Despite the fact that polyps of the rectum are considered benign tumorous neoplasms, each of them should be treated as a precancerous disease.
The concept of
Polyps of the rectum, which are tumorous protrusions that grow inside the intestinal lumen, are a very insidious disease that has not had any clinical manifestations for a long time.
In the early stages of development, they can be detected quite accidentally during a scheduled physical examination or diagnostic study conducted for a completely different disease. Most often, having the color of the mucosa from which they formed cells, polyps can acquire a scarlet, red, crimson color( depending on the number of vessels feeding the neoplasms, as well as the presence of suppuration or inflammation in their tissues).
Photo polyp in the rectum
Polyps can be attached to the wall of the intestine with a wide leg, giving them a mushroom shape, and can also spread along the walls of the affected bowel.
In the international classification of diseases( ICD-10), polyps of the rectum have been assigned code K62.1.
Despite the fact that polyps of the rectum are occasionally found in adolescents and even young children, they most often affect people of mature age.
The age-related dynamics of the disease is as follows: if at 30 years of age, polyps of the rectum are detected in 5% of patients, by the age of 45 this factor is doubled and is 10%;By the age of 60 they are already found in half of the patients.
Classification
Depending on the tissues whose cells predominate in the benign neoplasm, the polyps of the rectum are:
- . This name they got because of the huge number of thin and easily bent fringed villi, giving the polyp a spongy appearance.
- Adenomatous. Consisting of glandular epithelial tissues, polyps of this type are malignant enough that the name of the precancerous condition is assigned to them.
- Fibrous. Neoplasms of this type consist of connective tissues capable of replacing the epithelial lining of the intestinal walls. Fungi are extremely rare, they tend to develop frequent inflammatory processes.
- Mucous-cystic and glandular-villous ( in the medical literature they are often called juvenile).Polyps are of a mixed type, they have a structure characteristic of multiple neoplasms.
Polyps of all the above types can have both single and multiple character.
There is another type of classification, based on the reasons that led to the appearance of polyps. According to this classification principle, polyps can be:
- inflammatory ( developed as a result of a long-lasting inflammatory process);
- by neoplastic ( which appeared due to excessive proliferation of intestinal tissues);
- by hyperplastic ( formed as a result of overgrowth of abnormal cells).
Fibrous type
Fibrous polyp of the rectum, often called "false", consists of a connective tissue covered with a layer of ordinary epithelial cells.
This it differs from all other neoplasms of the rectum. Another feature of fibrotic polyps is the impossibility of their degeneration into a malignant tumor.
The cause of the formation of fibrotic polyps are all kinds of inflammatory processes that occur in the anal canal and complicate the course of hemorrhoids, internal fistula, cryptite and a number of similar diseases.
During the inflammatory process there is a degeneration of empty hemorrhoidal nodules and hypertrophied anal papillae into fibrous polyps finger-shaped or pear-shaped.
Adenomatous
The basis of adenomatous polyps in the rectum, considered a precancerous condition, are different types of tissues. Their appearance is due to malfunctions in the process of normal renewal of the intestinal epithelium, occurring for various reasons.
As a result of uncontrolled division of epithelial cells on the inner surface of the rectum walls, rapidly growing colonies of neoplasms appear, eventually overlapping the intestinal passage and traumatized with each passage of fecal matter through it.
When the size and number of adenomatous polyps increase significantly, the patient begins to experience discomfort, itching and pain in the anal canal area. Neoplasms having a thin leg may fall out of the affected bowel.
The main danger of adenomatous growths is the high probability of malignant degeneration and the development of acute intestinal obstruction.
To eliminate adenomatous polyps, a very complicated surgical procedure and a long rehabilitation period are necessary.
Slender
Having a round or elongated shape and pinkish-red color, the villous polyps of the rectum have a velvety surface, consisting of a large number of papillae resembling villi and characterized by a high malignancy( malignancy is subjected to every second villous tumor).
The branching connective tissue, which forms the basis of villous tumors, is covered with a layer of cylindrical epithelium containing many goblet cells.
In the initial stages of development, the villous polyps grow either inside the intestinal lumen or in the direction of the mucosa. The process of malignancy changes the direction of growth on the submerged one. The rate of growth of villous tumors, capable of reaching ten centimeters, is extremely high.
The clinical course of villous tumors is characterized by:
- Isolation of a mucous secretion, similar to raw chicken protein. A large amount of mucus produced, overflowing the rectum, provokes a frequent stool consisting of mucus alone.
- The presence of bloody discharge in the stool as a result of chronic damage to villous tumors.
- Sensation of gravity and pressure in the rectum.
- Occurrence of frequent constipation due to intestinal obstruction, the lumen of which is blocked by an overgrown polyp.
- Abaissement of polyps located near the anus.
