Rectal polyp is a precancerous tumor formation of the rectal mucosa. It has been asymptomatic for a long time. It may manifest as bloody or mucous secretions, sometimes significant bleeding is observed; constipation or diarrhea, false urges, a feeling of a foreign body or incomplete bowel emptying. The diagnosis is made on the basis of finger examination, anoscopy, rectoromanoscopy or colonoscopy, X-ray examination with contrast, biopsy. Treatment includes minimally invasive surgical techniques: electrocoagulation and radio wave therapy
K62.0 Rectal Canal Polyp
Rectal polyp is a benign neoplasm originating from the anorectal mucosa. Polypous outgrowths can be single and multiple, located separately and in groups; be connected to the mucosa by means of a pedicle or a wide base. The shape of the tumor is mushroom-shaped, branching, spherical or oval. The size varies from millet grain to hazelnut (2-3 cm in diameter). Pathology occurs in all age categories, starting from childhood. Polyps are of glandular origin (most often found), hyperplastic or villous. The pathological process, as a rule, proceeds asymptomatically until a significant increase in the tumor or the polyp falls out due to a long leg.
Causes of rectal polyp
Rectal polyp almost never occurs on a healthy and unchanged rectal mucosa. Usually, the appearance of polyps is preceded by transferred inflammatory diseases (chronic colitis, ulcerative colitis, typhoid fever, ulcerative proctosigmoiditis, dysentery). Also predisposing factors are chronic constipation or diarrhea, intestinal motility disorders (dyskinesia), low acidity of gastric juice. In children, unlike adults, polyps can appear on the unchanged mucous membrane, against the background of complete health. This is due to anomalies in the development of the rectum due to violations of embryogenesis. The assumption about the viral origin of polyps is also put forward.
In modern proctology, the systematization of rectal polyps is used, compiled on the basis of morphological features. Taking into account the morphological affiliation, adenomatous, villous, fibrous and mixed formations are distinguished. The most common tumors are in the form of adenomas; they do not differ in appearance from the mucous membrane (they have a pale pink color and a normal vascular pattern), they are dense neoplasms, smooth to the touch. Villous polyps are attached with a wide base, have a spongy structure and bleed easily. Fibrous tumors most often have a leg and quite often can grow from a hemorrhoidal node. Due to the overgrowth of the connective tissue pedicle, polyps can fall out of the rectum.
Symptoms of rectal polyp
The manifestations of polyps depend on their location, type and size. For many years, the pathological process may not make itself felt until a significant increase in the tumor or its loss to the outside. The symptoms of the disease are nonspecific, may be similar to many pathological processes of the gastrointestinal tract. Initially, there may be a feeling of discomfort in the anus, a feeling of incomplete bowel emptying or the presence of a foreign body in the anorectal area.
Most often, the disease is accompanied by bleeding: when the neoplasm is located in the distal rectum, the appearance of a strip of fresh blood on the surface of the feces is noted. With a higher location of polyps, the discharge has a mucous or bloody-mucous character. Prolonged existence of rectal polyp with frequent bleeding from it can lead to the development of posthemorrhagic anemia. The work of the intestine, as a rule, is not disturbed. Only with impressive sizes of polyps can constipation or diarrhea occur, as well as symptoms of intestinal irritation – false urges (tenesmus).
If rectal polyp is suspected, a proctologist’s consultation with a finger rectal examination is required. The patient assumes a knee-elbow position. At the same time, the doctor examines all the walls of the rectal canal and the lower ampullary rectum. This allows you to identify polyps, concomitant conditions (hemorrhoids, anal fissures, etc.), as well as to determine the state of the sphincter and its tone. Anoscopy is also performed for the same purpose. If it is necessary to exclude multiple polyps of the rectum and other parts of the large intestine from instrumental research methods, rectoromanoscopy or colonoscopy is used with the possibility of endoscopic mucosal biopsy and subsequent morphological examination of biopsies. In the absence of the possibility of endoscopy, irrigoscopy with double contrast or radiography of the passage of barium through the large intestine is prescribed.
Differential diagnosis of true rectal polyps is performed with false polyps or pseudopolypes. The latter consist of granulation tissue resulting from inflammatory diseases of the colon. Pseudopolypes have an irregular polygonal shape, bleed easily, most often do not have legs, are located against the background of an inflamed mucous membrane. Rectal polyps should also be distinguished from papillitis – hypertrophied papillae in the rectal canal. The latter represent the elevation of the mucous membrane in the sinuses of the rectum. In children, the manifestations of ulcerative colitis and polyp should be distinguished. Difficulties are associated with similar symptoms of these two pathologies (bleeding and mucous discharge).
Treatment of rectal polyp
Treatment of formations consists in their endoscopic excision. Minimally invasive techniques such as electrocoagulation and radio wave therapy are used. Electrocoagulation is performed after preliminary preparation similar to that carried out before endoscopic examination of the colon (cleansing enemas in the evening, on the eve of surgery and two hours before the intervention). Preoperative medication may also be prescribed, including anti-inflammatory drugs (if there is an acute inflammatory process). Manipulation is performed using an endoscope. If the polyp has a leg, the latter is captured as close to the base as possible. Removal of the polyp by means of the supplied current is carried out within a few seconds (2-3 sec.). If the tumor is fixed with a wide base, then it is clamped, slightly pulling the neoplasm on itself.
With large polyp sizes, it is eliminated in parts, with an interval of intervention stages of 2-3 weeks. The greatest difficulty of removal is polyposis along the entire length of the mucosa – in the latter case, resection of the rectal mucosa or sigmoidectomy is performed within healthy tissues, followed by colorectoplasty. Recovery after surgery can take from 3-5 days and up to 2-3 weeks, during which the patient observes bed rest and a slack-free diet.
Prognosis and prevention
The prognosis after surgical removal of rectal polyps is quite favorable (except in cases when an entire section of the rectum, and sometimes the sigmoid colon, is removed). The patients are monitored by a dispensary, which includes an endoscopic examination every 1.5-2 months after the intervention and then at least once a year. Timely removal of rectal polyps is a kind of prevention of the development of colorectal cancer (especially in the presence of signs of anemia and the threat of malignancy). The prevention of the development of polyps is the medical examination and examination of all categories of citizens who have certain disorders of the large intestine.