Don’t assume it’s piles… it could be cancer.
Eve commented on my earlier post:
i had a patient , 27 yrs old, pregnant , complaining of piles..was treated everywhere and given Daflon for abt 6 months..n still complaining of bleeding every time at stool..she came to see me for the pregnancy actually…which i did a scan n bb was alright..i referred her to UMMC , n they found her to have cancer of the rectum…the patient was advised to terminate her pregnancy..which she refused..n has since gone home to Sarawak..i don’t know what happen to her after that….bleeding n pain does not necessarily mean piles..
And George said “assumption” is “a sum o’ sins”. If we “assume”, we’ll end up making an “ass” out of “u” and “me”.
The next photo came from a patient who had treatment for piles for months before she had a proper diagnosis made. And it turned out to be a low rectal cancer. The rectum and the anus were resected, she had a permanent colostomy formed and she received radiotherapy and chemotherapy. Unfortunately for her, the cancer recurred after initial treatment; and became locally advanced.
An ulcerated, advanced rectal cancer
it will be difficult if piles and cancer occur concurrently…when u do a proctoscope..all u see are the prolapsed piles..how do u identify which is which?..
Actually, you can usually differentiate between piles and cancer on proctoscopic and digital examination.
If they were not complete because of:
1. pain, treat first and wait for another time to examine. Or examine under anaesthesia.
2. prolapse, and the proctoscopic examination was not satisfactory, repeat the examination after completing treatment.
A proctoscopic and digital examination is for the final 4-5 cm only. Sigmoidoscopy or colonoscopy may be required to complete the examination of patients with blood in the stools if any of the following is present (because of a higher risk of cancer):
1. Age above 40 years.
2. Presence of dark blood or mucus.
3. Recent change in bowel habit.
4. Tenesmus.
4. Anaemia.
5. Persistent bleeding after treating the piles.
Colorectal cancer is the No. 3 cancer in Malaysia after lung and breast cancer
Docs are not mind readers , yes, it is up to the patient to reveal all his medical history ( where the pain is no matter which part of the autonomy) but do you think the doc has a role to play too to get the patient to divulge his medical history or the onus is solely on the patient?
Patients “click” with certain docs…right? and vice versa?
The doc has the responsibility to ask the relevant questions. The patient is not expected to know what is important and what is not.
Sometimes, however, the doc IS expected to read minds
particularly when the story doesn’t quite sound right. Don’t bluff, ok?
Goodness!! How unfortunate for the pt…
Is is true that red meat n processed food r the predisposing factors for colorectal ca?
Then again, cancers r so prevalent these days, u either die of this or that cancer in the end….
You seem like a very conscientious doctor. Very few doctors will take the time as the faster their turnover of patients during the day the more money they get. I have yet to find a doctor that will actually sit down and explain things to me in layman’s terms, other than “You balik makan ini ubat, kalau sakit lagi, come back”. No explanation as to what this “ubat ” is. Any side effects or interaction with any other meds that you might currently be on.
Firehorse, haha, then maybe you can try looking for doctor which have very few patients like myself? Just kidding.
I think it is up to you to find a doctor whom you are comfortable with. Communication IS everything. Without good communication, the rate of error is … killing, literally.
SK, there is no evidence that red meat and processed food cause or increase the risk of colorectal cancer. There is some evidence that a diet high in fat and calories and low in fibre increases the risk.
Firehorse, being in an “out-of-city” practice has it’s advantages
hehe. I get busy talking to patients. It’s not as exhausting as counseling, though. 
yenjai, i agree.
I had a bad sprain on my left foot. Limp-ed for a week with no visible signs the swelling to subside. Checked myself in a “specialist” hospital if there any bone fractures. Guess wht, the doc took only 5 mins to examine the x-ray film and another 5 to tell me I’m ok. No chance to ask more as he get the nurse to shoo me out from the room! However, I managed to find out from him that I got abnormality bone structure in my left foot! Interesting finding
hoiling, 5 minutes is a long time to look at a foot x-ray already. And 5 minutes to say that “there’s no fracture” is a lot of time too. well.. he did show you what was abnormal in your foot bones.
Well there are doctors who will explain but we are few in number. But find them until you are happy with them. Then again some will talk so well that you would not realise that you have just been taken for a ride.
Eww, gross!! Now that’s a picture that can make me lose my appetite.
the patient did seek treatment and the attending doctor only diagnose it only after 6 mths??
and, yenjai, i seriously want to know the name of your practice, please.
jonzz, i thought nothing would do that trick.
eve and yenjai, got an answer for my penang-lang nyonya?
