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Gut Bacteria and Fatty Liver
Fatty liver is a growing problem in Singapore because of rising prevalence of obesity and diabetes in our population. Although fatty liver is generally a mild disease, those with the more severe forms may develop cirrhosis (hardening of the liver), liver failure and liver cancer, and may even require a liver transplant. The patient with raised liver enzymes (SGPT or ALT, and SGOT or AST) is likely to be a greater risk of developing complications. Obesity, poor diabetes control, high triglyceride levels and alcohol consumption will worsen the condition. In one interesting experiment, an intense period of eating fast foods resulted in the development of fatty liver. The most important action that a person with fatty liver must take is to lose weight. A weight loss of about 10% of the person’s current weight will usually result in an improvement in liver enzymes, better diabetes control, and a lowering of the triglyceride level. There is a major blood vessel known as the portal vein that provides a direct connection between the gut (another name for the intestines or the bowels) and the liver. Bacteria found in the gut can influence the absorption of fat, the release of fatty acids and the development of inflammation in the liver. Furthermore, some gut bacteria are very efficient at harvesting energy from the diet, and in this way, contribute to the development of obesity. Probiotic treatment has also been reported to result in lowering of liver enzymes and in reducing inflammation.

Bowel disorders may affect bladder and sexual functions
There appears to be a rising prevalence of bowel, bladder and sexual dysfunction. In a recent island wide survey involving 3000 households, we found that one third of the population had some form of bowel disturbance on a regular basis; women 20 to 40 years of age are most affected by irritable bowel with an estimated prevalence of 14%, the other end of the spectrum, men 70 years of age and above experience the most constipation with an estimated prevalence of 36%. In the same survey, we found that 20% of the male population had experienced a sensation of not emptying the bladder completely and 32% had to urinate again less than two hours after urination. As for erectile dysfunction, 53% of our male population reported some degree, of whom more than one third was severe. As these problems affect very private aspects of a person’s life, many sufferers are too shy to seek help.

The effects of bowel disorders frequently extend beyond the bowel to affect the bladder and the sexual organs. Studies from the UK report that women with IBS are more to overactive bladder and experience more dissatisfaction with their sexual relations, often experiencing discomfort during sexual intercourse. In the UK, 50% of women consulting a gynaecologist for pelvic pain, pain experienced during sexual intercourse, menstrual cramps had irritable bowel syndrome. Studies from UK and US reveal that many women with IBS related symptoms see a gynaecologist thinking that they have a problem of the female organs. In these countries women with IBS appear to have surgery such as hysterectomy and laparoscopy. It is important to be aware that IBS patients often do worse after surgery than patients without IBS. In one study from the US, 70% of women who underwent laparoscopy and 56% who underwent hysterectomy thinking that their IBS was due to a gynaecological problem, continued to suffer with their IBS one year after their surgery.

In the community survey that I conducted in Singapore, I found that many of our IBS sufferers feel a frequent need to pass urine and have difficulty emptying their bladder. In addition we found that elderly men in Singapore were significantly affected by a combination of constipation, prostate symptoms and erectile dysfunction. In addition to the bladder and sexual dysfunction, many will also experience bloating, reduced appetite, lack of energy, feeling of wind, shoulder aches and poor sleep

Gwee KA, Wee S, Wong ML, Png DJ. The Prevalence, Symptom Characteristics and Impact of Irritable Bowel Syndrome in an Asian Urban Community. Am J Gastroenterology 2004 May;99(5):92431.

Tan JK, Png DJC, Liew LCH, et al. Prevalence of prostatitis like symptoms in Singapore: a population- based study. Singapore Med J 2002;43:18993.

Tan JK, Hong CY, Png DJC, et al. Erectile dysfunction in Singapore: prevalence and its associated factors a population based study. Singapore Med J 2003;44:20

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