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Rectal Polyps

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Introduction

Rectal polyps refer to abnormal tissue growth (cells) in the inner lining of the large intestine and colon. Most rectal polyps are asymptomatic and harmless, but eventually, some may develop into cancerous masses, causing rectal cancer, which is fatal if identified in later stages.

What Are Rectal Polyps?

Rectal polyps are a common medical condition diagnosed in 15-20 percent of the adult population and affect parts of the large intestine. They can vary in size and number.

Rectal polyps are classified into two types, neoplastic and non-neoplastic polyps. Non- neoplastic polyps are, in most cases, harmless and typically do not develop into cancer. They are further classified into hyperplastic, inflammatory, and hamartomatous polyps.

Compared to non-neoplastic polyps, the risk of cancer is higher in neoplastic polyps.

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What Causes Rectal Polyps?

The exact cause of rectal polyps remains unknown, but they usually result from excessive cell growth in the rectum.
Old and damaged cells in the body are periodically replaced by newer, more healthy cells. Mutation or changes in the genetic material within the cells lining the colon may lead to uncontrolled growth of immature cells in the colon’s lining. This eventually results in polyps.
Different types of polyp carry various risk factors. Their size and location determine the potential severity of the polyps.

What are the Classifications of Rectal Polyps?

  • Non-neoplastic Rectal Polyps : Non-neoplastic polyps include hyperplastic polyps, hamartomas polyps, Juvenile polyps, lymphomas, and other rare tumours. In most cases, non-neoplastic polyps have the potential to develop into cancer. Treatment is required only for severe cases of non-neoplastic polyps, in which the patient may experience excessive bleeding.
  • Neoplastic Rectal Polyps : Neoplastic rectal polyps are also known as adenomatous polyps, and these carry the potential risk of developing into cancerous cells in the large intestine. Neoplastic polyps include tubular adenomas, tubulovillous adenomas, and villous adenomas. Neoplastic rectal polyps may show epithelial dysplasia.

What Are the Symptoms of Rectal Polyps?

Most rectal polyps are not associated with symptoms. In most cases, patients remain asymptomatic until the doctor detects it during a physical examination of the bowel. Some  symptoms that a person suffering from rectal polyps might experience include:

  • ● Bleeding from the rectum- it is the most common symptom of rectal polyps.
  • ● Abdominal pain
  • ● Black stools
  • ● Iron deficiency leading to anaemia
  • ● Muscle weakness and fatigue
  • ● Diarrhoea/constipation
  • ● Nausea and vomiting
  • ● Excess mucus

How Are Rectal Polyps Diagnosed?

The diagnosis of rectal polyps begins by analyzing a person’s medical history, evaluating the risk factors, and performing a physical examination. Early diagnosis of rectal polyps can reduce the risk of complications. The following screening exams can be used to diagnose rectal polyps.

  • Colonoscopy : Colonoscopy is a medical procedure used to examine the internal region of the colon. The colonoscope is an instrument consisting of a camera attached to a flexible tube. The colonoscope is inserted through the anus to examine the colon. Most polyps can be surgically removed with the use of colonoscopy. Further, the extracted polyp samples are sent to a laboratory for examination under microscopy.
  • Flexible Sigmoidoscopy : Flexible sigmoidoscopy is a minimally invasive method used to examine the large intestine, colon, and rectum’s inner lining. It works similar to colonoscopy and involves a flexible tube with a camera to visualize the colon. If polyps are detected, colonoscopy is performed to remove them surgically.
  • Computed Tomography Chronograph : CT chronograph uses electromagnetic radiation (X-ray or MRI) to produce two-dimensional images of the colon. CT chronography is a non-invasive procedure. Hence its result is less sensitive compared to colonoscopy tests.
  • Stool Based Test : The presence of stool in the blood can be used as an indicator for diagnostic identification of rectal polyps. Following the confirmation from the stool DNA analysis, colonoscopy is performed to remove polyps in the colon.
  • Barium Enema : This is a medical procedure that involves an injection of fluids called an enema into the large intestine by way of the rectum for visualization of the inner lining of the colon under X-ray. This test enables doctors to find structural and functional abnormalities in the internal organs.