Insect polyps are often detected during digital examination of the anal canal. The fingers of a specialist who discovered a villous new growth are immersed in a loose tissue with a gelatinous consistency.
Hyperplastic
Neoplasms of the hyperplastic type, usually of small size, are formed as a result of rapid division of the epithelial cells of the rectal mucosa.
Their form is diverse: there are mushroom, branchy or spherical polyps.
The same color variation varies from yellowish to dark red.
Since newly appeared hyperplastic neoplasms do not manifest themselves in any way, they can be detected only in the course of a survey conducted with suspicion of ulcers or gastritis. In patients with this, nausea, belching and heartburn are observed, they are troubled by pain in the stomach and bloating.
In advanced stages of the disease, hyperplastic polyps of the rectum provoke the appearance of :
- pain in the anus;
- mucus and bleeding during the act of defecation;
- drawing pains in the lumbar region.
Neoplasms of considerable size can lead to rupture of the walls of the rectum.
Hyperplastic polyps, usually of a multiple nature, belong to the category of precancerous conditions and are removed only surgically.
Causes of
The exact causes of the pathology are not known for certain. Experts believe that benign tumors in the intestine are caused by fault:
- chronic inflammatory diseases( proctitis, enteritis and colitis);
- hemorrhoids;
- of dyskinesia of the intestine;
- cracks in the anus;
- infectious intestinal diseases( dysentery, typhoid fever);
- chronic constipation;
- of a genetic predisposition( for the most part it concerns cases of family polyposis);
- of intrauterine malformation;
- improper diet, abundant in animal fats and almost free of vegetable fiber;
- adverse environmental conditions in the place of residence;
- sedentary lifestyle.
Symptoms typical for polyps in the rectum
The most typical manifestations of polyposis of the rectum are the following symptoms:
- Irregular character of the stool, in which there is an alternation of constipation and diarrhea. This symptom is characteristic of early stages of the disease. At the very beginning of the disease, rarely developing constipation is replaced by frequent attacks of diarrhea, which arises from the irritation of the mucous membranes of the tissues of a growing neoplasm. With the gradual narrowing of the intestinal lumen, filled with an overgrown polyp, the picture changes. Constipation becomes durable( their duration depends on the degree of narrowing of the intestinal lumen) and chronic. It is about the long constipation, often the only manifestation of ailment, that the patient seeks medical help.
- Sensations of extreme discomfort in the rectum and the presence of a foreign body in it. This clinical manifestation, due to the pressure of the polyp on the walls of the affected bowel, is most typical for this disease. Growing and filling the cavity of the rectum, the polyp gradually narrows its lumen. In order for the symptom to manifest itself, the neoplasm should reach medium or large size. With a relatively small size of the polyp, the sensation of the presence of a foreign object arises in the patient not constantly, but periodically or grasps - in full accordance with peristaltic contraction of the intestine. In a patient recently suffering from polyposis of the rectum, discomfort occurs periodically either on one side of the pubis, or in the anal canal. With neglected polyposis, unpleasant sensations, assuming a bursting character, arise in the patient constantly. The situation is aggravated by constipation, which is a frequent companion of polyps. When constipation occurs, the sensations of discomfort become worse.
- Another fairly late symptom, which is a consequence of congestion in the large intestine, is the pain in the lower abdomen. The mechanism of pain development is as follows: first the overgrown polyp overlaps the lumen of the affected bowel, provoking a violation of the evacuation of the stool and the development of chronic constipation. The accumulation of fecal masses in the loops of the intestine, which abound with nerve endings, leads to their stretching and the appearance of painful sensations in the lower abdomen. The situation is exacerbated by gases accumulating in the intestines and also contributing to its stretching.
- Abundant mucus in the stool. This symptom, due to increased secretion of mucosal cells, is a compulsory companion polyposis. In the intestine of a healthy person, special glands and goblet cells located in the mucous membranes of the rectum produce mucus, moisturizing the cavity of this organ and substantially facilitating the passage of feces along it, in the amount necessary for this. The presence of a steadily growing polyp, which continuously irritates the cells of the mucous membrane, forces the above structures to work in a strengthened mode. The excess mucus resulting from this process accumulates in the anal sinuses and is removed from the patient's body along with the calves during defecation after prolonged constipation. A large amount of stagnant mucus is an excellent medium for pathogenic microflora. Attachment of infection leads to the appearance of mucopurulent discharge.
- An admixture of blood in the stool or bleeding from the anal canal. The cause of this anxiety symptom may be necrosis or entrapment of the polyp, as well as damage to the blood vessels that permeate the submucosal layer of the rectum. At the very beginning of the disease, blood loss is insignificant. The patient can guess the presence of bleeding only by blood strips on the surface of feces. These minor but regular bleeding almost always result in the development of anemia.
