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How Can You Tell If You Have Been Infected With Hepatitis B?


August 4, 2020 Blog

Hepatitis is an inflammation of the liver, and it comes in numerous forms such as hepatitis A, hepatitis B, and hepatitis C. Often caused by viruses, hepatitis infections cause damage and impedes the normal functions of the liver. Although all hepatitis types affect the liver, they differ in the viruses that cause them and the effects they have.

Hepatitis B is one of the more common types of liver inflammation. In adults, most hepatitis B infections recover by itself within a few weeks. In fact, many cases go undetected because of the lack of symptoms. However, in some cases, especially in young children, hepatitis B may progress into a chronic infection, and cause long-term health effects like liver damage, cirrhosis, or liver cancer.

Symptoms of hepatitis B

With such an elusive infection having such great potential to harm the body, it is crucial to get an idea of how to tell if you have been infected with hepatitis B. Unfortunately, some hepatitis B patients don’t experience any symptoms at all, or exhibit flu-like symptoms that are easily dismissible.

If there are any symptoms at all, a person affected by hepatitis B may experience signs such as:

Symptoms, if any, typically occur between 2 to 5 months after exposure to the virus. Acute conditions usually last for a few weeks.

Risk factors for hepatitis B

Knowing when you have been placed in a vulnerable situation that increases your risk is another way to be on guard against hepatitis B. Along with your awareness of possible exposure, you can suspect a hepatitis B infection, especially if the symptoms begin 2 to 5 months after exposure.

Here are some situations that put people at higher risk of contracting hepatitis B:

  • Accidental pricks from used needles (e.g. injection syringes)
  • Sharing of unsanitary needles (e.g. tattoo needles)
  • Sexual contact with infected persons
  • Infants born to infected mothers
  • Direct contact with blood or open wounds of an infected person

Hepatitis B is not spread through sharing of food or water, eating utensils, coughing, sneezing, and other forms of skin-to-skin contact like hugging, holding hands, or kissing. Different hepatitis types are transmitted differently as well, so it’s important not to get confused.

Testing for hepatitis B

While looking out for symptoms and risk exposure are vital steps in spotting a possible hepatitis B infection, the only way to confirm an infection is to get tested for it. If you have observed any symptoms and have recent suspected exposure to the virus, it is best to visit a doctor to receive a blood test.

There are a few different blood tests used to detect the hepatitis B virus. Make sure to consult with your doctor about the options before making the most appropriate choice.

Guarding against hepatitis B requires vigilance in looking out for symptoms, risk exposure, and taking action to receive testing. That way, you can be assured of receiving timely and suitable care to keep the infection under control.


July 28, 2020 Blog

Pancreatic cancer is a cancer of the pancreas, an organ that lies between the stomach, liver, and intestine. The pancreas is made out of two glands, one that produces insulin, and the other which produces enzymes to aid with digestion. These enzymes drain into ducts before entering the small intestine. While cancer rarely develops in the gland tissue, the ducts are where cancer most commonly develops.

A majority of pancreatic cancer cases go undetected until the cancer worsens. Often, the disease does not cause any symptoms until it has progressed to the later stages, when the cancer has spread to other organs. It is no surprise then that pancreatic cancer is often referred to as the silent killer.

Symptoms of pancreatic cancer

Unlike other types of cancer like breast, prostate, or colorectal cancer, there is no routine screening test for pancreatic cancer. This makes it all the more crucial that you understand the symptoms of the disease, so you can get it diagnosed as soon as possible. Due to the location and function of the pancreas, pancreas cancer symptoms range widely from digestive issues to hormonal conditions.

  • Belly or back pain

Tumours that grow in the body or tail of the pancreas may apply pressure on nearby organs, resulting in stomach pain. The tumour could also press on nerves around the pancreas, leading to back pain. However, abdominal and back pain can also be caused by many other conditions besides cancer, including musculoskeletal and digestive issues. 

  • Unexplained weight loss

Sudden and unexplained weight loss can occur in pancreatic cancer cases for several reasons. Cancer steals nutrients from the body to grow and multiply, depriving the body of energy. A tumour pressing on the stomach can also cause nausea and vomiting, making it difficult to keep food down. Even while maintaining a healthy diet, the body may not be able to properly digest the food due to the pancreas failing to make sufficient digestive fluids.

