Polyps in the intestine, the rectum: symptoms and treatment
Polyps in the intestines are quite common in all age groups, affecting a fifth of the population of all countries and continents. In men, they are detected more often. A polyp is a benign glandular formation in the intestinal wall, growing out of the mucous membrane.
Polyps can occur in any part of the intestine, but most often it affects the left half colon, sigmoid and rectum. These benign tumors are often asymptomatic, but there is always the risk of malignant transformation, so to allow the disease to chance is unacceptable.
It is no secret that all the processes in the body depend on what we eat. The nature of power determines not only the metabolic substances, but also, first and foremost, the condition of the digestive system. The intestinal wall directly in contact with eaten food, experiencing the entire range of adverse impacts associated with the quality and composition of food intake. The fascination of contemporary man with fast food, oily and refined foods, lack of vegetables and fiber create problems with digestion, constipation and contribute to structural alteration of the mucosa of the colon. In such conditions of excess proliferation of epithelial cells of the intestinal wall leads to the appearance not only of polyps but also of malignant tumors.
A clear definition of a polyp is not formulated. Usually, it means the elevation above the surface of the mucosa in the form of a mushroom, papillary excrescences or bunches located on the stem or broad base. The polyp is single or multiple, affecting different sections of the intestine. Sometimes there are up to a hundred or more such entities, then talk about polyposis of the colon.
Asymptomatic polyps does not make them safe, and the risk of malignant transformation increases with prolonged existence and growth. Some types of polyps initially pose a risk of cancer, and therefore should be promptly removed. Treatment of this pathology engaged surgeons, proctology, endoscopic.
Because polyps and polyposis is usually diagnosed within the colon, this localization of the disease and will be discussed below. In the small intestine polyps are very rare, the only exception is the duodenum, where they can be identified hyperplastic polyps, especially if you have ulcers.
Causes and types of intestinal polyps
The reasons for the formation of intestinal polyps varied. In most cases there is a complex influence of various environmental conditions and lifestyle, but because of bessimptomnom currents to determine the exact cause of the polyp is almost impossible. Moreover, some patients do not come to the attention of specialists, so the presence of a polyp and its prevalence can be judged only conditionally.
The most important are:
- Genetic predisposition;
- Pathology of the digestive system and other organs;
- Bad habits.
The hereditary factor is of great importance in familial cases of polypoetry in the gut. Such a serious disease as diffuse polyposis family found in close relatives and is considered to be obligate precancer, ie bowel cancer in these patients will arise sooner or later unless you remove the entire affected organ.
Diet significantly affects the state of the mucosa of the colon. Especially clearly this influence can be seen in economically developed regions, whose residents can afford to eat a lot of meat, confectionery products, alcohol. For the digestion of fatty food requires a large amount of bile, which is in the intestine is transformed into carcinogenic substances, but the content, poor fiber, inhibits motility, and excreted more slowly, leading to constipation and stagnation of feces.
Physical inactivity, sedentary lifestyle and neglect physical activity cause a reduction of the contractile function of the intestine, lead to obesity that is often accompanied by constipation and inflammatory processes in the mucosa of the colon.
It is believed that a major factor in polypoetry becomes chronic inflammation of the intestinal wall (colitis), in which the mucosa cells begin to multiply rapidly with the formation of a polyp. The colitis cause constipation, improper and irregular meals, abuse of certain types of food and alcohol.
At the risk of poledourisbasil includes persons with chronic inflammatory processes of the colon and constipation, «victims» of unhealthy food and harmful habits, as well as individuals who are close family members who have suffered or are suffering this disease.
Types of polyps are defined by their histological structure, abundance, and localization. Distinguish single and multiple polyps (polyposis), and the group scattered through the intestines of education. Multiple polyps have a higher risk of malignancy than single. The greater the polyp, the higher the probability of transition to cancer. Histological structure of the polyp determines its course and the likelihood of malignancy, which is a fairly important indicator.
Depending on the microscopic features there are several varieties of intestinal polyps:
Glandular polyps are diagnosed more often. They represent a rounded structure up to 2-3 cm in diameter, located on the stalk or broad base, pink or red. For them apply the term adenomatous polyp, as in structure they resemble the glandular benign tumor – adenoma.
Villous tumors have the appearance of lobed nodules that are solitary or «trail» on the surface of the intestinal wall. These tumors contain villi and a large number of blood vessels that bleed easily and ulcerate. If you exceed the size of 1 cm, the risk of malignant transformation increases tenfold.
