The rectum, along with the sigmoid colon, is the most frequent site of polyps (and cancers) in the gastrointestinal tract. Adenomatous polyps of the colon and rectum have the potential to become malignant. The chance of developing invasive cancer is enhanced if the polyp is more than 1 cm in diameter. Removal of all polyps is recommended to allow complete histological diagnosis and exclude carcinoma. This is best done using endoscopic biopsy or snare polypectomy techniques. If one or more rectal polyps are discovered on sigmoidoscopic examination, a colonoscopy must be performedbecause further polyps are frequently found in the colon.
The rectum shares the same spectrum of polyps as the colon. Polyps are described in terms of their appearance (pedunculated, sessile, flat) or histological composition (tubular, villous, tubulovillous).
POLYPS RELEVANT TO THE RECTUM: -
Hyperplastic polyps These are small, pinkish, sessile polyps, 2–4mm in diameter and frequently multiple. They are common and generally harmless.
TUBULAR ADENOMAS: Tubular adenomas, or mixed tubulovillous adenomas, are the most common type of polyp. They have the potential to turn malignant, particularly if over 1cm in diameter.
VILLOUS ADENOMAS: - These have a characteristic frond-like appearance. They may be very large, occupying much of the circumference of the rectum. These tumours have an increased tendency to become malignant. Rarely, the profuse mucus discharge from these tumours, which is rich in potassium, causes electrolyte and fluid losses.
SERRATED ADENOMAS: - These polyps are more commonly found in the right colon, but may be present in the rectum. They are typically sessile lesions that have a distinct microscopic architecture and can give rise to cancers through an alternative ‘serrated’ pathway.
FAMILIAL ADENOMATOUS POLYPOSIS: - This autosomal dominant inherited condition is characterized by the development of multiple rectal and colonic adenomas around puberty. It is due to mutation in the adenomatous polyposis coli (APC) gene, allowing genetic testing in the 75% of families in which a mutation can be identified. A colonoscopy and biopsy will confirm the diagnosis. As this condition is premalignant, total colectomy is usually recommended within 10 years of disease onset. This may take the form of pan-proctocolectomy with permanent ileostomy. Rectal preservation may be an option if the rectal polyp load is not too severe, with colectomy and ileorectal anastomosis, but continuous rectal surveillance for synchronous polyps will be required. The alternative, if restoration of gastrointestinal continuity is desired, is to undertake restorative proctocolectomy with ileal pouch–anal anastomosis.
INFLAMMATORY PSEUDOPOLYPS: - These are oedematous islands of mucosa. They are usually associated with colitis in the UK, but most inflammatory diseases (including tropical diseases) can cause them. They are more likely to cause radiological difficulty, as the sigmoidoscopic appearance is usually associated with obvious signs of active or quiescent inflammation.
Juvenile polyp: - This is a bright red, glistening pedunculated sphere (‘cherry tumour’), which is found in infants and children. Occasionally, it persists into adult life. It can cause bleeding, or pain if it prolapses during defecation. It often separates itself, but can be removed easily with forceps or a snare. A solitary juvenile polyp has virtually no tendency to malignant change, but should be treated if it is causing symptoms. It has a unique histological structure with large mucus-filled spaces covered by a smooth surface of thin rectal cuboidal epithelium. The rare autosomal dominant inherited syndrome juvenile polyposis does carry an increased risk of malignancy. It is characterised by multiple polyps and a positive family history.
HOMOEOPATHIC MANAGEMENT OF RECTAL POLYPS: -
The homoeopathic system of medicine offers holistic treatment for rectal polyps. These remedies are made of natural substances and hence are safe to use without any side effects. Homoeopathic medicines help in the symptomatic management of polyps include: -
Kali bromatum:- Used in cases where the bowel habits become altered. They may have either diarrhea or constipation. The diarrhea is mostly painless but may be attended by a feeling of chilliness. In some cases, blood or mucus may appear in the stool. If there is Constipation no bowel movement and stool, if present, is hard or dry with missing of days without a stool.
Calcarea phosphorica :- Indicated for individuals who get diarrhea. Stool is watery, hot and slimy. White flakes may pass in the stool in some cases. Offensive foetid flatus may attend the passage of stool. Stitching pain in the rectum appears in some cases.
Ammon mur:- Indicated when there is Constipation. The stool is scanty and hard and is passed after a lot of straining. It also tends to crumble at the verge of the anus. A glairy mucus may be present with the hard stool in some cases. Burning or smarting sensation in the rectum may assist.
Nux vomica:- Indicated where the person experiences a constant, ineffectual urging to pass stool. The person passes frequent, scanty stool and there is constant uneasiness in the rectum. A dragging sensation in the rectum may also appear along with abdominal colic.
Phosphorus: - For polyps that cause bleeding. Bleeding from rectum may appear while passing stool. Other accompanying symptoms include a painless, watery stool, weakness after passing stool, and cramps in the rectum. In some cases, needle like stitching pain may appear in the rectum