the food you eat. 

What are Gallstones, and why do they occur?

Gallstones are small, hard deposits that form in your gallbladder. They can range in size from a grain of sand to a golf ball. These stones form when there's too much cholesterol, bile salts, or bilirubin in the bile. When this happens, the excess material hardens into stones. Gallstones are usually harmless, but they can sometimes block the flow of bile and cause pain, nausea, inflammation/infection, and other complications. 

Who is at risk of gallstones?

Generally, several groups are more likely to develop gallstones:

• Age: As you age, your risk of developing gallstones increases. Men are more likely to get them after age 60, while women are more prone between the ages of 20 and 50.

• Gender: Women have a higher risk of gallstones than men because of their naturally higher oestrogen hormone levels. Oestrogen increases cholesterol in bile, and another hormone, progesterone, can slow the gallbladder's emptying process.

• Weight: Carrying extra weight is a major risk factor. Body fat releases oestrogen, which increases cholesterol levels in bile. Rapid weight loss can also trigger gallstones because it simultaneously dumps a lot of cholesterol into the bile.

• Genetics: If gallstones run in your family, you’re also more likely to get them.

• Hormones: Hormonal changes, such as those from pregnancy, hormone replacement therapy, or birth control pills, can raise the risk of gallstones by increasing oestrogen levels.

• Cholesterol-lowering drugs: While these drugs lower cholesterol in your blood, they can increase the cholesterol in your bile, leading to a higher risk of gallstones.

• Diabetes: People with diabetes often have high levels of fatty acids called triglycerides, which can contribute to the formation of gallstones.

• Diet and lifestyle: Eating a diet high in fat and cholesterol and low in fibre, and a sedentary lifestyle can increase your risk of gallstones.

Can gallstones be prevented from forming in the first place?

• There is some evidence that a healthy lifestyle, regular physical activity, and ideal body weight might prevent cholesterol stones and symptomatic gallstones. However, the evidence for this recommendation is not strong.

• Medications with Ursodeoxycholic acid may be useful in preventing high-risk patients (e.g., morbidly obese patients undergoing rapid weight loss following bariatric (weight loss) surgery) from developing gallstones. However, studies suggest that ursodeoxycholic acid does not reduce biliary symptoms once the stones have formed.

What are the symptoms of gallstones?

Most people with gallstones don’t even know they have them because they don’t always cause symptoms. But if a gallstone gets stuck in the bile duct, it can cause sudden, severe pain in the upper right part of your abdomen. This pain is known as biliary colic.  If the blockage isn't treated, it can lead to serious problems like infections or inflammation of the gallbladder. 

If the bile does not drain well, it can cause:

• jaundice
• dark urine
• light-coloured stools

What treatment options are there for gallstones?

• Gallstones causing no symptoms or issues

Gallstones do not cause any symptoms in a majority of people. In such cases, there is no specific treatment apart from general diet control and treating any underlying causes that predispose gallstone formation. 

• Gallstones causing symptoms and complications

Gallstones may lead to:

• biliary colic
• gallbladder infection/inflammation
• obstructive jaundice
• pancreatitis
• fistula formation
• blockages in the bowel

These conditions require specific treatment for each condition. For example, painkillers for pain symptoms, antibiotics for infection/inflammation, clearing the bile duct when there is obstructive jaundice, drainage of gallbladder in certain conditions, specific treatment for pancreatitis, operation when bowel blockage due to gallstones, etc. These are only general suggestions, and usually, they require a combination of treatment strategies.

In addition, it would also usually require the removal of the gallbladder (called Cholecystectomy). Cholecystectomy is the most common treatment for gallstones. This is typically performed with a minimally invasive surgical operation. The gallbladder is not an essential organ, so people can live normal lives without it. 

Medical or shockwave treatments (called lithotripsy) can be considered to dissolve the gallstones, but they may not be as effective.

Can there be other conditions mimicking symptoms similar to those due to gallstones?

Other conditions that mimic gallstone symptoms include:

• vague abdominal discomfort
• distension
• nausea
• flatulence

intolerance of fats may also be caused by: 

• gastric reflux
• gastritis
• gastric ulcers
• irritable bowel syndrome
• pancreatitis
• tumours
• large intestine conditions

Sometimes, the conditions can overlap. Hence, seeing a specialist and making a detailed assessment is important. Investigations are usually required to diagnose gallbladder/gallstone-related problems and as well as to exclude other conditions.

What investigations can be considered to diagnose gallstone-related problems?

• Ultrasound Is one of the best ways to demonstrate stones, being 90-95% sensitive:

• Sometimes, stones are not mobile, so they are not easy to differentiate from unimportant polyps, and very small ones may be missed or fail to throw a helpful acoustic shadow.

• Ultrasonography can also allow measurement of the diameter of the common bile duct (CBD) and show the liver and hepatic bile ducts. Still, it can only identify about half of any stones in the CBD with certainty.

• If the ultrasound scan findings are negative but there is a high level of suspicion, such as in a patient with upper abdominal pain and abnormal LFTs, it is worth repeating the investigation after an interval. This may pick up stones that were previously missed.

• An MRI scan (magnetic resonance cholangiopancreatography) may often be helpful when further clarifications are needed.

• Endoscopic retrograde cholangiopancreatography (ERCP) may be used for the diagnosis of CBD stones and has also evolved from a diagnostic to a therapeutic procedure for the removal of CBD stones.

• Blood tests (to assess for infection markers, bilirubin levels, liver enzymes, and amylase/lipase to assess for pancreatitis), Urinalysis, Chest X-ray (CXR), Electrocardiogram (ECG), OGD/Endoscopy, and Colonoscopy may help exclude other diseases.

At CRCS, we provide expert assessment, diagnosis, and treatment to help restore your health.

If you have any questions regarding your Gallbladder or Gallstones, then do get in touch with us today to have them answered. https://www.thecrcs.com

Important: Please note: The information provided here is not specific and is meant for general information only. It does not constitute guidance for the management or treatment of any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.