Hyperplastic polyp is a local proliferation of the glandular epithelium, which from time to time shows no signs of tumor structure, but the growth of this education may develop in adenomatous polyp or villous tumor. The size of hyperplastic polyps rarely exceed half an inch, and they occur often on the background of long-term chronic inflammation.
A separate species of polyps are juvenile, more characteristic of children and youth. Source they are considered the remnants of embryonic tissues. Juvenile polyps are able to reach 5 cm or more, but the risk of malignancy is minimal. Moreover, these formations do not belong to the true tumors, because they have no cell atypia and proliferation of the glands of the intestinal mucosa. However, they should be removed, since the probability of cancer cannot be excluded.
Signs of intestinal polyps
As mentioned above, polyps, a phenomenon asymptomatic in most patients. For many years the patient may be unaware of them, therefore, the planned research is recommended for everyone after age 45, even if no complaints and disorders not. Symptoms of a polyp, if they occur, are nonspecific and due to the accompanying inflammation of the intestinal wall, the trauma neoplasms or ulceration.
The most common symptoms of polyps include:
- Bleeding from the intestines;
- Pain in the abdomen or the anus;
- Constipation, diarrhea.
Relatively rare polyps are accompanied by intestinal obstruction, electrolyte imbalance and even anemia. Electrolyte balance may be disturbed due to the allocation of a large amount of mucus, especially in large villous formations. Polyps of the colon, cecum and sigmoid colon are able to achieve large size, bulging into the lumen of the intestine and causing intestinal obstruction. The patient’s condition will progressively worsen, appears intense abdominal pain, vomiting, dry mouth, signs of intoxication.
Tumors of the rectum tend to be a pain in the anal canal, itching, discharge, feeling of a foreign body in the lumen of the intestine. You may receive constipation or diarrhea. Discharge of blood in large quantities is an alarming symptom that requires an immediate visit to the doctor.
Diagnostic procedures in intestinal polyps often become a therapeutic procedure if it is technically possible to remove the mass with the help of an endoscope.
Usually, the diagnosis of conduct:
Treatment of intestinal polyps
Treatment of polyps of the bowel surgery only. No conservative treatment or a promising traditional medicine is not able to get rid of these formations or reduce them. Moreover, delaying surgery leads to a further increase in polyps, which threaten to turn into a malignant tumor. Medical treatment is permissible only as a preparatory stage for surgery and to relieve negative symptoms of the tumor.
After removal of a polyp, it necessarily undergoes histological examination for the presence of atypical cells and signs of malignancy. Preoperative study of the fragments of a polyp inappropriate, because accurate conclusions required the entire volume of education with the stalk or base that it is attached to the intestinal wall. If after complete excision of the polyp and examination under a microscope will reveal signs of malignancy, the patient may require additional intervention in the form of resection of the intestine.
Successful treatment is possible only through surgical removal of the tumor. The choice of access and the method of intervention depends on the location of education in a particular section of the intestine, of the size and characteristics of growth relative to the intestinal wall. To date, there are:
- Endoscopic polypectomy via colonoscope or proctoscope;
- Excision through the rectum (transanal);
- Removing through an incision of the bowel wall (colostomy);
- Resection of area of bowel with the tumor and the formation of an anastomosis between the ends of the intestine.
Before surgery to remove a polyp, the patient has to undergo appropriate training. Before the intervention and two hours before it produced a cleansing enema to remove the contents of the intestine, the patient is restricted in the diet. When carrying out endoscopic removal of a polyp, the patient is placed in knee-elbow position, possible local introduction of anesthetics or even a dip in a medicated sleep, depending on the specific clinical situation. The procedure is performed on an outpatient basis. If necessary, bowel resection, and more extensive intervention, hospitalization, and surgery is performed under General anesthesia.
The most common method of removing a polyp of the colon is endoscopic resection of education. It is held with small polyps and no obvious signs of malignant growth. Through the rectum is introduced a proctoscope or a colonoscope with a loop that captures a polyp, and flowing an electric current through it as if to cauterize the base or stem education, while simultaneously providing hemostasis. This procedure is indicated when polyps are secondary parts of large intestine and rectum, when education is high enough.
If polyp large and cannot be removed simultaneously by means of a loop, it is removed piece by piece. This requires extreme caution on the part of the surgeon because there is a risk of explosion of gas accumulating in the intestine. The removal of large tumors requires highly skilled professionals, and the skill and precision of action of which depends on the result and the possibility of life-threatening complications (intestinal perforation, bleeding).