How Are Rectal Polyps Treated?

The treatment usually involves surgical removal of the polyps. Any of the following techniques can be used to remove the polyps.

  • Medication to treat rectal polyps : Aspirin, a nonsteroidal anti-inflammatory drug (NSAID) or COX-2 inhibitors, may help prevent the formation of new polyps in patients with polyps or colon cancer.
  • Transanal minimally invasive surgery (TAMIS) : TAMIS is a less invasive surgical procedure that uses an anal opening rather than creating an incision in the abdominal wall to remove polyps. Early-stage polyps can be treated by this method.
  • Colonoscopy : Colonoscopy is a medical procedure used to detect and treat abnormalities in the large intestine. A colonoscope consists of a flexible tube with a camera for visualization and an electrical wire loop at the end that can be operated from outside to perform polypectomy or polyp removal. Liquids can uplift smaller polyps to isolate them from the surroundings and facilitate removal by colonoscopy. A tissue biopsy can also be taken with the help of colonoscopy.
  • Laparoscopy : It is a surgical diagnostic tool used to treat abnormalities in the intestine. Laparoscopic treatment is a minimally invasive procedure and requires only a small incisional opening. The principle of laparoscopy is similar to colonoscopy. In this procedure, a tool called a laparoscope is used to visualize the internal organs. Larger polyps can be removed by using laparoscopic methods.
  • Total proctocolectomy : Treatment of severe cases of rectal polyps involves surgical removal of the rectum and all or part of the colon. This method is mostly recommended for the treatment of very serious cases of neoplastic adenomas. Medical anesthesia is used while performing surgical operation treatments.
  • Non-surgical treatment : Non-surgical treatment is not very effective in treating rectal polyps and is only suggested if the conditions do not allow for surgery. Advancements in robotic techniques and laparoscopic surgery make non-surgical treatments less risky than they used to be.

What Are The Risks Associated with Rectal Polyp Surgery?

Usually, laparoscopic rectal polyp removal does not cause any complications. Uncommon, possible complications include:

  • ● Fever or chills
  • ● Abdominal pains
  • ● Persistent cough
  • ● Complications from general anaesthesia
  • ● Inflammation of the abdominal wall

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FAQ's

Are Rectal Polyps Dangerous?

In most cases, Rectal Polyps remain harmless and don’t cause any symptoms. But over time, some colon polyps can develop into colon cancer, often fatal when detected in later stages.

Can Polyps be Cured using Medicine?

Medications often do not work in the treatment of Rectal Polyps. The best way to treat Rectal Polyps is to remove them through colonoscopy.

What Food Items should I Avoid Eating when Suffering from Rectal Polyps?

The following food items may increase the risk of Rectal Polyps, so it is recommended to limit or reduce the intake of the following items:

  • ● Fatty foods, such as fried foods
  • ● Red meat, such as beef, pork
  • ● Processed meat, such as bacon, sausage, hot dogs, and lunch meats

Is Colorectal Surgery Dangerous?

Colorectal surgery is associated with a high risk of mortality in comparison to other general surgery subspecialties.

What are the Risk Factors associated with Rectal Polyps?

The following risk factors increase the risk of Rectal Polyps:

  • ● Age
  • ● Tobacco and alcohol use
  • ● Family history of recurrent polyps
  • ● Low physical activity
  • ● Obesity
  • ● Inflammatory bowel disease such as ulcerative colitis
  • ● Type 2 diabetes

How do Patients Prepare for a Laparoscopic Diagnosis?

Before Laparoscopy, the doctor may order other blood tests, urine analysis, electrocardiograms, and chest x-rays. These tests help the doctor gain a better understanding of the abnormalities under observation during laparoscopy.

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