Acknowledgment

https://patient.info/doctor/gallstones-and-cholecystitis

Further reading and references:

1. Gallstone disease; NICE Quality standard, December 2015
2. Gurusamy KS, Davidson BR; Gallstones. BMJ. 2014 Apr 22;348:g2669. doi: 10.1136/bmj.g2669.
3. David GG, Al-Sarira AA, Willmott S, et al; Management of acute gallbladder disease in England. Br J Surg. 2008 Apr;95(4):472-6.
4. Khan HN, Harrison M, Bassett EE, et al; A 10-Year Follow-up of a Longitudinal Study of Gallstone Prevalence at Necropsy in South East England. Dig Dis Sci. 2009 Jan 22.
5. Shojaiefard A, Esmaeilzadeh M, Ghafouri A, et al; Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract. 2009;2009:840208. Epub 2009 Aug 6.
6. Sakorafas GH, Milingos D, Peros G; Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007 May;52(5):1313-25. Epub 2007 Mar 28.
7. Jones MW, Kashyap S, Ferguson T; Gallbladder Imaging
8. Roy A, Martin D; Complicated bile duct stones. BMJ Case Rep. 2013 Aug 14;2013. pii: bcr2013200667. doi: 10.1136/bcr-2013-200667.
9. Cholecystitis - acute; NICE CKS, January 2017 (UK access only)
10. Laser lithotripsy for difficult-to-treat bile duct stones; NICE Interventional procedures guidance, June 2021
11. Sanders G, Kingsnorth AN; Gallstones. BMJ. 2007 Aug 11;335(7614):295-9.
12. Dasari BV, Tan CJ, Gurusamy KS, et al; Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013 Sep 3;9:CD003327.
13. Machado FHF, Castro Filho HF, Babadopulos RFAL, et al; Ursodeoxycholic acid in the prevention of gallstones in patients subjected to Roux-en-Y gastric bypass1. Acta Cir Bras. 2019 Feb 14;34(1):e20190010000009. doi: 10.1590/s0102-865020190010000009.
14. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones; European Association for the Study of the Liver (2016).

Posted by Dr. Ronnie Mathew, Senior Consultant Surgeon

A hernia occurs when an internal part of the body pushes through a weak spot in the surrounding muscle or tissue wall. There are many types of hernia, depending on the body's sites and the nature of hernia protrusion. Abdominal hernias occur when a weakness in the wall of the tummy (abdominal wall) results in some of the contents in the abdominal cavity bulging through. Inguinal hernias are the most common among the abdominal hernias.

Some common abdominal Hernias:

What are the main causes for Hernia?

There are many contributing factors that can cause a hernia to occur:

1. Congenital (i.e., present at birth):
   • An opening or weak spot that’s present at birth.
   • Congenital differences in the strength of your connective tissue (collagen).

2. Acquired (due to the below risk factors):
   • Chronic persistent cough
   • Chronic straining on the toilet
   • Frequent lifting, carrying or pushing of heavy loads
   • Being overweight
   • Pregnancy
   • Previous abdominal surgery, that can lead to an opening or weak spot

Why do Hernias need treatment?

Although having a hernia is not usually a serious condition, treatment to fix it is usually advised for two reasons:

• It may gradually become bigger and more uncomfortable.
• The contents of the hernia may become trapped in the weak point in the abdominal wall. This can cause bowel obstruction with severe pain, nausea and vomiting (incarcerated hernia).
• There is a small chance the hernia might strangulate:
  • This happens when the bowel (intestine) that comes through the gap in the weak spot becomes squeezed. This can cut off the blood supply to the portion of intestine in the hernia.
  • This can lead to severe pain and some damage to the part of the intestines in the hernia.
  • A strangulated hernia is uncommon and is usually dealt with by emergency surgery.

The risk of strangulation is greater with a femoral hernia than with an inguinal hernia. The risk is also greater with smaller hernias. In some areas, NHS funding for hernia repair is not automatically given and your GP or surgeon may need to apply for this.

Do you need an operation to repair the Hernia?

Most hernias do not need immediate treatment (unless it is an emergency hernia presentation). Although hernias can be managed conservatively (without an operation), it is generally advisable to repair them for the above-mentioned reasons. Surgery is the most common treatment for a hernia. 

What are the types of surgical approaches for Hernia operation?

• The three main types of hernia surgery are open, laparoscopic (minimally invasive), and robotic repair (minimally invasive). In all three approaches, the surgeon puts the contents of the hernia back into its original position and then repairs the hernia defect. Synthetic or biological meshes are then used to repair the defect.

Your surgery and recovery will depend on multiple factors, including the type of hernia you have and how complex the surgery will be.

• Open (conventional): This is usually done by a cut over the hernia swelling. 

• Laparoscopic: This is done by usually three tiny cuts (half to one cm cuts). Then, a video camera (laparoscope) is inserted to view the area. 

• Robotic: The cuts on the skin are similar to laparoscopic surgery’s. The surgeon then controls the robotic instruments to perform the operation.

Acknowledgement: https://patient.info/digestive-health/hernia-leaflet

Further references:

• Castorina S, Luca T, Privitera G, et al; An evidence-based approach for laparoscopic inguinal hernia repair: lessons learned from over 1,000 repairs. Clin Anat. 2012 Sep;25(6):687-96. doi: 10.1002/ca.22022. Epub 2012 Jan 24.
• Lockhart K, Dunn D, Teo S, et al; Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev. 2018 Sep 13;9:CD011517. doi: 10.1002/14651858.CD011517.pub2.
• International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165. doi: 10.1007/s10029-017-1668-x. Epub 2018 Jan 12.
• Kockerling F, Simons MP; Current Concepts of Inguinal Hernia Repair. Visc Med. 2018 Apr;34(2):145-150. doi: 10.1159/000487278. Epub 2018 Mar 26.

Posted By Dr. Ronnie Mathew, Senior Consultant and Director of Colorectal Care Specialists

Colorectal cancer is increasingly affecting younger adults. This concerning scenario has been noted for some time in the recent past (1-3). This is further highlighted in a recent article in December 2024 from Lancet Oncology (4), where there seems to be a worrying trend of rising cases sharply among those in their 20s to 50s: amongst Generation Z, Millennials, and Generation X. 

Many of these individuals have no family history or traditional risk factors like obesity, making this trend especially concerning. This surge remains a perplexing medical mystery for clinicians (5), as noted in an opinion piece from the American College of Surgeons. Traditionally, family history/hereditary factors were the attributed factors causing colorectal cancers amongst younger populations. However, this persistent trend is unlikely due to familial/hereditary factors alone. There are likely to be more factors at play here for this global rise. 

Although it could be due to the usual culprits of diet and lifestyle, etc., epigenetic factors may be more likely to be the cause. In simple terms, epigenetics refers to how behaviors and environment can cause changes that affect the way our genes work. An essential factor to note is that unlike genetic changes (mutations), epigenetic changes are reversible (in effect, they do not change the sequence of DNA bases). This reversibility potential gives hope that if we can find these factors, we could potentially halt or decrease this trend of rising colorectal cancers in our younger population.

Until then, it is prudent for the national population screening programs for colorectal cancer detection to start from an earlier age. Currently, most countries in the Western world start this at the age of 50.  Dr. Ronnie Mathew, Director of Colorectal Care Specialists, is one of the proponents, amongst other global experts, calling on all colorectal societies/ associations globally to consider revising the guidelines for population screening age from current 50 years old to at least 45 years (or even 40 years for any particular country that has a higher statistic for cancer rise in even younger people).

