So, let’s talk about haemorrhoids/piles

I hope to gather all necessary information in one post for you so you do not have to open so many tabs to understand about haemorrhoids/piles. To whoever reading this, I feel you :’)

1. What?

Haemorrhoids, also known as piles (Chinese: 痔疮), are abnormally enlarged and bulging blood vessels in and around the anus and lower rectum1.

Two types –

(A) External
• develop near the anus
• covered by very sensitive skin
• painful swelling may occur if blood clot develops
• feels like a hard, sensitive lump
• bleeds only if it ruptures

(B) Internal
• develop within the anus beneath the lining
• painless bleeding and protrusion during bowel movements
• can be pushed back if mild

Internal Vs External haemorrhoids

Four degrees2

1st degree: bleed but do not prolapse
2nd degree: prolapse and retract on their own (with or without bleeding)
3rd degree: prolapse but must be pushed back in by a finger
4th degree: prolapse and cannot be pushed back in

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2. Why you and me?

Common contributing factors1,3:

  • Ageing (it’s ok, we can learn how to prevent it from worsening!)
  • Chronic constipation or diarrhoea (watch your diet!)
  • Pregnancy (noble mums)
  • Hereditary (it’s ok, we can learn how to prevent it from worsening!)
  • Faulty bowel function due to overuse of laxatives (are detox products necessary?)
  • Straining during bowel movements (linked to constipation)
  • Spending long periods of time in toilet (stop bringing your phone everywhere…)
  • Weight-lifting (your choice :))
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Author’s experience:

Of course, the fact that you are reading this post means that you suspect yourself having pile(s). I want to tell you that it is alright, almost one in two will be affected by pile at some stage in their lives1. I spotted mine when I was fifteen. It did not bother me for years although it did become slightly larger and one day in my early 20s, the second pile appeared out of nowhere. Usually they would not be affected as I pass motion but they would swell if I attempted extremely spicy food such as Mala :P. Nonetheless, slight swelling and occasional constipation did not deter me from eating what I wanted. Until things got worse.

Whenever I passed motion, the swelling of my piles worsened. I thought that the way I wiped was not clean enough so I would wash with soap BUT this action is a big NO NO4. (Soap can dry out and irritate piles! Water is sufficient.) Soon, I experienced itch so severe that my sleep was disrupted. Like most of us, I felt embarrassed about my condition and never wanted to visit a doctor but the itch was killing me. I scratched my head to think of something that I can apply to temporarily stop the itch. I googled and found out that tea tree oil might help!5 After application, I didn’t bother if it will help and rushed my ass, literally, to the nearby polyclinic. Thankfully, I could feel the itch subsiding as I made my way there.

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I was anxious about the examination by the doctor as it was so embarrassing. However, I was told to lie sideways, hug my knees, and pulled down my pants to the extent that only my buttocks were exposed (so yeah our reproductive organs are safe). The examination was quick as my swelling piles were already waving their hands in the doctor’s face. I was given a tube of Proctosedyl ointment and eighteen days’ worth of Diosmin tablets.

Application of the ointment was extremely tedious and I would suggest if you end up having to do a deep application, wash with water and dry the area before inserting the cannula. The ointment (all kinds of ointment actually) is very greasy. To me, the ointment did not help much so I would not recommend you to buy ointments online to try to cure the piles on your own. After diligently eating the medication prescribed, my piles no longer swell. Unfortunately, they are still there.
What can I try to do to prevent surgery?