  • Jaundice

A tumour at the head of the pancreas can cause blockage of the liver’s bile duct. In these cases, the body is not able to effectively get rid of bilirubin, a waste product from the breakdown of blood cells.

Bilirubin then builds up in the body, causing jaundice. Signs of jaundice include yellow skin and eyes, pale-coloured stools, and dark-coloured urine. An excess of bilirubin in the skin can also cause itching and irritation. Aside from cancer, jaundice also occurs in liver-related diseases.

  • Diabetes

Once pancreatic cancer has progressed, it may destroy the insulin-making cells in the pancreas. This could cause one to experience symptoms of diabetes, as the body cannot produce enough insulin to maintain healthy blood sugar levels. Such symptoms include excessive hunger or thirst, frequent urination, weight loss, and fatigue.

  • Enlarged gallbladder

When the tumour blocks the common bile duct, bile can get trapped and accumulate in the gallbladder. This results in a swollen gallbladder. Doctors may be able to feel this as a lump on the right side of the belly, under the ribs. Apart from cancer, gallstones can also cause the gallbladder to swell if it blocks the cystic duct or bile duct.

  • Blood clots

Pancreatic cancer increases the risk of deep vein thrombosis (DVT), which is when a blood clot forms in a large vein, often in the leg. This can cause several uncomfortable symptoms in the leg, including pain, redness, swelling, and warmth.

In some cases, the blood clot can dislodge and travel to the lungs, causing a pulmonary embolism (PE). When this happens, the patient usually experiences shortness of breath or chest pain. Blood clots can be caused by a variety of conditions as well, so discovering them in one’s body is not a sure sign of cancer.

  • Pale and greasy stools

Blockage of the common bile duct can cause a few changes in the stool. A lack of bilirubin from bile causes the stools to appear lighter in colour. Stools can also contain undigested fat, causing it to appear greasier and float. This is because the body is unable to break down fat well due to the lack of digestive juices from the damaged pancreas.

What to do if you are experiencing symptoms

If you are experiencing one or more of these symptoms, it does not necessarily mean that you have pancreatic cancer. There are several other possible causes for most of them. Still, it would be best to consult a gastroenterology specialist who can advise you on the best course of action.


July 23, 2020 Blog

Colon cancer is a cancer that forms in the cells lining the inside of the large intestine. It is usually grouped together with cancer of the rectum and referred to collectively as colorectal cancer.

Colorectal cancer is one of the most common cancers among Singaporeans. According to the Singapore Cancer Registry, between the years 2011 to 2015, colorectal cancer was the most common cancer among men in Singapore, and second most common among Singaporean women. It is also the second-largest cause of cancer-related deaths among men, and the third-largest among women.

Recognising colon cancer

The symptoms of colon cancer can sometimes be overlooked or unnoticed. This is especially so in the early stages of the disease, when the symptoms may be milder, or not even be present. Yet, early diagnosis is crucial as it can expedite life-saving treatment.

As such, colorectal cancer screening tests like the faecal immunochemical test (FIT) or lower gastrointestinal endoscopy are recommended for Singaporeans above 50 years old. Regular screening should be accompanied by vigilance in looking out for early warning signs of colon cancer. Here are some of the noticeable symptoms that you should look out for.

  • Rapid, unexplained weight loss

A sudden drop in weight could be a cause for concern. If you experience a loss of about 4.5kg or more in six months or less without any marked change in your diet or lifestyle, you should consult a doctor about it. Cancer cells tend to use a lot of the body’s nutrients to grow and multiply, which can lead to weight loss.

  • Fatigue and lethargy

Fatigue is a feeling of tiredness that does not go away even with rest. Like unexplained weight loss, this could occur due to the cancer cells depleting the energy stores in the body. This is a rather common symptom shared across many conditions, like diabetes and heart disease, so it should be considered alongside other symptoms.