What do you think of some ppl who had irregular motion and usually passing hard stool? At time she had bleeding because of the hard stool. Piles occured once and it went back there again. That was roughly 2 years ago. Now her real problem is irregular motion and hrad stool. To sum up, she has pain in the ass! teheheeee..
Doc..After all these “shitty” posts..I really cleaned up my act. I still eat my hawker food, but i also eat alot of fibre and I practise healthy toilet habits and poo everyday (I was quite irregular before).
Everyone out there, Doc has strong community message (free somemore), “Take care of your colon and it will take care of you!”
But..sorry ah Doc..I cannot find my running shoes..so belum lari la!! HEE HEE!!!
Queen, firstly, irregular motion is not a problem unless there are other symptoms. By itself, it is not a disease or even a disorder. It’s normal because our diet is not perfectly regular in terms of fibre content anyway.
Secondly, hard stools are likely to be due to:
1. inadequate fibre and/water in the diet,
2. postponing bowel movements when nature calls, which causes more water to be absorbed from the stools in the rectum,
3. inherent slow passage of bowel contents.
The recurrent, long term pain during passage of hard stools may be due to:
1. fissure.
2. piles.
She needs an examination by a doctor to make a proper diagnosis.
mott, UAHHHH…. glad to be of service. And thank you for sharing this feedback… it encourages me too.
ok.. your running shoes? let me see, they’re in the storeroom right behind the boxes of old books. but dah rosak.. stiff already … so get new ones. HAHA!!
*waves to all the docs in here*
I’m just curious, how can you girls & guys docs still eat your food after seeing all these gross thingie from your patients?
*waves back to titoki*
Just as how you can eat after seeing the gross resumes from your recruit-wannabes.
Picture is gross, I agree, but narration and comments here are really enlightening. Thank you all.
Oooh boy.. this is oh oh so gross! BUEK!
happy, thanks.
zara’s mama, THANKS!
At last can see what cancer down there looks like. Then again, I got a feeling they probably come in a whole lot of other shapes, colours and sizes. Scary! I was told once that if bleeding in stools is not just piles then…. need to have it check by Doc.
milo, this is not what the typical rectal cancer look like. i’ll post a photo of a typical rectal cancer some time soon.
Hello Bernard,
The pics you have in the other post, are those then the typical Colorectal cancer? They look more like internal growth.
What are the likely cause of Colorectal cancer? I do a few guess: Genetically inherited and drink & smoke too much maybe.
Does piles at any stage turn cancerous?
Milo, colorectal cancers are growths arising from the internal lining of the colon and rectum. Only cancers arising from the last 5 cm of the rectum can actually be found on examination of the anus.
The risk factors for colorectal cancers are:
Piles do not increase the risk of colorectal cancer.
Thanks for bringing clarity to that. Long list indeed. When I look at this list, I am thinking, which are the ones I can do something about it…
a) Those we cannot change:
- Can’t stop aging and family history.
- History of cancer
- History of ulcerative colitis
b) Those we can do something about:
- Diet high in fats and calories
- Diet low in fibre, calclum and folate
- Obesity, sedentary lifestyle, alcohol, smoking
Protein - Here I am thinking egg white and possibly red & white meat. How much is considered high enough to cause colorectal cancer?
Definitely looking forward to what you have to say on Polyps.
Milo, protein doesn’t cause cancer. It’s just that a high-protein, high-fat, high-calorie diet is a risk factor for colorectal cancer. Don’t stop taking proteins. Haha.
ah…ok…Thats great! I love 3-4 egg white for breakfast. Sounds like I get to keep having that, part of my replenishment for the workout (cardio, weights, yoga) I do in gym 3 times a week.
Milo, your dietary requirements depend on your lifestyle. For a physically active person as you are, i think you can afford more protein, and even calories and fat than the average joe.
Hi Doc, suggestion to post pics of STD adv. stage just so general public can take precaution and abstain from casual sex. Teenagers are so ignorant nowadays, most, sorry, did not mean to generalize. Am sure after those pics, everyone will think twice before going on a bed-hopping spree.
Sweetpea, thanks for the suggestion. I don’t usually see many patients with STDs in my line of medicine, but if there are any interesting images, I shall think about posting them.
It’s true that many people are not aware of the dangers of having multiple unprotected casual sexual partners.