In the meantime, we need to continue to reduce or modify the already known risk factors for colorectal cancers, such as:

• Limiting consumption of red meat, fats
• Eating a diet rich in fruit, vegetables, and whole grains.
• Stopping smoking
• Limiting alcohol consumption.
• Active lifestyle with regular exercise
• Reducing obesity
• Control of diabetes

In addition, those with higher risk need surveillance:

• Older age — the risk of colorectal cancer starts to rise after the age of 50 years
• Medical history — previous history of colorectal polyps or colorectal cancer
• Genetic predisposition — family history of colorectal cancer or hereditary conditions
• Inflammatory bowel diseases — inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease
• Immunosuppression — individuals with chronic low immunity

Symptoms such as rectal bleeding, abdominal pain, changes in bowel habits and weight loss, and feeling tired (if caused by low haemoglobin in the blood) are often overlooked or dismissed. This could lead to delayed diagnoses and more advanced stages of the disease. If any of these symptoms are present, it is advisable to see a doctor as soon as possible. Raising awareness about these red flags and encouraging timely action can save lives.

Notably, there are usually no symptoms in the earlier stages of colorectal cancer. Hence, early detection through screenings, like colonoscopies, or participation in national screenings (like stool occult blood/immunochemical testing) is essential. 

Colorectal cancer is one of the few cancers that can often be prevented. Colonoscopy has consistently shown itself to be the ideal option among all interventions/tests to diagnose or reduce/avoid the risk of colorectal cancer. The latter is because most colorectal cancers develop from polyps, and such polyps can be found and removed at colonoscopy. Removal of polyps is essential before they have the chance to become cancerous.

References

1. Global patterns and trends in colorectal cancer incidence in young adults.
   Siegel, RL ∙ Torre, LA ∙ Soerjomataram, I ∙ et al.
   Gut. 2019; 68:2179-2185
   Crossref
   PubMed
   Google Scholar
   
2. Changes in colorectal cancer incidence in seven high-income countries: a population-based study
   Araghi, M ∙ Soerjomataram, I ∙ Bardot, A ∙ et al.
   Lancet Gastroenterol Hepatol. 2019; 4:511-518
   Full Text (PDF)
   PubMed
   Google Scholar
   
3. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years
   Vuik, FE ∙ Nieuwenburg, SA ∙ Bardou, M ∙ et al.
   Gut. 2019; 68:1820-1826
   Crossref
   PubMed
   Google Scholar

4. Colorectal cancer incidence trends in younger versus older adults: an analysis of population-based cancer registry data
   Sung, Hyuna et al.
   The Lancet Oncology: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2824%2900600-4/fulltext

5. Clinicians Struggle to Understand Dramatic Rise in Early Onset Colorectal Cancer
   Tony Peregrin
   American College of Surgeons article; December 4, 2024
   https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2024/november-december-2024-volume-109-issue-10/clinicians-struggle-to-understand-dramatic-rise-in-early-onset-colorectal-cancer/?utm_campaign=publications-bulletin&utm_medium=social&utm_source=facebook

Abscesses can appear anywhere on the body, but an abscess on your buttocks can be particularly painful and disruptive, interfering with your usual daily activities — from sitting down to walking. If you’ve ever experienced pain and discomfort around your butt, or even bleeding from the anus, you may have a buttock abscess.

Understandably, due to the location of the lesion, it can also be embarrassing to seek medical attention. However, it is important to get the abscess treated as soon as possible to avoid further complications with your infection.

What is a Buttock Abscess?

An abscess is a lump filled with pus caused by an infection. Put simply, a buttock abscess, or perianal abscess, just means that the abscess forms on the buttocks.

Common areas on the buttocks where abscesses can form are:

• Anorectal region — These can be [1, 2]: 
  
  • perianal abscesses – Infection spreads downwards from the anal sphincters, to the subcutaneous tissue near the anus.
    
  • ischiorectal abscesses – Infection spreads outwards from the anal sphincters, to the surrounding fat and fibrous tissue.
    
  • intersphincteric abscesses – Located between the internal and external anal sphincters.
    
  • supralevator abscesses – Infection in the rectal walls, above the levators.
    
  • submucosal abscesses – Located in the mucosal lining of the anal canal or rectum
    
• Pilonidal region (more commonly known as the “butt crack”) — Sometimes cysts called pilonidal cysts also form in the area.

Abscesses can also form anywhere on the skin of the buttocks, like a pimple. Symptoms of buttock abscesses differ according to the location of the lesion. Abscesses near to the surface of the skin can appear to have:

• A lump filled with pus
• Redness
• Swelling
• Pain and discomfort on the lump
  

Deeper abscesses can present the following:

• Pus-like discharge from the anus
• Bleeding from the anus
• Constipation
• Painful bowel movements
• Irritated skin around the anus

What causes a Buttock Abscess?

Anorectal abscesses

Anorectal abscesses form due to inflammation of the subcutaneous tissues, usually caused by clogged and infected anal glands. Bacteria start to grow in these clogged anal glands, which cause the body to produce an inflammatory response. 

A pocket of pus forms as a result of this inflammatory response, which subsequently causes pain and discomfort. Common bacteria that cause these infections include Escherichia Coli, Staphylococcus aureus, Streptococcus, and Enterococcus. Risk factors that can lead to anorectal abscesses include [3, 4]:

• Smoking
• Liquid stool entering the duct
• Dilated duct which leads to improper bowel emptying
• Infections (HIV or other STDs)
• Crohn's disease
• Trauma 
• Cancer
• Ingrown hairs
• Skin injuries or friction

Pilonidal abscess

Pilonidal abscess usually stem from pilonidal cysts, which usually happens when hair is stuck or embedded between folds of skin of the pilonidal region, the spot just above the buttock cracks. This can happen due to friction from clothing, rubbing of the skin, or sitting for long periods of time. This pocket of hair gradually collects dead skin cells, debris, or other matter and forms a cyst. 

If left untreated, the cyst may be infected and form into an abscess. Common risk factors for pilonidal cyst formation are:

• Excess weight
• Sedentary lifestyle
• Male sex
• Ingrown hairs
• Skin injuries or friction

What can happen to a Buttock Abscess if left untreated?

If left untreated, complications can occur, such as:

• Further infection — A buttock abscess can infect surrounding tissue (cellulitis) or even the bloodstream. In the case of a systemic spread, sepsis can occur, causing fever or even organ failure.

• Fistula — A fistula is an abnormal connection between the rectum or the anus, causing discomfort and may require surgical intervention.

• Chronic abscess — A chronic abscess is one that continues to recur as a result of improper treatment or healing.

• Scarring — Prolonged presence of an untreated abscess can lead to scar tissue formation.

How are Buttock Abscesses treated?