Diagnosis of
The presence of polyps in the rectum can be detected by:
- Finger research. With this method, which allows you to examine a section of the rectum that is not more than 10 centimeters distant from the anus, a specialist can not only verify the presence of polyps, but also determine their size, quantity, consistency, presence or absence of ulceration and a long leg,as well as the ability to shift.
- Recto-manoscopy - a method that involves the introduction of a thin metal tube equipped with a video camera into the rectal cavity( not more than 20 cm) and allows you to inspect the condition of the walls of the rectum and sigmoid colon.
- Colonoscopy is a study almost identical to that described above, but allows one to examine the colon throughout its entire length.
- Irrigoscopy - X-ray study consisting in the introduction of an X-ray contrast substance - barium sulfate - into the rectum lumen. Thanks to barium sulphate, the intestinal walls on X-rays are more contrasting and clear. Locations of localization of polyps on the roentgenogram look like voids, not filled with contrast material. To obtain more objective results, a double contrast method is used, which involves the parallel introduction of barium suspension and air into the lumen of the intestine.
- Computer tomography - a method by which it is possible to obtain information about the localization, quantity, shape, exact size and condition of tumors. Not requiring preliminary preparation and not having contraindications, this technique has the only drawback: the high cost of the procedure.
Differential diagnosis of
Polyposis of the rectum is differentiated from the pathological processes of the pelvic organs:
- Lipomas are benign neoplasms, often reaching large sizes and most often localized in the submucosal layer of the right colon, but occasionally spreading throughout its length.
- Large fibroids - fairly rare neoplasms, which can significantly impede intestinal permeability.
- Angiomas are vascular tumors, the distinguishing feature of which is high bleeding.
- Actinomycosis of the colon.
- Crohn's disease, often manifested by signs of pseudopolyposis.
How to treat polyps in the rectum in adults and children?
Since polyps in children never become malignant, the goal of their surgical removal is not the prevention of cancer, but the elimination of a source of permanent bleeding that impedes the full development of the growing body.
The removal of polyps from the intestines of adult patients is performed in order to prevent their malignancy. Methods of surgical intervention, applied to children and adults, do not differ in principle.
Operative removal of
When choosing a surgical technique, localization of polyps and the prevalence of the tumor process are taken into account. Polyps in the rectum are removed by:
- Transanal excision. In this way, the lesions located in the immediate vicinity of the anus are removed. To gain access to the polyp, the anal canal is either stretched by hooks from Farabef, or enlarged by special mirrors until the sphincter is completely relaxed. Having applied a special clip to the polyp stalk, it is stitched and bandaged. After this, the polyp is cut off.
- The most popular method of polypectomy is a loop electrocoagulation ( the so-called "cauterization"), performed using an operating sigmoidoscope or a colonoscope. Before the operation, the patient's intestines, refrained from dinner and breakfast, are thoroughly cleaned with osmotic laxatives. The operation is preceded by an intramuscular injection of a sedative. In the anal canal of the patient, who has taken a knee-elbow position, a colonoscope, lubricated with a special gel, is injected. Through a special tube of the colonoscope, a loop is inserted, by means of which the polyp's leg is grasped. After that, a special apparatus consisting of electrodes and an alternating current source is fed to the base of the loop. After a few seconds of exposure to electric current, the base of the polyp or its leg is charred. If necessary, the current supply is repeated. The charred neoplasm is removed, and the remaining wound is cauterized. Polypes on a wide base, having impressive dimensions, are cauterized in parts. Given the vastness of the remaining wound surface, several additional operations are performed, the interval between which is at least two to three weeks.
- Highly located single neoplasms on a wide base, without legs, are removed by performing a cavitary operation - a colotomy. Having opened the abdominal wall, perform a careful palpation of the affected area of the intestine. After the detection of the polyp, the problem segment of the intestine is isolated by means of soft clamps, and the abdominal cavity is protected with a large number of gauze napkins. Having opened the lumen of the intestine, they perform excision of the polyp. The mucous membrane is sutured with catgut, a double-row seam( using capron and catgut) is applied to the intestinal wall. After the introduction of antibiotics, the abdominal cavity is tightly closed.
- Malignant polyps are removed either by resection of the entire rectum together with neoplasm, or by the method of extirpation of the affected area. In both cases, general anesthesia is used.
Patient feedback
Nikolay:
I came to the operating table from a polyclinic where I was asked about an acute intestinal obstruction. The doctor, who conducted the reception, ordered the urgent hospitalization. The procedure for polypectomy in the hospital was performed during the colonoscopy. Since it was performed without anesthesia, I could observe the progress of the operation on a special monitor.
I felt painful pains only by introducing a colonoscope into the intestinal cavity. The procedure for removing polyps( they were simply cut with a special loop) was absolutely painless. I was discharged from the hospital two days later.
Elena:
I recently removed the polyp that bothered me( it bleeded).I did not dare for an operation for a long time - I was afraid of pain. Fears were in vain. The operation lasted a little over half an hour, there were no unpleasant sensations.