When polyps in the rectum, located at a distance of not more than 10 cm from the anus, are shown transanal polypectomy. In this case, the surgeon after local anesthesia solution of novocaine to stretch rectum using special mirrors, the polyp captures a clip, it cuts off, and the mucosal defect sutured. Polyps with a broad base are removed within healthy tissues with a scalpel.
When polyps of the sigmoid colon, villous tumors, large adenomatous polyps with a thick stalk or broad base may require opening of the lumen of the intestine. The patient is General anesthesia, during which the surgeon dissects the abdominal wall, highlight the section of the intestine, it makes the cut, finds, examines the tumor and removes it with a scalpel. Then the incisions are sutured, and the abdominal wall sutured.
Resection, or removal of a section of the intestine is performed upon receipt of results of the examination indicating the existence of malignant cells in the polyp or growth of adenocarcinoma. In addition, such a serious disease as diffuse polyposis family when polyps a lot and sooner or later they become cancer always requires total removal of the colon with the imposition of the anastomosis between the remaining sections of the intestine. These operations are traumatic and carry a risk of dangerous complications.
Among the possible consequences of removal of polyps the most common – bleeding, perforation of the bowel and recurrence. Usually at various times after polypectomy doctors face bleeding. Early bleeding occurs within the first day after surgery and is caused by insufficient good legs coagulation of the tumor, containing blood vessel. The appearance of blood in the secretions from the intestine is a characteristic feature of this phenomenon. When rejection of a scab in the area of the excision of a polyp may also see bleeding, usually 5-10 days after surgery. The amount of bleeding can be different – from minor to massive, life-threatening, but in all cases, these complications required re-endoscopy, the search of the bleeding vessel, and repeated a careful hemostasis (electrocoagulation). During massive bleeding may be indicated laparotomy and removal of a fragment of the intestine.
Perforation is also a fairly common complication that can occur not only during the procedure, polypectomy, but some time after it. The electric current causes burns of the mucous membrane, which may be deep enough to ruptured intestinal wall. As the patient before surgery is performed with appropriate training, into the abdominal cavity gets only intestinal gas but, nevertheless, patients are treated as in case of peritonitis: antibiotic treatment is laparotomy and removal of the damaged portion of the colon superimposed fistula on the abdominal wall (colostomy) for the temporary diversion of the fecal mass. In 2-4 months, depending on the condition of the patient, the colostomy is closed, forming the inter-intestinal anastomosis and restores the normal passage of the contents to the anus.
Although the polyp is usually removed completely, the causes of polypoetry often remain unresolved, they may cause recurrence of tumors. Regrowth of polyps is observed in approximately one third of patients. In the event of relapse the patient is hospitalized, examined, and raises the question about the choice of methods of treatment of tumors.
After excision of the polyp need constant supervision, especially during the first 2-3 years. The first control colonoscopy study through two months after treatment of benign tumors, then every six months and annually with a relapse-free course of the disease. In the case of villous polyps colonoscopy is performed every three months for the first year, then once a year.
Removal of polyps signs of malignancy requires a lot of alertness and attention. Patient once a month spend endoscopic examination of the bowel during the first year after treatment and every three months in the second year. Only 2 years after successful removal of a polyp and the absence of recurrence or cancer moving to testing every six months.
Excision of the polyp is considered to be the prevention of further growth of such entities and colon cancer, but patients who completed treatment, and persons from risk groups must adhere to certain rules and lifestyle features:
These simple activities are designed to eliminate the likelihood of growth of polyps in the intestine and the possibility of recurrence of cancer in individuals who have already completed appropriate treatment. Seeing a doctor regularly and control colonoscopy is mandatory in all patients after removal of tumors of the intestine, regardless of their number, sizes and localization.
Treatment of folk remedies has no scientific basis and is not brings patients who refuse removal of the tumor, the desired result. The Internet has a lot of information on the use of celandine, chaga, St. John’s wort and even the horseradish with honey, which can be taken orally or as enemas. It is worth remembering that self-medication is dangerous not only a waste of time, but injury to the intestinal mucosa, leading to bleeding and increases the risk of malignancy of a polyp.
The only true is the surgical removal of tumors, and traditional medicines can only be of a subsidiary character after the operation, but only in consultation with your doctor. If it is difficult to resist the popular recipes safe can be a decoction of chamomile or calendula, including vegetable oil, which may have antiseptic effect and facilitate defecation.