4. How? (Home remedies VS Non-Surgical Procedures VS Surgeries)3, 8

Home remedies:

a) Prevent constipation
– moderate-fibre diet (more fruits, vegetables & whole grains)
– drink plenty of water (at least 8 glasses of water per day)
– exercise regularly (at least 60 minutes of moderate-intensity physical activity per week)

b) Avoid holding off bowel movements for too long

c) Avoid sitting on the toilet for more than 5 minutes (just don’t bring your phone or book in, it is very doable)

d) Topical treatments
– Apply over-the-counter haemorrhoid cream (Effectiveness varies between people)
– Use pads containing witch hazel or numbing agent (I personally did not try this before so I am not sure about its effectiveness)
– Apply tea tree oil (as mentioned under experience)
– Insert suppository for piles (I personally did not try this before so I am not sure about its effectiveness)

e) Soak regularly in warm bath or sitz bath (Effectiveness varies between people)

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NON-SURGICAL PROCEDURES:

a) sclerotherapy – a chemical is injected into the haemorrhoid to decrease its size, which will happen over several weeks

b) rubber band ligation – a method to cut off the blood supply to the haemorrhoid by tying an elastic band around it, causing it to fall off in up to 10 days

c) electrotherapy – a gentle electric current is applied to your piles to shrink them

d) infrared coagulation – an infrared light is applied to shrink the piles by cutting off blood supply

e) Oral medications Used to treat small bleeding piles

SURGICAL TREATMENTS:

a) Haemorrhoidectomy – complete surgical removal of the piles

b) Stapled haemorrhoidopexy – removal of piles using a special stapler device (less painful than “conventional” haemorrhoidectomy)

c) Transanal haemorrhoidal dearterialisation (THD) – Using an ultrasound to locate the problematic blood vessels and stitching the piles

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5. When? (to seek treatment)

Usually it is fine to live with piles as long as they do not bleed or swell severely. However, if they cause irritation, result in unbearable itch, swell continuously without showing any sign of recovery, it is highly recommended to seek a doctor’s advice whether to undergo a surgery to remove them or not.

To note, do not be overly optimistic about the surgery, piles do reappear after surgery. In fact, about 5% of the patients redeveloped piles after surgery.6 The success of the surgery depends heavily on the effort of patients to lead a healthier and “piles-friendly” lifestyle.

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6. Where? (to seek treatment)

Specialist Services at Singapore General Hospital:
Call 6321 4377

Specialist Services at Mount Elizabeth Hospital:
Call 6250 0000 (Orchard) / 68986898 (Novena) or make an appointment online (https://www.mountelizabeth.com.sg/make-appointment)

Or you can visit the nearest polyclinic and request a referral to one of the governmental hospitals.

7. Do haemorrhoids lead to cancer?

As I was researching about piles, I came across “anal cancer”. The signs of anal cancer such as bleeding from the anus or rectum, a lump near the anus, itching or discharge from the anus, and a change in bowel habits7 are very similar to that of haemorrhoids. There is no way for us to tell the difference unless we go for tests, if you are worried, please see a doctor to correctly diagnose your symptoms.

On the other hand, if you are sure that the condition you have is piles instead of cancer, then good news to you, research shows that there is no relationship between piles and cancer1. But once again, we cannot be too optimistic about anything. A healthy and active lifestyle is the way to go!


  1. Haemorrhoids. (2018, December 12). Retrieved April 19, 2021, from https://www.singhealth.com.sg/patient-care/patient-education/haemorrhoids
  2. Tan, K., Cheong, W., Dr, Lim, F., Dr, Lieske, B., Chong, C., Lee, K., Dr, & Tan, I., Dr. (2020, October 8). Haemorrhoids or Piles. Retrieved April 20, 2021, from https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Haemorrhoids-or-Piles.aspx
  3. Ng, C. (2020, October 29). Should you get surgery for piles? Retrieved April 20, 2021, from https://www.mountelizabeth.com.sg/healthplus/article/surgery-haemorrhoids-piles-treatment
  4. Hemorrhoids: Home remedies, lifestyle changes, and overview. (n.d.). Retrieved April 20, 2021, from https://www.medicalnewstoday.com/articles/317114#:~:text=Hemorrhoids%20are%20highly%20sensitive%2C%20and,blood%20and%20make%20bleeding%20worse.
  5. Gotter, A. (2018, April 12). Tea Tree Oil for Hemorrhoids (1323669709 971843726 D. Wilson Dr, Ed.). Retrieved April 20, 2021, from https://www.healthline.com/health/tea-tree-oil-for-hemorrhoids#benefits
  6. Society for Surgery of the Alimentary Tract (2008). SSAT Patient Care Guidelines: Surgical Management of Hemorrhoids. Available online: http://www.ssat.com/cgi-bin/hemorr.cgi.
  7. Anal cancer treatment (pdq®)–patient version. (2020, April 17). Retrieved April 24, 2021, from https://www.cancer.gov/types/anal/patient/anal-treatment-pdq#:~:text=Anal%20cancer%20is%20a%20disease,a%20lump%20near%20the%20anus.
  8. Colorectal Surgery, Singapore General Hospital. (2018, April 24). Hemorrhoids (Piles). Retrieved April 24, 2021, from https://www.kkh.com.sg/patient-care/conditions-treatments/hemorrhoids-piles/treatment