Prices for removal of
The cost of surgery to remove polyps of the rectum in different clinics can vary significantly.
This depends on the level of the medical institution, the qualifications of its specialists and the region in which the clinic is located.
- For transanal electrocoagulation of polyps in the rectum, the patient will have to pay from 4,000 to 12,000 rubles.
- For the prompt removal of polyps of the rectum( depending on the degree of complexity and the method of performing the operation), an amount of 5,000 to 29,000 rubles may be required.
- Electroexceration of polyps through the rectoscope costs from 6 000 to 10 000 rubles.
Medicated
Drug treatment for polyps in the rectum is performed exclusively in the early stages of the disease. Sometimes for this purpose a sigmoidoscope is used: with its help candles enter the lumen of the rectum( the "Chistobolin" drug proved to be quite good).
Candles are administered twice a day: in the morning and in the evening after the mandatory cleansing enema. To prepare a solution for its execution, in two liters of water, dissolve a tablespoon of salt and freshly squeezed lemon juice or apple cider vinegar.
Conservative treatment of polyposis can give good results under two conditions: it should begin as early as possible and be performed under the supervision of an experienced specialist. For the therapy of neglected disease, it is practically meaningless.
Folk remedies
The most popular method of folk treatment of polyps in the rectum, recognized even by a number of specialists, is the implementation of enemas based on celandine.
Under the influence of bioactive substances included in its composition, an effective rejection of small benign tumors with a leg occurs.
After filling a small syringe with a freshly prepared product, the patient lies on the left side and injects part of the broth through the anal opening. Lying a few minutes, he turns on the other side and repeats the manipulation. Having entered the remnants of the remedy, it is necessary to lie on your back.
To get a positive effect, treatment procedures are performed every other day. The duration of the course is from 15 to 20 sessions.
The use of this therapeutic method is strictly contraindicated in patients suffering from ulcerative colitis, hemorrhoids, anal fissures and having malignant polyps.
To improve the effectiveness of curative enemas, folk healers recommend simultaneously taking with them fresh celandine juice. Given the high poisonousness of the plant, taking the juice should be very careful.
For the first time take 1 drop of juice, diluted in a teaspoon of water. Each day, adding one drop of juice, bring its amount to fifteen drops, after which the dosage is gradually reduced.
Rehabilitation period
For complete recovery of the patient after a surgery to remove polyps in the intestine requires at least two weeks.
- The greatest danger is the possibility of bleeding, therefore during the entire rehabilitation period the patient should refrain from significant physical exertion, refuse to drive the car and control large machinery.
- In order to protect the intestinal mucous membranes from mechanical damage and trauma to the calves, a gentle diet that facilitates softening of the stool should be observed throughout the week. Eat should be at least five times a day. Portions should be small, and products should not contain coarse plant fibers. All food should be wiped and cooked by cooking, baking or steaming.
- Patients who have undergone a hollow operation are assigned bed rest. To prevent stagnation of blood, experts recommend that they perform a set of specially designed physical exercises.
Complications of the disease
Polyposis of the rectum may be complicated:
- Anal bleeding. Even small polyps can bleed, but most of the bleeding is affected by large neoplasms, especially villous. Pierced by a large number of blood vessels, they are easily traumatized and bleed very often. Anal bleeding can be profuse( abundant) and minor. Profuse bleeding can lead to hypodynamic shock. Minor( latent) bleeding becomes the culprit in the development of anemia.
- Fouling of polyps. The most capable of malignancy are villous and adenomatous neoplasms, as well as polyps that have a wide base. Polyps of large sizes malignantly more often.
- The formation of acute intestinal obstruction. This condition, which is complete and incomplete, develops due to overlapping of the intestinal lumen with the tissues of the overgrown polyp. Complete intestinal obstruction can lead to necrosis of intestinal walls with subsequent violation of their integrity. The ingestion of feces into the abdominal cavity can result in peritonitis( inflammation of the peritoneum).In most cases, this complication leads to the death of the patient.
Prognosis and prevention of
If polyps in the rectum were detected and removed in a timely manner, in the vast majority of cases the prognosis is favorable.
Given the likelihood of recurrence( they may occur within three years after removal), a year after the operation the patient must undergo a colonoscopy. In the subsequent endoscopic examinations, he will have to go every three years.
To prevent the appearance of polyps, it is necessary to minimize the influence of factors provoking their occurrence.
To prevent polyposis should:
- Prevent the development of chronic diseases and timely treat all ailments.
- Regularly undergo medical examinations.
- Eat foods that contain large amounts of plant fiber, vitamins and minerals, minimizing the consumption of all kinds of fats, spicy, canned and fried foods.
- Abstain from smoking and alcohol( especially from beer).
- Avoid constipation.
- Move as much as possible.