Treating buttock abscesses require medical intervention. Popping abscesses yourself can be painful and may lead to complications such as the abscess forming again, or further infections. Buttock abscesses are surgically removed through the following steps:

• Local anaesthesia – Local anaesthesia is usually applied to minimise patient pain and discomfort
  
• Incision – A cut is made on the abscess, sometimes in the shape of an ‘X’
  
• Drainage – The pus and debris are drained out from the incision, but the wound is left open to heal
  
• Packing – Wound packing can be applied to encourage further draining. The packing may need to be changed throughout the healing period
  
• Postoperative care – After the surgery patients will be given pain relief and laxatives to avoid constipation and further irritation. A sitz bath is also recommended for pain relief. Antibiotics may be prescribed by doctors, and patients will require a follow-up visit 3 to 8 weeks after the procedure to ensure proper and complete healing.

However, depending on the location of the abscess, some may be more complicated that others to treat. When consulting your doctor, they will inform you on the course of treatment that you may need to undergo.

Summary

Hopefully this guide helped you understand what buttock abscesses are and how they form. A buttock abscess can be frustrating and embarrassing to deal with, but it is entirely treatable. Getting it treated early will be less complicated and also reduces the risk for other issues to develop. Book a consultation with us today if you have any concerns about buttock abscesses and how to treat them.

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More about Buttock Abscesses

Will buttock abscesses go away on their own?

Buttock abscesses rarely go away on their own. It’s also advised to avoid popping the abscess on your own as this can make the abscess even worse or spread the infection. Your doctor will help you remove the abscess safely and effectively.

How long does recovery take after surgery?

Recovery can take anywhere from 3 to 8 weeks after surgery.

Can a buttock abscess come back?

Yes, a buttock abscess can recur, especially if its underlying cause has not been addressed. Proper treatment, hygiene and adhering to your doctor’s advice can help prevent recurrence.

When do I need to see a doctor?

You should see a doctor if you experience any of the following:

• Pain and discomfort on the buttock
• Bleeding from the anus
• Fever and chills (may indicate an infection)
• A bump in your rectal area

References

1. Hogan AM, Mannion M, Ryan RS, Khan W, Waldron R, Barry K. Beware the ischiorectal abscess. Int J Surg Case Rep. 2013;4(3):299-301. doi: 10.1016/j.ijscr.2012.08.005. Epub 2012 Sep 1. PMID: 23396392; PMCID: PMC3604705.
2. Thompson DT, Hrabe JE. Intra-abdominal and Anorectal Abscesses. Gastroenterol Clin North Am. 2021 Jun;50(2):475-488. doi: 10.1016/j.gtc.2021.02.014. Epub 2021 Apr 23. PMID: 34024453.
3. Klein JW. Common anal problems. Med Clin North Am. 2014 May;98(3):609-23. doi: 10.1016/j.mcna.2014.01.011. Epub 2014 Mar 21. PMID: 24758964.
4. Martín-Lagos Maldonado A, Herrera Mercader MDC, Lozano Cejudo C. Proctitis and perirectal abscesses: is there anything else to think about? Rev Esp Enferm Dig. 2018 Jun;110(6):410. doi: 10.17235/reed.2018.5500/2018. PMID: 29722270.

The digestive system is a vital part of our overall health, yet it is often overlooked until problems arise. From occasional indigestion to more serious issues like chronic abdominal pain or unexplained weight loss, digestive concerns can significantly affect your quality of life. In many cases, diagnosing these issues requires a closer look inside the digestive tract to understand what’s going on beneath the surface.

This is where procedures like colonoscopy, gastroscopy, and endoscopy come into play. While the names might sound daunting or confusing, each of these diagnostic tools is designed to examine different parts of your digestive system, which helps doctors detect and treat a variety of gastrointestinal problems. These procedures not only provide valuable insights into conditions such as polyps, ulcers and inflammation, but they also play a critical role in the early detection of more severe diseases like cancer.

In this blog, we will break down the differences between a colonoscopy, gastroscopy, and endoscopy. We’ll explore how each procedure works, why they are recommended and what you can expect during and after. By the end, you’ll have a clearer understanding of these essential diagnostic tools, helping to ease any concerns or questions you may have about your digestive health.

Understanding the Procedures: Colonoscopy, Gastroscopy, and Endoscopy

While the terms colonoscopy, gastroscopy, and endoscopy are often used interchangeably, they each refer to distinct procedures that examine different parts of the digestive tract. Let’s take a closer look at what each involves:

1. Colonoscopy

A colonoscopy is a procedure used to examine the large intestine (colon) and rectum. During this procedure, a flexible tube called a colonoscope, equipped with a small camera, is inserted through the rectum and guided along the length of the colon. This allows doctors to visualise the inner lining of the colon to check for any abnormalities such as polyps, tumours, inflammation, or signs of cancer.

• Why it’s done: Colonoscopies are often recommended for patients experiencing unexplained changes in bowel habits, rectal bleeding, or abdominal pain. They are also used as a preventative screening tool for colon cancer, especially in individuals over the age of 50 or those with a family history of the disease.
• What to expect: Prior to the procedure, patients are required to undergo bowel preparation, which involves consuming a special solution to cleanse the colon. During the colonoscopy, sedation is typically administered to ensure comfort, and the procedure usually lasts about 30 to 60 minutes. Any polyps found can be removed during the same session for further examination.

2. Gastroscopy

A gastroscopy, sometimes referred to as an upper endoscopy, focuses on examining the upper part of the digestive system, including the oesophagus, stomach and the first part of the small intestine (duodenum). A thin, flexible tube called a gastroscope is passed through the mouth and down the throat to allow the doctor to inspect these areas for issues such as ulcers, inflammation, tumours, or infections.

• Why it’s done: Gastroscopies are recommended for patients experiencing symptoms like persistent heartburn, difficulty swallowing, unexplained nausea, or upper abdominal pain. It is also used to investigate the cause of bleeding in the upper digestive tract.
• What to expect: Patients are typically given a mild sedative or local anesthetic to numb the throat. The procedure is quick, lasting around 15 to 30 minutes, and most patients experience minimal discomfort. A biopsy may be taken if abnormal tissue is found.

3. Endoscopy

The term “endoscopy” is more general and refers to any procedure that uses an endoscope to examine the inside of the body. While both colonoscopy and gastroscopy are types of endoscopy, the term is most commonly used to describe procedures involving the upper digestive tract (gastroscopy) or lower digestive tract (colonoscopy). However, endoscopy can also refer to other types of procedures used to examine different organs, depending on the part of the body being assessed.

