You are taking your medication, your symptoms have gone away, and life feels normal
again. So why does your doctor keep insisting you need another colonoscopy? Here is what
every Ulcerative Colitis (UC), a type of Inflammatory Bowel Disease (IBD), patient needs to
understand about true healing.
“I Feel Fine, Do I Really Need Another Test?”
Here is a conversation that happens in gastroenterology clinics every single day:
“I feel completely fine now. No more blood, no more rushing to the toilet. Why do I need
another colonoscopy?”
If you have had this thought about your IBD, you are not alone. It is completely natural to
think that when your symptoms disappear, you are cured. But here is the thing about
ulcerative colitis — what is happening inside your body and what you are feeling do not
always match up.
Think Of It Like A Cut On Your Skin
Imagine you get a deep cut on your hand. Here is what happens:
First, it stops hurting. Great! But the wound is still there.
Then, it looks closed from the outside. Even better. But underneath, your skin is still healing.
Finally, weeks later, your skin has completely regenerated at every layer. Now you are truly
healed.
Your colon with IBD (specifically Ulcerative Colitis) works exactly the same way. And just like
that cut, there are three stages to watch for.
The Three Stages Of Ulcerative Colitis: From “Feeling OK” to “Actually Healed”
Stage 1: You Feel Normal Again
Doctors call this “clinical remission.” Your symptoms are gone—no blood in your stool,
normal bathroom habits, no pain. This is wonderful, but it is just the beginning.
Stage 2: Your Colon Looks Normal
During a colonoscopy, your doctor can see that your colon lining looks healthy. No redness,
no sores, no bleeding. This is called “endoscopic remission.”
Stage 3: Your Colon Is Truly Healed
When your doctor takes tiny tissue samples and examines them under a microscope, there
is no inflammation at all – not even at the cellular level. This is “histologic remission,” and this
is the goal.
Here Is The Worrying Part
A study looked at 91 people with Ulcerative Colitis. Their colon looked completely normal
during colonoscopy. Everything seemed fine.
But when doctors checked the tissue under a microscope? Nearly 1 in 4 patients still had
hidden inflammation that nobody could see.
What happened to these patients over the next six years? They ended up needing more
steroids. They got admitted to hospital more often. Why? Because the inflammation was still
there, quietly doing damage, even though they felt perfectly well. Longstanding uncontrolled
inflammation also increased risk of colon cancer.
What This Means For You In Singapore
About 15 in every 100,000 Singaporeans have Inflammatory Bowel Disease (IBD) in the
form of ulcerative colitis. It is more common among Indians, then Chinese, then Malays – but
anyone can get it.
And here is what worries doctors: across Asia, more and more IBD patients with Ulcerative
Colitis are ending up in hospital. Hospital admissions are going up by 4% every year.
Why does stopping at “I feel fine” matter so much for your IBD? Because incomplete healing
means:
● Your Ulcerative Colitis is more likely to flare up again
● You will probably need steroids more often
● You might end up in hospital
● Your colorectal cancer risk stays higher
● You might eventually need surgery
But here is some good news: Singapore has excellent hospitals and testing facilities.
Whether you are at a public hospital or a private clinic, you have access to everything you
need to get properly healed.
The Colonoscopy Score That Makes A Big Difference
During colonoscopy, doctors use something called a Mayo score. Think of it like grading
your colon’s health:
Mayo 0 = Perfect. Completely normal.
Mayo 1 = Looks mostly fine, just a tiny bit of redness.
Sounds similar, right? But here’s what research found: patients with Mayo 0 had way fewer
flare-ups the next year compared to Mayo 1 patients. That tiny difference on the scope? It made a huge difference in their lives. Besides Mayo score, doctors also use UCEIS
(Ulcerative Colitis Endoscopic Index of Severity) score to grade the degree of inflammation
in the colon.
Ulcerative Colitis – How Does Your Doctor Check What You Cannot Feel?
You cannot sense minor inflammation, especially at the microscopic level. That is why you
need these tests:
1. The Colonoscopy (Still the Best Test)
Yes, the prep for colonoscopy is annoying. Yes, you need to take time off work. But it is the
only way to really see what is happening and check tissue under a microscope. It can detect
cancer which is increased in Ulcerative Colitis. It may also detect pre-cancerous tissue which
may be removed before it becomes cancer.
How often? Usually every 1-5 years, depending on how severe your Ulcerative Colitis is.
2. The Poo Test (Much Easier)
It is called a faecal calprotectin test. You collect a small stool sample at home, send it to the
lab, and they measure inflammation markers.
If the number goes above 100-250 µg/g, it means inflammation is likely to be active – even if
you feel fine. Think of it as your early warning alarm.
3. The Blood Test (Quick and Simple)
A simple blood test checks your CRP level – a marker that goes up when there is
inflammation anywhere in your body. It is not specific to your colon, but it helps your doctor
see the bigger picture. By the time it rises, substantial colonic inflammation has usually
already developed.
Your doctor uses all three tests together, like pieces of a puzzle.