  • Persistent changes in bowel habits

A tumour that has grown large enough can cause blockage in the colon. This could result in narrower stools or more frequent trips to the bathroom. It could also affect the ability of the large intestine to absorb water, leading to more watery stools. One may experience this as diarrhoea or constipation. If unrelated to another condition, these can be symptoms of colon cancer.

  • Stomach pain

Long-lasting and severe stomach pain that began recently can be a symptom of colon cancer. Colon cancer often causes changes in bowel habits, which can result in cramping and bloated stomach symptoms. Irritable bowel syndrome (IBS) can cause these symptoms as well, in addition to diarrhoea and constipation.

  • Blood in stool

A tumour can lead to bleeding in the colon and blood in the stool. One may notice this from blood on the toilet paper after wiping, or blood in the toilet bowl water. Alternatively, stool could appear very dark or even black due to dried blood. Bloody stool is also observed in cases of ulcerative colitis (UC) or inflammatory bowel diseases, like Crohn’s disease.


While one of these symptoms alone may not be sufficient to determine the underlying condition, multiple symptoms can give your doctor a better idea of the possible causes.

Frequent screening and knowledge of the symptoms of colon cancer could allow for early diagnosis and the provision of life-saving treatment. If you are experiencing these symptoms, want to explore your colon cancer screening options, or find out more about colon cancer treatment costs in Singapore, you can consult a gastroenterology specialist or a general practitioner.


July 8, 2020 Blog

Vomiting is an unpleasant symptom that most people have probably experienced in their lives. But as with most gastrointestinal issues like constipation or bloated stomach symptoms, it often signals fleeting issues in one’s digestion – like indigestion, reflux, or eating something ‘wrong’. Most vomiting symptoms go away within a day. However, in rarer cases, vomiting can also be a sign of more serious health problems.

Vomiting can point to many different kinds of health issues. These are not just limited to gastrointestinal problems, but also conditions that affect the brain, central nervous system, cardiovascular system, and so on. Often, the other symptoms that vomiting occurs with can be a helpful indication of the underlying health issue. Here are some symptoms that commonly occur with vomiting, and what they could mean:

  • Vomiting with abdominal pain

Food poisoning often leads to vomiting with abdominal pain, cramping, nausea, and diarrhoea. However, this is usually easily traced back to food. In cases where certain foods are not the issue, these symptoms can signal an underlying problem in the gastrointestinal tract. This could be due to chronic illnesses like Crohn’s disease or irritable bowel syndrome (IBS), or signal an emergency condition like intestinal blockage. If the onset of vomiting is sudden, with sharp, escalating abdominal pain, it could also point to a case of appendicitis.

  • Vomiting with headache

Feeling nauseated, vomiting, and suffering painful migraines sometimes come together. In these cases, it is usually the pain from the headache that triggers the nausea and vomiting. Migraine may also be accompanied by sensitivity to light, noise and odours. Some people find relief that their migraine is relieved after vomiting. It is also possible for these symptoms to be linked to emotional stress, like anxiety.

  • Vomiting with fever

Common problems like food poisoning and stomach flu (gastroenteritis) may be accompanied by fever. A huge cause of concern would be if vomiting occurs with sudden high fever, a stiff neck and severe headache. These are signs of meningitis – inflammation of membranes in the brain and spinal cord. It is an extremely serious, but relatively rare condition that can be caused by viral, bacterial, or fungal infection.

  • Vomiting with blood

Vomit with blood is often a worrying sign. If the blood appears as red streaks, it may indicate the presence of a tear in the oesophagus or stomach lining. In some cases, vomit with blood takes on a coffee grounds appearance, which happens when stomach acids and blood congeal. Peptic ulcers, gastroesophageal reflux disease, stomach cancer, or liver cancer, may all result in this kind of vomiting.

When does vomiting become a cause for concern?