• Why it’s done: Endoscopy is used for a variety of diagnostic purposes, depending on which part of the body is being examined. When referring to the gastrointestinal tract, it is often a first-line test for unexplained digestive symptoms.
• What to expect: The specifics of the procedure vary depending on which part of the digestive tract is being examined, but all forms of endoscopy involve the insertion of a flexible tube with a camera into the body to allow visualization of the area.

Key Differences and Similarities Between Colonoscopy, Gastroscopy, and Endoscopy

Though colonoscopy, gastroscopy, and endoscopy share the common goal of examining the digestive system, they target different areas and have specific roles in diagnosing various conditions. To help clarify the distinctions, here’s a simple breakdown of the key differences and similarities between these procedures:

Procedure	Focus Area	Purpose	Preparation	Procedure Time
Colonoscopy	Large intestine (colon) and rectum	Used to detect polyps, tumours, inflammation, and signs of colon cancer. Often used as a cancer screening tool.	Requires bowel preparation with a cleansing solution to empty the colon.	Typically lasts 30 to 60 minutes.
Gastroscopy	Esophagus, stomach, and duodenum	Detects issues like ulcers, inflammation, tumours, or bleeding in the upper digestive tract.	Fasting for 6-8 hours before the procedure.	Quick, usually 15 to 30 minutes.
Endoscopy	General term, most often referring to upper or lower GI tract examination	Allows visual inspection of the digestive tract for diagnostic purposes, including biopsies.	Varies depending on the type of endoscopy performed.	Varies depending on the procedure, typically 15 to 60 minutes.

Similarities

• Use of an Endoscope: All three procedures involve the use of a thin, flexible tube called an endoscope with a camera attached to examine internal organs.
• Sedation: In most cases, patients are sedated to ensure comfort throughout the procedure.
• Diagnostic Value: Each procedure allows for the detection of abnormalities such as inflammation, tumours, or bleeding, as well as the removal of polyps or tissue for biopsy when necessary.
• Low Risk: These procedures are considered minimally invasive and have low complication rates when performed by experienced medical professionals.

What to Expect During and After the Procedures

Knowing what happens during and after a colonoscopy, gastroscopy, or endoscopy can help reduce any anxiety and make the process smoother. Here’s a table outlining the main steps involved in each procedure, what you can expect during the procedure itself, and what happens afterward.

Procedure	During the Procedure	After the Procedure
Colonoscopy	Sedation is provided to ensure comfort.A colonoscope is inserted through the rectum to examine the colon.Polyps or tissue samples may be removed.	Mild bloating or cramping may occur.You will need someone to drive you home due to sedation.Results may be discussed immediately, but biopsy results may take a few days.
Gastroscopy	A gastroscope is inserted through the mouth and passed down the throat.Your throat will be numbed with local anesthetic.The doctor will inspect the esophagus, stomach, and duodenum.	You may have a sore throat temporarily.Similar sedation recovery as colonoscopy.Immediate results with possible biopsy report after a few days.
Endoscopy	Varies depending on the type of endoscopy (upper or lower GI).Sedation is typically provided.The doctor examines the area and may take biopsies or perform minor treatments.	Minimal discomfort after the procedure.Sedation recovery will require a companion to drive you home.Results depend on the procedure and any biopsies taken.

Common Recovery Tips

• Rest: It’s essential to rest for the remainder of the day, avoiding any strenuous activities.
• Diet: You can typically resume eating a normal diet unless your doctor advises otherwise. Start with lighter meals if you experience discomfort.
• Follow-up: Always follow your doctor's instructions, especially if a biopsy was taken or if additional treatment is needed.

Why Are These Procedures Important?

Colonoscopy, gastroscopy, and endoscopy are essential tools for diagnosing and preventing serious health issues in the digestive system. These procedures allow doctors to detect early signs of conditions like cancer, ulcers, and inflammation, often before symptoms become severe. Below is a table that highlights when each procedure might be recommended and why it’s important for your health.

Procedure	Why It’s Important	When It’s Recommended
Colonoscopy	Detects and removes polyps before they turn into cancer.Diagnoses causes of chronic bowel issues.	Routine screening for colorectal cancer, especially for individuals over 50 or with family history.Chronic diarrhea, rectal bleeding, unexplained weight loss, or changes in bowel habits.
Gastroscopy	Detects ulcers, tumours, and inflammation in the upper digestive tract.Helps diagnose GERD and other upper GI issues.	Persistent heartburn, difficulty swallowing, upper abdominal pain.Diagnosing ulcers, reflux, or unexplained nausea.
Endoscopy	Provides a closer look at specific areas of the digestive tract.Detects causes of unexplained digestive symptoms.	Further investigation when other tests are inconclusive.Abdominal pain, bleeding, or difficulty swallowing.

Why Early Detection Matters

Early detection is a cornerstone of modern medicine, especially when it comes to digestive health. Procedures like colonoscopy, gastroscopy, and endoscopy provide an opportunity to diagnose potential issues long before they become serious or life-threatening. This can make a significant difference in patient outcomes, and help transform what could have been a complex medical challenge into a manageable condition.

One of the most critical advantages of early detection is the ability to prevent diseases like cancer. For instance, during a colonoscopy, polyps—small growths in the lining of the colon—can be identified and removed on the spot. While polyps themselves are benign, certain types can develop into colorectal cancer over time if left untreated. By removing them early, doctors can effectively eliminate the risk of cancer before it even begins.

Similarly, a gastroscopy can help detect ulcers, inflammation, and even early signs of gastric cancer. These conditions often develop without obvious symptoms in the initial stages, which makes them difficult to detect through routine exams. By using a gastroscopy to closely examine the upper digestive tract, doctors can identify subtle abnormalities that may otherwise go unnoticed. For instance, an ulcer that’s caught early can be treated with medication, which can prevent it from worsening into a bleeding ulcer or a more severe condition.

Another major benefit of early detection is the ability to diagnose and manage chronic digestive diseases such as inflammatory bowel disease (IBD) and gastroesophageal reflux disease (GERD). While these conditions may not be immediately life-threatening, they can significantly impact your quality of life if left untreated. An endoscopy can reveal the extent of the inflammation and damage caused by these diseases, which can allow doctors to tailor treatment plans to prevent further complications and improve patient comfort.

Early detection doesn’t just mean catching life-threatening diseases—it also means finding answers for unexplained symptoms. Many digestive issues can present with vague symptoms like bloating, pain, or discomfort, which might be dismissed as minor. However, these can sometimes signal a deeper issue that requires medical attention. Procedures like endoscopy help to rule out more serious conditions, providing both reassurance and clarity to patients.

Medical Conditions Diagnosed Through Colonoscopy, Gastroscopy and Endoscopy. 

These diagnostic procedures are essential in detecting a wide range of medical conditions, many of which may not show obvious symptoms in the early stages. By providing a detailed view of different parts of the digestive system, colonoscopy, gastroscopy, and endoscopy help doctors diagnose and treat various conditions more effectively. Below is a table outlining the most common conditions diagnosed through these procedures.

