What are anal and rectal polyps_Zhengzhou Anorectal Disease Hospital

What are anal polyps? Rectal polyps refer to growths occurring on the rectal mucosa, which is a common benign tumor of the rectum. In ancient Chinese medical literature, there are terms such as polypoid hemorrhoids, grape-like hemorrhoids, cherry hemorrhoids, hanging gall bladder hemorrhoids, and droplet-like hemorrhoids. The concept of polyps refers broadly to any abnormal growth protruding within body cavities. From the perspective of modern medicine, polyps are abnormal protrusions formed on the mucosa. In modern medicine, the concepts of "polyps" and "polyposis" differ: polyps are fewer in number with localized lesions, further distinguished as either solitary or multiple; polyposis refers to over 100 polyps with widespread lesions. Rectal polyps are a common disease, seen across different age groups. Pediatric patients often have solitary polyps, while adult patients usually have multiple polyps. According to statistics, male clinical incidence is higher than female. Anal polyps refer to any protruding growth on the large intestine mucosa extending into the intestinal cavity, regardless of size, shape, and histological type, clinically collectively referred to as "polyps" or "multiple polyps," also known as "polyposis." Pathological examination can classify them into tubular adenomas, villous adenomas, and tubulovillous (mixed-type) adenomas. Special note: the onset of colorectal cancer involves many complex factors. Colorectal adenomas and multiple adenomas are closely related to the onset of colorectal cancer, representing the most important precancerous lesion for colorectal cancer. Familial multiple polyps, if left untreated in a timely manner, will eventually result in 100% canceration. Therefore, once anal polyps are discovered, one should seek reasonable surgical treatment at a regular hospital as soon as possible.

Symptoms and Signs:

Common clinical manifestations of rectal polyps include bloody stools, prolapse, intestinal symptoms, and systemic symptoms.

1. Bloody Stools

Generally, the amount of blood in stools is small, often noticed on toilet paper or as streaks on feces, sometimes with dripping blood during defecation, easily confused with bleeding from internal hemorrhoids or anal fissures. The blood color can be bright red or dark brown, sometimes with mucus. Bloody stools are the most common symptom of tubular adenomas, accounting for more than 90%; villous adenomas may also cause bloody stools, but they are often accompanied by mucus and blood; 88-100% of juvenile polyps can lead to bloody stools; familial adenomatous polyposis often presents with mucus and bloody stools.

2. Prolapse

When rectal polyps have long stalks, they often prolapse outside the anus. Polyp prolapse may only expose the anal opening or prolapse along with part of the stalk outside the anus. If the polyp is large, it may require manual repositioning and occasionally become incarcerated outside the anus. High-positioned polyps generally do not prolapse.

3. Intestinal Symptoms

Often manifested as diarrhea, tenesmus, etc. Some patients with tubular adenomas may experience mild diarrhea, mucus in stools, difficulty in defecation, thinning of stool, abdominal pain, etc.; most patients with villous adenomas may experience diarrhea, with large amounts of mucus in the stool being a characteristic feature, sometimes accompanied by tenesmus and discomfort during defecation. According to statistics, 5-19% of juvenile polyps patients may experience diarrhea, and 2-13% may experience constipation; diarrhea is the main symptom of familial adenomatous polyposis, often presenting with mucus and bloody stools, possibly accompanied by abdominal pain, tenesmus, etc.

4. Systemic Symptoms

Patients with more polyps and longer disease duration may present with anemia, weight loss, and other systemic weakness symptoms. Those who excrete large amounts of mucus may develop hypokalemic arrhythmia or weakness in the limbs; fatigue is also common. This affects the physical development of adolescent patients.

Familial colonic polyps have been recognized as a precancerous condition of hereditary colon cancer, belonging to autosomal dominant inheritance with a penetrance rate of 50%. Most anal polyps have a family history, but 20%-50% are new cases caused by gene mutations without a family history.

Treatment for familial colonic polyps involves total colectomy, which is beneficial for treating polyps. However, due to the loss of water absorption and storage function of the colon after surgery, patients often suffer from severe diarrhea, significantly affecting their quality of life. Since polyps often become cancerous in the rectum and sigmoid colon, we perform preventive resection of the sigmoid colon and most of the rectum in these patients. The retained rectum is everted through the anus, and polyps are electrocauterized under direct vision. Then, the colon is pulled out through the rectum and anastomosed with the end of the rectum. Electrocautery of rectal polyps should not be too deep to prevent bowel perforation. This surgical method can alleviate the condition with less physiological impact on the patient. However, strict follow-up of the remaining colon and rectum must be emphasized, and long-term efficacy requires observation.