When vomiting comes and goes within a day, it is usually not a cause for concern. However, certain combination of symptoms can be signs that the problem is more serious, and requires a thorough examination by the doctor. Here are some signs you shouldn’t ignore vomiting:

  • Repeated vomiting beyond 1 or 2 days
  • Moderate to severe dehydration
  • Vomit with blood
  • Significant loss of weight since onset of vomiting
  • On and off vomiting that occurs for over a month
  • Vomiting accompanied by severe pain

On top of these symptoms, you should be getting emergency medical attention if you experience vomiting with any of these signs:

  • Chest pain
  • Sudden, severe headache
  • Sudden, severe stomach pain
  • Shortness of breath
  • Blurred vision
  • Confusion
  • Stiff neck and high fever

Knowing how to identify your health symptoms is an important step in getting timely and appropriate care. Don’t wait until it is too late to visit your health practitioner or the ER.


June 26, 2020 Blog

Suffering from abdominal pain, stomach bloating, constipation, and flatulence are just some common symptoms that people with irritable bowel syndrome (IBS) face. While every individual’s experience will vary, in many cases, these digestive symptoms are uncomfortable enough to affect one’s quality of life significantly.

As with most gastrointestinal-related problems, food is often a trigger which can worsen or improve symptoms. For IBS sufferers, controlling one’s intake of certain foods can vastly reduce symptoms like flatulence and bloated stomach. In particular, a diet known as the low-FODMAP diet has been found to be helpful in improving IBS-related symptoms.

FODMAPs are carbohydrate sources containing fermentable oligo-, di-, mono-saccharides and polyols, which make these foods exceptionally good at triggering bloating, gas, and stomach pain.

Numerous studies have associated a low-FODMAP diet with reduced symptoms, with some putting the likelihood of improvement at 75% for bloating and 81% for stomach pain. But before we look at how to implement this diet, you will need to determine if such a diet is suitable for you.

Is the low-FODMAP diet for you?

The low-FODMAP diet is for persons with IBS who are experiencing chronic gastroenterological symptoms. However, it is not recommended for everyone as FODMAP foods are still an important course of nutrients, in particular, prebiotics. In some cases, a low-FODMAP diet could do more harm than good.

A low-FODMAP diet should be considered if you have been diagnosed with IBS, experience ongoing digestive symptoms, and your symptoms have not improved by following other first-line dietary advice.

How do you begin a low-FODMAP diet?

Experts advise taking the 3-step approach to a low-FODMAP diet. But before starting, it is crucial to know what FODMAP foods are so you can plan out your meals and groceries.

Here are some of the most common FODMAP foods from each category:

  • Oligosaccharides: Grains (e.g. wheat, rye), legumes (e.g. peas, beans), garlic and onions
  • Disaccharides: Dairy products (e.g. milk, yoghurt, cheese)
  • Monosaccharides: Some fruits (e.g. apple, peach, and mangoes), sweeteners (e.g. honey, agave nectar)
  • Polyols: Some fruits (e.g. blackberries, cherry, lychee), low-calorie sweeteners (e.g. xylitol in sugar-free mints)

Stage 1: Restriction

The low-FODMAP diet begins with a full ban on all high-FODMAP foods. The purpose is to see if eliminating FODMAPs from your diet actually improves your symptoms.

For it to work, being disciplined by removing all high-FODMAP foods is necessary. This stage should last about 3-8 weeks, depending on when you observe relief from your digestive symptoms.

Stage 2: Reintroduction

In this stage, high-FODMAP foods are reintroduced systematically, in turn. This helps you identify which types of FODMAPs your body can tolerate, and how much of them your body can take before digestive symptoms strike again.

To do this systematically, you should allocate 3-day blocks to test out each category of FODMAP foods by adding small amounts to your diet. It will help to do this under the advice of a professional dietitian, or you could use a diet-tracking app to help you.

During this stage, take note of the FODMAP foods and the symptoms that arise when you consume them. This will be necessary information for you in stage 3.

Stage 3: Personalisation

This stage is where you customise your low-FODMAP diet according to your personal tolerances. From what you have gleaned in stage 2 about your body’s reaction to certain FODMAP foods, you will restrict the known trigger foods, while re-incorporating foods that do not cause you problems.

As stage 3 is meant to be the long-term norm, it is important to craft the right diet to maintain diet variety while reducing triggers. This will help you stick to the diet and offer a better quality of life with improved gut health.

What if the diet doesn’t work?