Procedure	Commonly Diagnosed Condition	Description of the Condition
Colonoscopy	Colorectal cancer	A type of cancer that starts in the colon or rectum. Often develops from precancerous polyps, which can be detected and removed during a colonoscopy.
	Colonic polyps	Small clumps of cells that form on the lining of the colon [6]. While most polyps are harmless, some can develop into cancer if not removed.
	Inflammatory Bowel Disease (IBD)	A group of conditions, including Crohn’s disease and ulcerative colitis, that cause chronic inflammation of the gastrointestinal tract.
	Diverticulosis	A condition where small pouches (diverticula) form in the walls of the colon, which can sometimes become inflamed or infected (diverticulitis) [8].
Gastroscopy	Gastric ulcers	Open sores that develop on the lining of the stomach due to excess stomach acid or infection, causing pain and, in severe cases, bleeding.
	Gastroesophageal Reflux Disease (GERD)	A chronic condition where stomach acid flows back into the oesophagus, causing irritation and sometimes damage to the oesophagal lining.
	Stomach cancer	A malignant tumour that originates in the lining of the stomach. Early detection through gastroscopy is crucial for effective treatment.
	Esophagitis	Inflammation of the esophagus, often caused by acid reflux, infections, or certain medications.
	Hiatal Hernia	A condition where part of the stomach pushes upwards through the diaphragm and into the chest cavity.
Endoscopy	Barrett’s esophagus	A condition where the esophagus lining is damaged by stomach acid, leading to abnormal changes in its cells. This can increase the risk of esophageal cancer [1].
	Celiac disease	An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine, causing digestive issues and nutrient absorption problems [2].
	Esophageal cancer	Cancer that forms in the tissues of the oesophagus. Endoscopy is used to detect tumours or abnormal growths in the oesophagus early.
	Peptic ulcers	Sores that develop on the inner lining of the stomach, esophagus, or small intestine due to stomach acid, often causing pain and discomfort.

How to Prepare for a Colonoscopy, Gastroscopy, or Endoscopy

Proper preparation is key to ensuring the success of your procedure, whether it’s a colonoscopy, gastroscopy, or endoscopy. Each procedure requires different steps to prepare your digestive tract, and following these instructions carefully will help ensure accurate results. Below is a table outlining the preparation steps for each procedure.

Procedure	Preparation Steps	Additional Tips
Colonoscopy	Follow a low-fibre diet a few days before the procedure.Switch to a clear liquid diet 24 hours before.Take a prescribed laxative to cleanse the colon the night before.	Drink plenty of clear fluids to stay hydrated.Arrange for someone to drive you home as you will be sedated.Stop certain medications if instructed by your doctor.
Gastroscopy	Fast for at least 6-8 hours before the procedure to ensure the upper digestive tract is empty.	Wear loose, comfortable clothing on the day of the procedure.Let your doctor know if you are on blood-thinning medications.Arrange for transportation home after sedation.
Endoscopy	Follow similar guidelines as for gastroscopy (for upper endoscopy).For lower endoscopy (colonoscopy), follow the bowel cleansing and dietary restrictions.	As with other procedures, fasting or bowel prep is key depending on the type of endoscopy.Always inform your doctor about any medications you are taking.

General Tips for All Procedures

• Comfortable Clothing: Wear loose, comfortable clothes for the procedure since you will be sedated and may feel groggy afterwards.
• Hydration: Staying hydrated with clear fluids before your fasting period starts can make the preparation more comfortable.
• Ask Questions: If you have any uncertainties or concerns, don’t hesitate to ask your doctor beforehand for clarification.

Final Thoughts: Understanding These Essential Diagnostic Procedures

Colonoscopy, gastroscopy, and endoscopy are more than just medical tests; they are vital procedures that help safeguard your digestive health. Each procedure serves a specific purpose, whether it’s screening for colorectal cancer, diagnosing conditions like GERD or ulcers, or detecting abnormalities that might otherwise go unnoticed. By providing doctors with a clear view of your digestive system, these procedures enable early detection, prompt treatment, and ultimately, better health outcomes.

Understanding the differences between these procedures and knowing what to expect can reduce anxiety and empower you to take an active role in your health care. Whether you’re undergoing one of these procedures for a routine checkup or to investigate specific symptoms, they offer invaluable insight that can lead to timely and effective medical intervention. Prioritising your digestive health through these tests is an important step toward maintaining your overall well-being.

References 

1.  Barrett’s Esophagus - NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases, https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus.  Accessed 27 Sept. 2024.
2. “Coeliac Disease.” Nhs.Uk, 20 Oct. 2017, https://www.nhs.uk/conditions/coeliac-disease/.

We've all been there—feeling perfectly fine one moment and then suddenly our stomach swells up like a balloon, leaving us uncomfortable and often in pain. Stomach bloating is a common issue that affects millions of people worldwide, yet its causes are often misunderstood. It’s that tight, full feeling you get in your abdomen that can make your clothes feel snug and can sometimes be downright painful. This sensation can occur at the most inconvenient times, whether you’re about to give an important presentation, enjoying a meal with friends, or simply relaxing at home.

For some, bloating is a minor inconvenience that passes quickly. But for others, it can be a recurring problem that significantly impacts their daily lives, leading to a constant search for relief. The unpredictability of bloating can make it even more frustrating, as it seems to strike without warning or clear cause. But why does this happen? Is it something we ate, a sign of a more serious health issue, or just our bodies being unpredictable?

In this blog, we will explore the common triggers and underlying factors that lead to stomach bloating. By discovering these reasons, we aim to provide you with a better understanding of this uncomfortable condition and offer practical advice on how to manage it. Whether you experience occasional bloating or it’s a regular occurrence, gaining insight into the causes can help you take control and find relief.

1. Dietary Causes of Bloating

Understanding the dietary causes of bloating is crucial in managing and preventing this uncomfortable condition. Here’s how these common dietary factors cause bloating and affect your digestive system.

• Common Gas-Producing Foods
  Certain foods are known to produce more gas during digestion, which may result in bloating. These include:
  • Beans and lentils: rich in fibre and complex carbohydrates, beans [1] and lentils [2] can be difficult for the digestive system to break down completely. They contain oligosaccharides, which are fermented by gut bacteria, producing gas as a byproduct.
  • Cruciferous vegetables: vegetables like broccoli, cauliflower, cabbage, and Brussels sprouts are high in fibre and sulfur compounds [3]. While they are highly nutritious, their fermentation process in the gut can result in significant gas production.
  • Carbonated drinks: sodas and sparkling waters [4] contain dissolved carbon dioxide, which can lead to gas build-up in the stomach. This excess gas can cause a bloated feeling as it accumulates in the digestive tract.
  • Artificial sweeteners: sweeteners such as sorbitol, mannitol, and xylitol [5], found in sugar-free gum, candies, and some diet foods, are not fully absorbed by the body. As they pass into the colon, they are fermented by bacteria, producing gas and leading to bloating.