What To Do If You Are Not Fully Healed Yet?
First, do not panic. Not reaching complete healing does not mean you have failed. It just
means your treatment plan needs adjusting.
What Doctors Mean by “Tight Control”
Instead of just asking “How do you feel?”, your doctor uses test results to make decisions.
A big study called CALM compared two groups:
Group 1: Doctors adjusted treatment based on symptoms alone
Group 2: Doctors used blood and stool test results to guide treatment
Group 2 did much better. Their colons healed more completely, and they needed fewer
steroids.
Treatment Options For Ulcerative Colitis Available Here In Singapore
Your doctor might suggest:
● Increasing your current medication dose
● Adding suppositories or enemas (yes, less fun, but they work)
● Switching to a different medication
● Starting biologic injections or new oral advanced medications
● Creating a personalised plan just for you
The options are there. Your doctor will look at how severe your Ulcerative Colitis is, how
much of your colon is affected, and what’s realistic for your life.
What Is The Cancer Question Everyone Worries About?
If you’ve had IBD (Ulcerative Colitis) for more than 8-10 years, your colon cancer risk goes
up. However, most people with Ulcerative Colitis never get cancer if the inflammation is well
controlled.
When You Need Extra Monitoring
Your doctor will want closer surveillance if:
● You’ve had Ulcerative Colitis for over 8-10 years
● Your Ulcerative Colitis affects most of your colon
● You still have inflammation despite treatment
● Colon cancer runs in your family
● You have another condition like primary sclerosing cholangitis (PSC)
How Does Surveillance Works?
Regular colonoscopies catch problems early. Doctors may use a special technique called
chromoendoscopy – they spray dye on your colon lining, or use special endoscopic optical
imaging, to highlight any suspicious spots.
The goal is not just finding cancer. It is preventing cancer by removing any abnormal tissue
before it becomes a problem.
What You Should Do
Book That Colonoscopy
Your doctor would have advised the due date for colonoscopy. If it is overdue, call your
doctor and schedule it. Yes, even if you feel completely fine.
Ask About the Poo Test
The faecal calprotectin test can be done at home between colonoscopies. It’s a simple way
to keep track without needing another scope.
Set the Right Goal
Tell your doctor you want to aim for complete healing—not just symptom relief. Use the
words “histologic remission.” Your doctor will be impressed you know this.
Do Not Stop Your Medication
Even when you feel great. Especially when you feel great. That medication is keeping you in
remission.
Know Your Family History
Do you have relatives with IBD (Inflammatory Bowel Disease) or colon cancer? Tell your
doctor. It affects your monitoring schedule.
Come Prepared with Questions
At your next appointment, ask:
● “What stage of healing am I at?”
● “What was my Mayo or UCEIS score from my last colonoscopy?”
● “What do my latest test results show?”
● “Should we adjust my treatment to get deeper healing?”
These are not annoying questions. They are smart questions.
When To Call Your Doctor
Pick Up The Phone If:
● You see blood in your stool again, even just a bit.
● Your bathroom habits change despite taking medication.
● You’ve needed steroids more than once this year.
● You develop new stomach pain or it gets worse.
● You’ve had IBD (Ulcerative Colitis) for more than eight years and have not had a
recent colonoscopy.
Go to A&E If:
● You’re having more than 6 bloody stools a day.
● You have a fever over 37.8°C.
● Your heart is racing.
● You have severe stomach pain.
These could be signs of severe Ulcerative Colitis that needs urgent hospital treatment.
About Our Clinic
Dr Juanda Leo Hartono
Dr Juanda specialises in digestive system and liver problems. He is a senior consultant at
Mount Elizabeth Hospital with over 15 years of experience.
After completed his gastroenterology and hepatology training at National University Hospital
Singapore, he did advanced fellowship training at The Royal London Hospital in the UK. At
NUH, he was the IBD (Inflammatory Bowel Disease) lead and Clinical Director of
Gastroenterology/Hepatology Division.
He still works as a visiting consultant at National University Hospital Singapore and
continues to contribute to clinical training and education.
What We Offer
We provide everything from endoscopies (gastroscopy, colonoscopy, enteroscopy) to
advanced scans (ultrasound, Fibroscan, liver elastography, CT scan, MRI), capsule
endoscopy, and specialised IBD (Ulcerative Colitis and Crohn’s Disease) treatment including
biologic therapies and oral small molecules.
Our approach? We do not just ask how you feel. We use colonoscopy results, stool tests,
and blood tests to make sure your treatment is actually getting you to complete healing -the
kind that lasts.
Feeling fine is wonderful. But feeling fine and being truly healed are two different things.
That difference – the inflammation you cannot feel but a microscope can see – matters for
your future. It affects whether your Ulcerative Colitis comes back, how often you’ll need
steroids, and your long-term cancer risk.
Getting properly healed means regular monitoring, even when you feel great. It might seem
like a hassle now, but your future self will thank you.
Ready to make sure you’re truly healed, not just symptom-free?
Call us at (65) 6513 7678 or WhatsApp (65) 9651 6608.