While the low-FODMAP diet has been shown to help many IBS sufferers improve their symptoms, it is not a cure. There are also people who do not find success even by following the diet closely.

If the low-FODMAP diet does not work for you, your doctor may recommend other therapies or medications to work in conjunction with, or in replacement of the low-FODMAP diet. Some of these IBS therapies include stress management, fibre supplements, or using medications to relieve symptoms. Do speak to your gastroenterology specialist for personalised recommendations.


June 10, 2020 Blog

Bloating is a common type of discomfort experienced at the abdominal area. The direct cause of bloated stomach symptoms is the accumulation of gas in the gastrointestinal tract. While gas is produced normally during the digestive process, it can build up and cause bloating when other conditions (such as constipation) block the gas from being released easily.

The feeling of being bloated is often uncomfortable, and can cause the belly to swell. This is a temporary and common symptom that most people experience every once in a while. However, some medical conditions can also lead to frequent, chronic bloating.

If you have been experiencing bloating with or without constipation symptoms, here are some suggestions of things you can do to find relief:

  • Get moving

It might sound deceptively simple, but sometimes all you need to do is get some exercise. Physical activity helps the bowels move, which can promote the release of gas and stool. It doesn’t need to be rigorous exercise, either. Taking a walk in your neighbourhood often works wonders. You can also try low-impact exercises like yoga.

  • Relax in a warm bath

As with most tummy woes, a warm bath is always a comforting remedy. The relief is not just skin deep, either. The heat is effective in relaxing the abdominal muscles as well as reducing stress, which contributes to more ease in passing gas, relieving bloating, and relieving abdominal pain.

  • Take some gas relief pills

If you need quick relief and other home remedies do not work, popping a dose of gas relief pills works as well. There are plenty of over-the-counter capsules for gas relief, and some are combination drugs that also relieve other symptoms like diarrhoea or constipation. As always, make sure to follow the dosage instructions.

  • Increase fibre intake gradually

Bloating due to constipation can be relieved by increasing fibre intake. Dietary fibre promotes healthy bowel movements. However, fibre must be introduced gradually, as consuming too much fibre at once can aggravate gas and bloating symptoms.

  • Identify the underlying cause

For frequent bloating episodes, the best course of action is to identify the underlying cause and address it. Most cases of bloating can be attributed to diet, so keeping a food journal can help to pinpoint potential triggers. Foods that cause bloating mostly fall under what is called the FODMAP category: foods that contain fermentable oligosaccharides, disaccharides, monosaccharides and/or polyols. Examples of FODMAP foods are:

  • Oligosaccharides: Wheat, rye, garlic, onions, beans
  • Disaccharides: Dairy products like milk, cheese, yoghurt
  • Monosaccharides: Some fruits such as apples, peaches, mangoes; sweeteners such as honey and agave nectar
  • Polyols: Some fruits such as cherry and lychee; sweeteners like those in sugar-free mints and gum.

Apart from diet, hormonal changes such as during menstruation or pregnancy can also cause the gastrointestinal system to be more prone to bloat. Medical conditions that cause bloating include irritable bowel syndrome, lactose intolerance, celiac disease, and acid reflux, amongst others. If your bloating occurs frequently and causes significant discomfort, you are advised to consult a doctor to rule out any of these underlying conditions.


June 3, 2020 Blog

Most people would have experienced constipation at least once or more in their lives. Being unable to pass stools for more than a few days, or needing to strain to pass stools is a common issue that is usually easily resolved with home remedies or an over-the-counter laxative.

Most cases of constipation have causes that can be easily addressed. For example, lack of fibre, lack of fluids, lack of exercise, or ignoring the urge to go to the bathroom can all lead to constipation. However, chronic constipation or constipation that is accompanied by other worrying symptoms can also be a sign of more troubling problems, such as physical conditions in the gastrointestinal tract.

Thus, the question is, how does one tell apart the innocuous bout of constipation from constipation as an indicator of something more serious? Here are some clues you should look out for:

1. Persistent or intense abdominal pain

Constipation symptoms often include some abdominal pain. This pain is usually due to a build-up of gas or the need to pass stools. However, if the pain is debilitating or persistent, it could signal other issues with the gastrointestinal tract. If this occurs with the inability to pass gas or stools, you should seek medical help immediately.