What do we learn at a Standard First Aid Course? (Recap)

Last weekend, I completed and passed my Standard First Aid Course. My course spanned over two days, approximately 8 hours on each day. I feel that the course can be shortened if the trainers did not dwell so much on their personal stories (which some were not very relevant and I suspect exaggerations…).

I will be receiving the license shortly which will allow me to provide basic first aid for two years, afterwhich I will have to attend and pass a refresher course to renew my license every two years. I strongly encourage anyone reading this post to attend one! Who knows, you may be able to save the lives of your loved ones during an emergency.


Theory

The total number of slides I received was 212. Sounds daunting but trust me it is not that difficult! I have summarised the key points that you have to know before taking the Theory Test below. The test typically consists of 30 MCQs.

Things to know and memorise:
– First Aid is a form of emergency care/treatment to anyone who is injured or suddenly ill, before the arrival of doctor/nurse/paramedic. (Non-invasive treatment only!)
Reduce contact with body fluids: PPE > Gloves > Plastic bags > Bare Hands (To wash thoroughly afterwards!)
Primary Survey: “DRSABC” (AKA Doctors ABC) [This is very important as it will be tested in both theory and practical. D for Danger, R for Response, S for Shout, A for AED, B for breathing, C for Continuous Chest Compressions]
Recovery Position [To remember that if victim is breathing and unconscious, we have to put them in the recovery position to keep airway open until the paramedics arrive.]

( I was introduced to “My Responder App” which I find the function of locating the nearest AED super useful.)

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InjuriesKey Points to Note
Head InjuryDo not shift or move victim unless in danger.
Heat DisordersHelp to move victim to a cool place, during severe cases, wrap the victim in cool wet sheet until body temperature falls to 38 degree Celsius.
Fits/Convulsion/
Seizure/Epilepsy
Do not put hard objects in the victim’s mouth, try to prevent victim from injuring himself/herself.
FaintingRiase legs to improve blood flow to brain.
Diabetic EmergenciesIf victim has low blood sugar, provide surgery drinks or sweets to victim.
Stroke“FAST” (F for Face, A for Arms, S for Speech, T for Time) helps you to determine if the person is having a stroke.
ChokingAbdominal thrust for victims whom you are certain that they are choking. Chest thrust is to be performed on obese or pregnant victims.
HyperventilationDue to hyperventilation, there will be deficiency of carbon dioxide in the body. Do not use a paper bag to breathe in exhaled air again.
BleedingDirect pressure should be applied on the wound. Tourniquet is the last resort.
FracturesAn open fracture refers to a fracture in which there is an open wound or break in the skin near the site of the broken bone. Using a splint to secure to body part helps to reduce pain.
Soft Tissue Injuries“RICE” (R for rest, I for ice, C for compression, E for elevate)
BurnsWrap casualty with a big sheet of wet material if available and lie him/her on the ground and roll him/her.
Heart AttackOccurs when one of the coronary arteries is blocked by cholestorl deposits and/or blood clots. Place casualty in a comfortable position and assist him/her with own medication (if available).
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Practical

Bandages: You will be taught how to use a triangular bandage and a roller bandage. For triangular bandage, you will be required to learn how to make a broad and narrow bandage, how to tie a reef knot and how to make an arm sling and an elevation sling.