• Food Intolerances
  Food intolerances can cause significant digestive distress and bloating. Two common intolerances are:
  • Lactose intolerance: lactose intolerance occurs when the body lacks the enzyme lactase, which is needed to break down lactose, the sugar found in milk and dairy products. Consuming lactose can lead to bloating, gas, diarrhoea, and abdominal pain as undigested lactose ferments in the colon [6].
  • Gluten intolerance and celiac disease: Non-celiac gluten sensitivity can cause bloating, gas, and discomfort after consuming gluten-containing foods like wheat, barley, and rye [7]. Celiac disease is an autoimmune disorder where ingestion of gluten leads to damage in the small intestine [8]. Symptoms include severe bloating, diarrhoea, and malabsorption of nutrients.

2. Lifestyle Factors That Cause Bloating

Our lifestyle choices play a significant role in our overall digestive health and may contribute to the frequency and severity of bloating. These are some common lifestyle factors that may result in digestive issues, such as bloating:

• Stress and digestion: the gut and brain are connected through the gut-brain axis, which means that psychological stress can directly impact gastrointestinal function [9]. Stress can lead to various digestive issues [10], including bloating, by causing the stomach to produce more acid, altering gut motility, and increasing gut sensitivity. Moreover, stress can exacerbate conditions like Irritable Bowel Syndrome (IBS) [11], where bloating is a common symptom.
• Sedentary lifestyle: regular physical activity helps stimulate the natural contractions of your intestinal muscles, which helps facilitate efficient movement of food and gas through the digestive tract. A sedentary lifestyle can slow down these contractions, which can result in sluggish digestion and increased bloating. 
• Eating Irregularly and Its Impact on Bloating
• Certain eating behaviours can increase the likelihood of one developing consistent bloating. These include;
  • Inconsistent meal times: skipping meals or eating at irregular times can disrupt the body's natural digestive rhythm. Your digestive system functions best when it operates on a regular schedule and processes food predictably. Irregular eating patterns can cause digestive disturbances, which may result in bloating.
  • Mindless eating and overeating: eating while distracted, such as watching TV or working, can lead to overeating and swallowing excess air, both of which can contribute to bloating. Contrary to this, eating mindfully, paying attention to your food, and chewing thoroughly can improve digestion and reduce the likelihood of bloating.
  • Large meals and late-night eating: consuming large meals or eating late at night can overload the digestive system and slow down digestion. On the other hand, more frequent meals can help keep your digestive system functioning smoothly and prevent bloating.

3. Medical Conditions That Present Symptoms of Bloating

While diet and lifestyle factors are common contributors to bloating, certain medical conditions can also play a significant role. Here are some key medical conditions associated with bloating:

• Irritable Bowel Syndrome (IBS): IBS is a chronic digestive disorder characterised by symptoms such as abdominal pain, cramping, diarrhoea, constipation, and bloating. The exact cause of IBS is unknown, but it is believed to involve a combination of gut-brain axis dysfunction, increased gut sensitivity, and irregular gut motility. These factors can lead to excessive gas production and irregular bowel movements, which may contribute to bloating [12]. Managing IBS-related bloating often involves dietary modifications, stress management, and sometimes medication.
• Small Intestinal Bacterial Overgrowth (SIBO): SIBO occurs when there is an abnormal increase in the number of bacteria in the small intestine. This overgrowth can interfere with nutrient absorption and lead to digestive issues. The excess bacteria ferment ingested food, producing gas that accumulates in the intestines, which may cause bloating [13], abdominal pain, and discomfort. 
• Hormonal changes: hormonal changes, particularly in women, can also lead to bloating. Many women experience bloating as a symptom of premenstrual syndrome (PMS) due to hormonal fluctuations that cause the body to retain more water and salt. Conditions like polycystic ovary syndrome (PCOS) and menopause can also cause hormonal imbalances affecting digestion and fluid retention [14]. Managing hormone-related bloating often involves lifestyle changes, dietary adjustments, and sometimes medication to address the underlying hormonal imbalance.

Practical Tips to Manage and Prevent Bloating

Managing and preventing bloating effectively often requires a combination of dietary adjustments, lifestyle changes, and improved eating habits. Here are some practical tips to help you beat the bloat and maintain a comfortable digestive system.

1. Over-the-counter medication: luckily, most of the causes of stomach bloating listed can be treated easily. A doctor may prescribe over-the-counter antacids [15] as bloating relief when your bloated stomach is caused by certain food intolerances and excessive gas.  If your stomach pain and bloating are caused by constipation, fibre supplements or laxatives may be prescribed to help ease bowel movement and reduce bloating.

• Change in diet: attempting to identify your bloating triggers can help you navigate recurring bloating issues with a sense of predictability. For patients with celiac disease, removing gluten [16] from their diet completely is often advised by medical professionals to prevent exacerbating their condition. If you have been diagnosed with IBS, avoiding high-gas food (carbonated and alcoholic beverages) and abiding by a low-FODMAPS diet [17] can prove efficient in reducing bloating.
  
  FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. This diet guides on to identify and avoid hard-to-digest carbohydrates that can be found in certain grains, vegetables, fruits, and dairy products, including fructose, fructans, and lactose. A low-FODMAP diet cuts out some or all of the following:

• Abdominal massage: massaging your abdomen gently [18] can relieve bloating by softening your stomach muscles and speeding up digestion. It allows gas to pass through your digestive tract more easily and helps to move stool along the inside of your colon.
• Physical activity: being physically active including practising yoga can stimulate digestion [19] and reduce bloating. Physical activities work by improving blood flow to the digestive organs and promoting relaxation which helps to ease gas and enhance gut motility.

• Herbal teas: research [20] suggests that herbal teas, such as peppermint and ginger tea, can be effective in reducing bloating. These teas help relax the digestive muscles, reduce gas, and improve overall digestion, offering a natural remedy for bloating relief.

When to Seek Medical Advice

While occasional bloating is common and usually not a cause for concern, there are times when it may signal a more serious underlying issue that requires professional attention. Recognising the red flags and understanding the diagnostic tests and treatment options can help you take the necessary steps towards better health. It is important to know when bloating goes beyond a simple digestive inconvenience. 

If you experience persistent bloating that doesn’t improve with dietary and lifestyle changes, or if it’s accompanied by severe abdominal pain, weight loss, vomiting, or changes in bowel habits such as chronic diarrhoea or constipation, it’s time to seek medical advice. Other symptoms that warrant a doctor’s visit include blood in the stool, fever, and difficulty swallowing. These could be signs of more serious conditions such as gastrointestinal infections, inflammatory bowel disease, or even certain cancers.