Some possible causes of persistent, intense abdominal pain accompanied by constipation are:

  • intestinal obstruction
  • perforated intestine or stomach
  • pancreatitis
  • appendicitis
  • mesenteric ischemia (blockage of blood flow to the intestine)

2. Blood in your stool

Finding bright red blood in your stools seems like a worrying sign, but it is not always the case. Small bright red stains are often due to a scratch in the rectal area from straining or wiping too hard, or sometimes due to haemorrhoids (piles). These symptoms and conditions are relatively minor and you can find relief with home and over-the-counter remedies.

However, having large amounts of bright red stains or spots, or dark red or black stools may indicate problems in your intestinal tract itself. For these cases, it is best to consult a doctor to examine the source of bleeding.

Some possible causes for blood in stools are:

  • ulcerative colitis
  • diverticulosis
  • Crohn’s disease
  • colorectal cancer

3. Vomiting

If constipation and vomiting come together, you should suspect a case of faecal impaction or other forms of bowel obstruction. Faecal impaction is when a large, dry mass of stool becomes stuck in the colon or rectum. The blockage causes a build-up of waste, and is highly dangerous and potentially life-threatening. Learning to recognise the signs of faecal impaction can allow the sufferer to get prompt help and save them from this medical emergency.

4. Bloating

When constipation is accompanied by bloated stomach symptoms, it can be a sign of bowel obstruction. Bowel obstruction can also present itself with vomiting. Most cases of bowel obstruction require immediate attention, as it can become dangerous and life-threatening if left untreated. Obstructions in the small or large intestine can be caused by a variety of factors, including:

  • Scar tissue from previous surgery
  • Inflammation (e.g. due to Crohn’s disease, inflammatory bowel disease, etc.)
  • Tumour
  • Hernia

What to expect when seeing a doctor for constipation

If you experience any of the above symptoms, you know it’s time to visit your doctor or a gastroenterology specialist. The doctor will typically ask you a series of questions about your bowel movements, diet, lifestyle, and family history of digestive issues. Don’t feel embarrassed about answering them, but try your best to be as accurate as possible, as this will help your doctor pinpoint the cause of your constipation.

The doctor may conduct a physical examination by inserting a gloved, lubricated finger into your anus to check for blockage or bleeding. If further diagnostic tests are required, the doctor may advise you to undergo procedures like a colonoscopy, CT scan, or barium enema X-ray.


May 27, 2020 Blog

People often dismiss the occasional stomach discomfort, such as bloating, flatulence, or cramps. However, if these symptoms persist for longer than usual, or is significantly affecting your daily life, it is definitely worth it to get it checked out by a doctor. Yet, some people may avoid going to a specialist in gastroenterology for their symptoms, due to the hassle and costs involved.

Doing due research to find the best doctors and reasonable rates is thus of utmost importance. Let us help you make a more informed decision with some benchmarks and breakdowns of the costs typically involved in getting a colonoscopy and gastroscopy – two common methods for diagnosing gastrointestinal (GI) symptoms.


Colonoscopy is a procedure used to examine the lower GI tract, namely, the large intestine. Thus, it is performed to investigate the cause of digestive issues like chronic diarrhoea, chronic constipation, or blood in stools. Colonoscopy is also a highly effective examination technique for the diagnosis, treatment, and follow-up to patients with colorectal cancer, Crohn’s disease, ulcerative colitis, and more.

Average cost of colonoscopy in Singapore (fees indicate total bill amount)

Public hospital (with government subsidies)Private hospital
Colonoscopy screening$397-*
Diagnostic colonoscopy (day surgery)$576$2,590
Diagnostic colonoscopy (in-patient)$1,365 (Ward C)
$1,827 (Ward B2)

*Average cost unavailable due to insufficient data points

Many factors can influence the cost of colonoscopy. Colonoscopy for general screening purposes is usually kept more affordable. Diagnostic colonoscopy for the purposes of identifying specific conditions is slightly costlier. With the addition of procedures like removing growths, taking biopsies, or other treatments performed using colonoscopy, the fees will increase.