Cardio Pulmonary Resuscitation (CPR): Mouth-to-mouth resuscitation is no longer a must. However, one can still perform mouth-to-mouth resuscitation if one is comfortable with it. Elbows should be locked, only heels of palm should be touching victim to direct force towards lower part of sternum.

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Automated External Defibrillator (AED)
PurposeTo be performed with CPR to increase the chances of survival during a sudden cardiac arrest.
FunctionIt detects and analyses the heart rhythm to prompt the operator whether defibrillation is required. When a shockable rhythm (Ventricular Fibrillation) is detected, shock will be advised.
RecommendationThe usual AED is recommended for use on children above the age of 8 and the weight requirement is at least 25 kg.
AED DangersExclude AED dangers, namely metal, water and gas, before setting up AED.
Chest PreparationCut/remove clothing > Move necklaces away from the path between the pads > Shave hair at pads areas if necessary > Dry wet chest > Remove medication patches > Place pads four fingers away from Pacemaker (if applicable).
Placement of PadsThe electrode pads are to be placed one to the right below the collar bone and another below the left nipple.
Arrival of ParamedicsTo report the estimated duration of CPR performed and the number of shock given to the victim. To ask paramedics for the hospital which the victim will be sent to, and return AED to owner.

Save lives, be a first aider 🙂

Stay Safe,
PinkOlifant

Citizenship Ceremony

Finally, I have received the letter (hard copy) to attend my Citizenship Ceremony. FYI, I renounced my previous citizenship in Oct 2019, everything was pushed back due to COVID-19.

For those who wish to have a peek at the letter, here it is:

Front
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Back
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Do note the stringent dress code required and remember to bring (a) the letter and (b) your identity card / identity card collection slip!

Unfortunately for those of us who are attending the ceremony in the midst of COVID-19, we will not be provided with any food or drinks, heard from my parents who attended years back that the food was not bad :/

In any case, stay safe everyone, and hope that everything is well for you 🙂

PinkOlifant

Collection of Form K & Birth Certificate

I hope that this post will smoothen your journey of collecting Form K and your Birth Certificate.
– – – – –

1. You must either receive a hard copy letter stating that your Form K (final renunciation letter) and Birth Certificate are ready for collection or you need to request an email confirmation that your documents are ready for collection. Usually the documents are ready for collection approximately 8 months after renunciation, but there might be unforeseen circumstances leading to your documents not being ready so you would not want to risk. (If you ask me if a phone call confirmation is sufficient, I would say no. However, that’s just my opinion.)

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2. You do not need to book an appointment for the collection. Head down Consular Section of MHC between 2.30pm to 4pm, Monday to Friday. Would suggest you start queueing at around 1.45pm as there were already ~30 people in front of me when I arrived at 2pm sharp. I queued under the sun for about half an hour. (Photos below may also encourage you to bring along an umbrella and be an early bird.)

3. Bring along the following documents (Original and two photocopies each in A4 size paper):

i) Singapore IC or 11B Card (photocopy front and back of the document)
ii) Singapore Passport (bio-data page only)
iii) Singapore Citizenship Certificate* (photocopy front & back of the document)
iv) Deed poll / Baptism (if name has been changed / if applicable)

Also, you must bring along the letter stating documents are ready for collection. If you do not have the letter, get ready to show your email confirmation to the officer.



*If you have not received the Singapore Citizenship Certificate, please email ICA (ICA_Citizenship_Unit@ica.gov.sg) to request for a soft copy of the certified true copy. Two photocopies of this is needed as well.