When you consult a healthcare professional about persistent bloating, they may recommend a variety of diagnostic tests to determine the underlying cause. These can include gut screenings to check for infections and inflammation or stool tests to identify parasites or further investigate the presence of blood.  Imaging tests such as ultrasounds, CT scans, or endoscopy (insert link to service page) may also be used to get a closer look at your digestive tract.

Based on the results, your doctor will suggest appropriate treatment options. These may range from dietary modifications and medications to manage symptoms to more specific treatments for conditions like IBS, SIBO, or celiac disease. In some cases, referral to a gastroenterologist for specialised care may be necessary.

Conclusion

Bloating can be a persistent issue that affects both comfort and quality of life, but it’s often within our power to manage effectively. By making thoughtful dietary choices—such as steering clear of known gas producers and embracing gut-friendly foods—you can significantly reduce bloating incidents. Likewise, adopting healthy lifestyle habits, including regular exercise and effective stress management, supports optimal digestion.

However, if bloating becomes severe or chronic, it’s crucial to seek medical advice, as it may indicate a more serious underlying condition. With the right approach, you can achieve a more comfortable and balanced digestive system, which can help ensure a healthier and more enjoyable life.

References

1. “Why Do Beans Cause Gas?” Verywell Health, https://www.verywellhealth.com/why-do-beans-cause-gas-1942947.  Accessed 21 June 2024.
2. Bellini, Massimo, et al. “Low Fermentable Oligo- Di- and Mono-Saccharides and Polyols (FODMAPs) or Gluten Free Diet: What Is Best for Irritable Bowel Syndrome?” Nutrients, vol. 12, no. 11, Nov. 2020, p. 3368. PubMed Central, https://doi.org/10.3390/nu12113368. 
3. “Worst Foods for IBS Sufferers.” Advanced Endoscopy & Surgical Center, LLC, https://advancedendoscopy.com/news/worst-foods-for-ibssufferers. Accessed 21 June 2024.
4.  “Is Carbonated (Sparkling) Water Good or Bad?” Healthline, 3 Nov. 2019, https://www.healthline.com/nutrition/carbonated-water-good-or-bad. 
5. Lenhart, Adrienne, and William D. Chey. “A Systematic Review of the Effects of Polyols on Gastrointestinal Health and Irritable Bowel Syndrome.” Advances in Nutrition, vol. 8, no. 4, July 2017, pp. 587–96. PubMed Central, https://doi.org/10.3945/an.117.015560. 
6. Robles, Luelle, and Ronny Priefer. “Lactose Intolerance: What Your Breath Can Tell You.” Diagnostics, vol. 10, no. 6, June 2020, p. 412. www.mdpi.com, https://doi.org/10.3390/diagnostics10060412. 
7. Roszkowska, Anna, et al. “Non-Celiac Gluten Sensitivity: A Review.” Medicina, vol. 55, no. 6, June 2019, p. 222. www.mdpi.com, https://doi.org/10.3390/medicina55060222. 
8. Lebwohl, Benjamin, and Alberto Rubio-Tapia. “Epidemiology, Presentation, and Diagnosis of Celiac Disease.” Gastroenterology, vol. 160, no. 1, Jan. 2021, pp. 63–75. ScienceDirect, https://doi.org/10.1053/j.gastro.2020.06.098. 
9. Labanski, Alexandra, et al. “Stress and the Brain-Gut Axis in Functional and Chronic-Inflammatory Gastrointestinal Diseases: A Transdisciplinary Challenge.” Psychoneuroendocrinology, vol. 111, Jan. 2020, p. 104501. ScienceDirect, https://doi.org/10.1016/j.psyneuen.2019.104501. 
10. Oroian, Bianca Augusta, et al. “New Metabolic, Digestive, and Oxidative Stress-Related Manifestations Associated with Posttraumatic Stress Disorder.” Oxidative Medicine and Cellular Longevity, edited by Juan F. Santibanez, vol. 2021, Dec. 2021, pp. 1–18. DOI.org (Crossref), https://doi.org/10.1155/2021/5599265. 
11. Balmus, Ioana-Miruna, et al. “Irritable Bowel Syndrome and Neurological Deficiencies: Is There A Relationship? The Possible Relevance of the Oxidative Stress Status.” Medicina, vol. 56, no. 4, Apr. 2020, p. 175. www.mdpi.com, https://doi.org/10.3390/medicina56040175. 
12. Serra, Jordi. “Management of Bloating.” Neurogastroenterology & Motility, vol. 34, no. 3, Mar. 2022, p. e14333. DOI.org (Crossref), https://doi.org/10.1111/nmo.14333. 
13. Takakura, Will, and Mark Pimentel. “Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update.” Frontiers in Psychiatry, vol. 11, July 2020. Frontiers, https://doi.org/10.3389/fpsyt.2020.00664. 
14. Kałużna, Małgorzata, et al. “Are Patients with Polycystic Ovary Syndrome More Prone to Irritable Bowel Syndrome?” Endocrine Connections, vol. 11, no. 4, Apr. 2022. ec.bioscientifica.com, https://doi.org/10.1530/EC-21-0309. 
15. Booth, Stephanie. “Remedies for Bloating.” WebMD, https://www.webmd.com/digestive-disorders/remedies-for-bloating.  Accessed 21 June 2024.
16.  Medicine, Northwestern. “Celiac Disease vs. Gluten Intolerance (Infographic).” Northwestern Medicine, https://www.nm.org/healthbeat/healthy-tips/celiac-disease-vs-gluten-intolerance-infographic.   Accessed 21 June 2024.
17. FODMAP Diet: What You Need to Know. 29 Dec. 2021, https://www.hopkinsmedicine.org/health/wellness-and-prevention/fodmap-diet-what-you-need-to-know. 
18. Contributors, WebMD Editorial. “What to Know About Belly Massage for Digestion.” WebMD, https://www.webmd.com/digestive-disorders/what-to-know-about-belly-massage-for-digestion.  Accessed 21 June 2024. 
19. D’Silva, Adrijana, et al. “Yoga as a Therapy for Irritable Bowel Syndrome.” Digestive Diseases and Sciences, vol. 65, no. 9, Sept. 2020, pp. 2503–14. Springer Link, https://doi.org/10.1007/s10620-019-05989-6. 
20. Sattar, Tabinda. “Would Some Herbal Teas Play a Medicating Role for Certain Diseases?” Current Nutrition & Food Science, vol. 17, no. 2, Feb. 2021, pp. 176–88. IngentaConnect, https://doi.org/10.2174/1573401316666200514224433.