Another consideration to make is the choice of hospital you choose, and whether you decide to undergo the procedure on an out-patient or in-patient basis. Out-patient colonoscopy at a public hospital is the most cost-effective option, especially with government subsidies. However, if you prefer a more private, personalised, and premium experience, you can also opt for a private hospital, for a higher price.


Gastroscopy is a type of endoscopy used to examine the upper GI tract, which includes the oesophagus, stomach, and the upper portion of the small intestine. It is commonly employed to assess the cause of GI symptoms like heartburn, difficulty swallowing, persistent vomiting, and bloatedness. Gastroscopy is also involved in the diagnosis and examination of conditions such as gastroesophageal reflux disease (GERD), stomach ulcer, stomach cancer, gastritis, and more.

Average cost of gastroscopy in Singapore (fees indicate total bill amount)

Public hospital (with government subsidies)Private hospital
Gastroscopy (day surgery)$342$2,139
Gastroscopy (in-patient)$1,387 (Ward C)
$1,655 (Ward B2)

Like with colonoscopy, the cost of receiving a gastroscopy is also influenced by factors such as additional procedures required, the type of medical facility, and whether the procedure is done on an in-patient or out-patient basis.

At the end of the day, how much you spend on your colonoscopy or endoscopy is dependent on your budget, level of service expected, and whether additional procedures are needed. To find out more about Singapore’s cost for various medical procedures, you can also explore the Ministry of Health’s portal for more fee benchmarks based on past transacted bills.


May 15, 2020 Blog

Having occasional upset tummy, bloating, or flatulence symptoms is pretty normal, and many people don’t even see a doctor for it. However, having to see a specialist in gastroenterology for symptoms like these probably mean it is adversely affecting your life. In addition to following doctor’s orders for treatments, what else can you do to improve your general gut health?

What if we told you that breathing can affect your gut health? It’s a relation that few people think about, but is in fact quite significant. Understanding the link between your breathing and your digestive system can be a tremendous breakthrough if you are seeking to improve your gut health.

Stress, breathing, & gut health

It’s popular knowledge that stress is a trigger for countless health issues. From headaches to asthma, stress can make it worse. That familiar anxiety, tight feeling, and restlessness we experience during a busy work-week, right before a test, or when faced with an emergency is accompanied by quick, shallow breathing, which isn’t ideal for our digestive system.

Shallow breathing occurs due to the fight or flight response, when adrenaline in the body kicks in. Breathing quickens to channel more oxygen to the muscles in preparation to attack or run – but the drawback is that blood flow to other systems, like the digestive system, becomes compromised.

As a result, prolonged or frequent periods of stress can interfere with the digestive system, hampering its normal functions, and increase the chances of inflammation. Overall, the immune system also weakens, and causes the body to be more vulnerable to various infections and illnesses.

Two ways to breathe

While stress is unavoidable – and even good for you at moderate levels – there are some ways you can teach your body to counter it.

To begin with, many people don’t breathe optimally to encourage deep breathing. Instead, they employ chest breathing, which is a shallow breathing method. As can be imagined, during times of stress, this breathing becomes even more shallow, and incurs more damage to health.

A better way to breathe will be to practice abdominal breathing. This is the natural breathing method of babies and people when asleep. Rather than having the chest move up and down when breathing, the motion engages the abdomen instead.

Abdominal breathing doesn’t just help our organs take in more oxygen for improved health; it also has a relaxing effect, which helps to chase off the feelings of stress and anxiety.

Tips for deep breathing

For those of us who have un-learnt how to breathe abdominally, you can pick it up again by practising regularly. Here’s how you can perform abdominal breathing:

1. Sit or lie down comfortably with one hand on your chest and another on your stomach.
2. Breathe in comfortably through your nose for two seconds, and let the air ‘enter’ your stomach. You should feel the hand on your stomach rising, and minimal movement for the hand on your chest.
3. Exhale slowly from your mouth for two seconds. You should feel the hand on your stomach lowering as your abdomen deflates.
4. Repeat for 10 minutes.

