Rectal Polyps

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

What are Rectal Polyps?

Rectal polyps are abnormal growths that form in the lining of the rectum. These growths can vary in size and shape and are usually benign (non-cancerous), though some types can become cancerous over time if not removed. Rectal polyps are common and often discovered during routine screenings such as colonoscopies. Early detection and removal are necessary to prevent potential complications, including rectal cancer.

Types of Rectal Polyps

Rectal polyps come in different types, each with varying risks of becoming cancerous. Identifying the type of polyp aids in determining the appropriate treatment.

Adenomatous Polyps (Adenomas)

Adenomatous polyps, or adenomas, are considered precancerous, meaning they have the potential to turn into rectal cancer if not removed. Although not all adenomas become cancerous, their presence increases the risk, especially if they are large or if there are multiple polyps.

Hyperplastic Polyps

Hyperplastic polyps are typically benign with a low risk of becoming cancerous. These polyps are usually small and found in the lower part of the rectum. However, if a hyperplastic polyp grows larger than usual or occurs in certain areas of the colon, doctors may recommend its removal or monitoring to ensure it remains harmless.

Inflammatory Polyps

Inflammatory polyps are often found in individuals with chronic inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis. These polyps are generally not precancerous, but their presence can be a sign of long-term inflammation in the rectum or colon, which can raise the overall risk of colorectal cancer. Individuals with inflammatory polyps may require regular monitoring and treatment of their underlying condition to reduce this cancer risk.

Causes and Risk Factors of Rectal Polyps

Rectal polyps develop when the normal cell growth in the lining of the rectum becomes abnormal, resulting in small growths. Several factors contribute to the risk of developing these polyps:

Genetic Mutations

Certain genetic mutations, whether inherited or acquired, can lead to abnormal cell growth in the rectum. This abnormal growth results in the formation of polyps. For instance, mutations in genes like APC (adenomatous polyposis coli) can cause precancerous adenomatous polyps.

Chronic Inflammation

Conditions that cause long-term inflammation in the rectum, such as inflammatory bowel disease (IBD) (e.g., Crohn’s disease and ulcerative colitis), can directly lead to the formation of inflammatory polyps. Chronic irritation and inflammation disrupt the normal cell turnover, leading to abnormal growth.

Cellular Overgrowth

Polyps form when cells in the rectal lining proliferate (multiply rapidly) more than they should. This abnormal cell proliferation can occur due to age-related changes in the tissue, leading to benign polyps like hyperplastic polyps.

Familial and Hereditary Conditions

Certain hereditary syndromes, like Familial Adenomatous Polyposis (FAP) or Lynch syndrome, directly cause the development of numerous polyps, including those in the rectum. These conditions are linked to specific genetic mutations that increase the likelihood of polyp formation.

Diagnosis of Rectal Polyps

Diagnosing rectal polyps involves several tests that help identify abnormal growths and assess their potential risks. Early detection allows for timely removal or monitoring.

Colonoscopy

A colonoscopy is the most thorough method for detecting rectal polyps. A long, flexible tube with a camera (colonoscope) is inserted into the rectum to examine the entire colon lining for abnormal growth. If polyps are found, they can be removed immediately.

Flexible Sigmoidoscopy

A flexible sigmoidoscopy is similar to a colonoscopy but examines only the rectum and the lower part of the colon using a shorter tube. While effective for detecting polyps in these areas, it may miss polyps located higher up in the colon. If polyps are found, a full colonoscopy may be recommended to check the rest of the colon.

Stool Tests

Stool tests, such as the faecal occult blood test (FOBT) or faecal immunochemical test (FIT), can detect hidden blood in the stool, which may indicate polyps or other abnormalities in the colon. Advanced stool tests can also identify DNA changes linked to polyps or colorectal cancer. If these tests suggest the presence of polyps, a colonoscopy is typically performed to confirm the diagnosis and remove the polyps if needed.

Treatment Options For Rectal Polyps

Non-surgical Treatment Options

Non-surgical treatments are often recommended for small or low-risk polyps to avoid invasive procedures.

Endoscopic Polyp Removal

Endoscopic tools enable the removal of polyps without traditional surgery. These tools are inserted through the rectum during a colonoscopy, and the polyps are removed with minimal impact on surrounding tissues. This option is suitable for larger polyps that remain accessible through non-surgical methods, reducing recovery time and surgical risks.

Endoscopic Mucosal Resection (EMR)

This technique is used to remove larger or more complex rectal polyps that cannot be addressed with a standard polypectomy. A liquid is injected beneath the polyp to lift it off the rectal wall, allowing for easier removal with endoscopic tools. This minimally invasive method avoids major surgery and is preferred when polyps are too large for standard techniques but can still be managed non-surgically.

Surgical Treatment Options

Surgery may be necessary for larger or high-risk polyps to remove them effectively and prevent cancer development. The approach depends on the size, number, and location of the polyps.

Surgical Resection

When polyps are too large or numerous to be removed through less invasive methods, a surgical resection may be necessary. This involves removing part of the rectum where the polyps are located to lower the risk of cancer development.

Laparoscopic Surgery

Laparoscopic surgery uses small incisions to insert a camera and surgical tools for the precise removal of polyps or, in severe cases, sections of the rectum. This technique results in less post-operative pain and faster recovery compared to traditional open surgery.

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How to Prevent Rectal Polyps?

Preventing rectal polyps primarily involves regular colonoscopy screenings, particularly for individuals over 50 or with a family history of polyps, as they enable early detection and removal.

Adopting a healthy lifestyle, including a high-fibre diet rich in fruits, vegetables, and whole grains, supports overall colorectal health. Reducing the intake of red and processed meats may also reduce polyp risk.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Are there medications to treat rectal polyps?

    There are no medications specifically for rectal polyps. The primary treatment is removal during a colonoscopy. In cases where polyps are related to inflammation from conditions like Crohn’s disease or ulcerative colitis, managing the underlying condition may help reduce the risk of new polyps forming.

    Can rectal polyps grow back after removal?

    Polyps that are completely removed during a colonoscopy usually do not grow back, but new polyps may develop over time. Regular follow-up screenings are recommended to monitor for new growth.

    How long does it take to recover after polyp removal?

    Recovery after polyp removal is typically quick. Most people can resume their normal activities within a day. Some may experience mild discomfort or a small amount of bleeding, which usually resolves quickly.

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