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4. At the guard house, you will have to scan QR codes for SafeEntry and Health Declaration (https://docs.google.com/forms/d/e/1FAIpQLSd_tUssXY3b4EC236Cl4MBtvPd4p0J98Ay-RwVxDZLD4BXoeg/viewform). (Just in case you need help for English, you can read through the questions beforehand.) And as usual, use one of your cards with your NRIC/Name to exchange for a pass to enter.

5. Go to Consular Section. You do not have to take a ticket at the ticketing machine. Just queue at Counter 1 and the officer will collect the necessary documents from you. Next, you just have to sit down and wait.

6. Waited for about 10 minutes for my name to be called. Collected Form K and my Birth Certificate after signing on a document and headed out to get back my card at the guard house.

7. Went home to scan the front and back of Form K and emailed the soft copy to ICA (ICA_Citizenship_Unit@ica.gov.sg).

DONE! I do not think I have to return to MHC for the rest of my life!


– – – – –

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This is a follow-up to my previous posts on renunciation of Malaysian Citizenship.

(1) Renunciation of Malaysian Citizenship: https://pinkolifant.com/2019/10/10/oct-2019-renunciation-of-malaysian-citizenship/

(2) Registration of Singapore Citizenship:
https://pinkolifant.com/2019/11/28/oct-2019-registration-of-singapore-citizenship-at-ica/

(3) Collection of NRIC & Citizenship Certificate (certified true copy):
https://pinkolifant.com/2020/07/10/updates-renunciation-of-malaysian-citizenship/

Stay safe,
PinkOlifant (Updated as of 2020)

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Updates [Renunciation of Malaysian Citizenship]

Thank you everyone who has posted questions related to problems they face while renouncing Malaysian Citizenship, as well as getting their Singapore IC and certificate, during this COVID-19 period. And many thanks to all readers who actively tried to help one another out, your generosity in sharing your knowledge and experience, I believe, will be greatly appreciated by all whom you have lent a helping hand.

After reading this post, I hope that you have a clearer picture of:
(1) How to collect Singapore NRIC
(2) How to obtain certified true copy of Singapore Citizenship Certificate
(3) How to collect Form K (final renunciation letter) & Birth Certificate

(1) Collection of Singapore Identity Card (NRIC)

Thank you one of the readers who updated me that she has emailed ICA to check on the collection of her NRIC. I followed her footsteps and emailed ICA (ICA_Citizenship_Unit@ica.gov.sg).

I received a reply a few days later saying that I have been granted permission* to enter ICA Building on a certain date to collect my NRIC while collection of Singapore Citizenship Certificate will be advised on a later date.

*Some readers received their NRIC via snail mail even before the general election.

The entire collection process took about 30 minutes. Asked about the Singapore Citizenship Certificate and they told me that it can only be collected during the ceremony which we will be informed on a later date.

(2) Certified true copy of Singapore Citizenship Certificate

For those who need a certified true copy of Singapore Citizenship Certificate for the collection of Form K (final renunciation letter) at MHC, you just have to write to ICA (ICA_Citizenship_Unit@ica.gov.sg) and request the soft copy of it via email. MHC does not require the original citizenship certificate.

(3) Collection of Form K (final renunciation letter) & Birth Certificate

I have received a letter stating that my application for renunciation of Malaysian Citizenship has been approved. Also, I have to personally go down to the Consular Section of MHC between 2.30pm to 4pm, Monday to Friday, to collect both Form ‘K’ and my birth certificate.

I have to bring along the following documents (Original and two photocopies each in A4 size paper):

i) Singapore IC or 11B Card (photocopy front and back of the document)
ii) Singapore Passport (bio-data page only)
iii) Singapore Citizenship Certificate (photocopy front & back of the document)
iv) Deed poll / Baptism (if name has been changed / if applicable)

Collection has to be done within three months from the date of the letter (booking of appointment is NOT needed).

For more details on the collection of Form K and Birth Certificate, please proceed to this post (https://pinkolifant.com/2020/09/24/collect-formk-bc/).

Stay safe,
PinkOlifant