Getting started with abdominal breathing may feel weird if you are not used to it, but you will become more used to it as you practise. The good thing is, you can easily practise as you go about your day – while sitting in your commute to work, as you are watching TV, or as part of your cooling down routine after a work-out.

The effects of abdominal breathing will be well worth picking up this simple habit. In future, your body will be able to respond more calmly during moments of stress, and reduce the impacts to your gut health.


May 8, 2020 Blog

Getting a colonoscopy is not something most people will look forward to. However, it is a very useful procedure for keeping up with your gut health. Widely regarded as the best procedure for colon cancer screening, colonoscopy is also frequently used to check out various gastrointestinal symptoms like piles, blood in the stools, constant stomach bloating or cramping, and more.

When the time comes to get your first colonoscopy, it is normal to feel nervous and worried about it. Yet, knowing that you have an experienced doctor with a wonderful track record can give you more confidence and help to allay your fears. Talking to your doctor and making sure you know what to expect can also go a long way in preparing yourself mentally for the procedure.

To make your colonoscopy experience as comfortable and worry-free as possible, here are some questions you should definitely ask your doctor before the colonoscopy:

  • What is their adenoma detection rate?

Adenoma detection rate (ADR) is often taken as a strong indicator of how effective a doctor’s colonoscopies are. A doctor’s ADR is defined as the proportion of patients with at least one adenomatous polyp detected out of all the first-time colonoscopy patients over 50 years old that are screened by the doctor in a given time period.

A lower ADR may mean a higher chance of missed polyps or cancers, while higher ADRs are an indication of effective colonoscopy. A general guideline for a ‘good’ ADR is 20% or higher for women patients, and 30% or higher for men. However, you should also note that the demographics of a doctor’s patient base also affect their ADR. For example, a doctor who sees relatively higher numbers of young and female patients may have a lower ADR, but it might not mean they are any less competent in performing colonoscopies – rather, their patients are just less likely to have polyps in the first place.

  • What is their average withdrawal time like?

A doctor performs colonoscopy by first inserting the scope fully into the colon, then conducting examinations as the scope is being withdrawn. Thus, common sense will have it that doctors who are more thorough in their examinations will take longer in their withdrawal time.

It is during this withdrawal time that precancerous polyps and other lesions are typically found, and studies show that doctors with a longer withdrawal time often also have higher ADRs. Experts recommend looking for a doctor with a withdrawal time of at least 6 minutes.

  • What is their cecal intubation rate?

The cecum is the furthest point of the colon from the rectum, which is where the large intestine meets the small intestine. A total colonoscopy means that the cecal intubation rate is 100%, where the scope reaches all the way to the cecum. Having a lower cecal intubation rate will mean a higher chance of missing any polyps that are in the colon.

The average cecal intubation rate is about 90%, so if your doctor has a rate above that, you are likely to be in good hands. However, in some cases, low cecal intubation rates can be due to incomplete bowel preparation by the patient, which prevents the doctor from advancing the scope fully.

  • What is the preparation process like?

Following the right preparation steps will help ensure that your bowels are completely cleared for the procedure. Inadequate clearing will affect the cecal intubation rate, and in the worst case, will mean you have to postpone your colonoscopy appointment – and go through the bowel prep again.

Different doctors may have slightly different instructions and colon-clearing solutions for their patients. So, make sure you hear it from your doctor on the right steps to follow, and commit to it diligently. Just remember, colonoscopy can save your life, so putting up with a few days of inconvenience will be worth it!

  • What will the procedure be like?

Being nervous about an upcoming medical appointment can be truly nerve-wracking, but knowing what to expect at the procedure can at least help you prepare your mind for it. You can ask people you know who have gone through colonoscopy before on what to expect.

Most of all, ask your doctor directly about what will happen at the procedure. They will know best about how long the process will take, what kind of discomfort you will feel, and what sedation methods are available.

As with any medical procedure, it is always good to pick a doctor you are comfortable with and confident in. Asking the right questions can help you make the right choice!

Experiencing piles, flatulence, or blood in stool symptoms? If you have persistent gastrointestinal symptoms or a high risk of colon cancer, it might be time to set a colonoscopy appointment with your doctor.

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