Intestinal polyps are raised lesions that protrude from the surface of the intestinal mucosa into the intestinal lumen and can occur anywhere in the intestine. Colorectal polyps are the most common, accounting for approximately 80% of intestinal polyps. The risk of developing these polyps increases with age and is more common in men than in women. Small, uncomplicated polyps often have no obvious symptoms, while larger polyps can cause recurrent abdominal pain, black or bloody stools, and other symptoms. Colorectal polyps are more likely to present with increased mucus in the stool, blood in the stool, and changes in bowel habits. When more than 100 polyps are widespread throughout the intestine and exhibit distinct clinical manifestations, this condition is called intestinal polyposis. Currently, endoscopic examination and histological biopsy are the best methods for diagnosing and differentiating intestinal polyps.
Clinical classification
1. Classification according to the site of onset
(1) Small intestinal polyps: The incidence of small intestinal polyps is much lower than that of large intestine. They are more common in the duodenum and the polyps vary in size.
(2) Colorectal polyps: Colorectal polyps account for 80% of intestinal polyps, most of which are located in the sigmoid colon or rectum.
2. Classification based on pathological histology
(1) Adenomatous polyps: The most common type is a true polyp formed by glandular epithelial hyperplasia. This type also includes papillary adenomas, villous adenomas, etc.
(2) Inflammatory polyps: These are polyp-like lesions that occur in diseases such as ulcerative colitis, Crohn’s disease, and schistosomiasis due to long-term inflammatory stimulation of the intestinal mucosa.
(3) Hamartoma polyps: Juvenile polyps, Peutz-Jeghers polyps, etc. belong to this category.
(4) Others: such as hyperplastic polyps formed by mucosal hyperplasia, polyps caused by hyperplasia of submucosal lymphoid follicles, and certain polyps arising from carcinoid tumors.
Epidemiology
Contagious
There is no evidence that intestinal polyps are contagious.
Incidence
The incidence of small intestinal polyps is low, and colorectal polyps are a more common digestive system disease, but there is no accurate data available for reference on the exact incidence.
Incidence trend
In recent years, the incidence and recurrence rates of intestinal polyps have also been increasing year by year [4] .
High-risk population
There are more elderly people (age ＞50 years) and men than women.
Causes
Overview
Different pathological types of intestinal polyps have different causes. Currently, there is no consensus on the etiology and pathogenesis of intestinal polyps. Genetic factors, inflammatory stimulation, and unhealthy lifestyle and dietary habits are closely related to the development of intestinal polyps.
Basic cause
1. Inflammatory stimulation
Diseases such as ulcerative colitis, Crohn’s disease, schistosomiasis, and bad bowel habits such as constipation cause the intestinal mucosa to be stimulated by inflammation for a long time, resulting in the proliferation of inflammatory polyps.
2. Genetic factors
The occurrence of certain polyposis diseases is related to genetics, such as familial intestinal polyposis.
Risk factors
1. If you have a family history of cancer or a family member with intestinal polyps, the risk of developing the disease will increase.
2. Having bad habits such as smoking and drinking. A high-fat diet, high intake of red meat (such as beef, lamb, and pork), and a low-fiber diet in daily life will increase the risk of disease.
3. People with obesity, hyperlipidemia, abnormal uric acid, and type 2 diabetes have an increased risk of developing intestinal polyps.
4. Older people have a higher risk of developing intestinal polyps.
symptom
Overview
Small polyps may cause no noticeable discomfort, but larger polyps can cause recurrent abdominal pain and black or bloody stools. Clinically, large intestinal polyps are more common, and they present early with increased mucus in the stool, blood in the stool, and changes in bowel habits.
Typical symptoms
1. Blood in the stool
Large polyps can develop erosions or ulcers on the surface due to pressure or irritation from stool, leading to bleeding. The stool may contain blood and mucus. The blood is often bright red and small, but sometimes there is more bleeding.
2. Changes in bowel habits
Patients may experience diarrhea, or alternating diarrhea and constipation. They may have more frequent bowel movements or a feeling of urgency (a strong desire to defecate but an inability to do so).
3. Abdominal pain
Small polyps may cause no obvious symptoms. However, as they grow larger, recurrent dull abdominal pain may occur. Larger polyps may lead to intestinal obstruction or intussusception, in which case the abdominal pain may be significant and persistent.
Associated symptoms
Patients with a long course of the disease may develop symptoms of anemia, such as pale skin and mucous membranes, weight loss, and other symptoms due to prolonged bleeding. In some patients, polyps may compress nearby organs and tissues, such as the common bile duct, causing jaundice.
complication
The main complications of intestinal polyps are bleeding, infection, and cancer. Larger polyps can cause abnormal intestinal motility and may induce intussusception or intestinal obstruction.
examine
Scheduled inspection
After inquiring about the patient’s medical history, the doctor will first perform a physical examination to assess any abnormalities. Laboratory tests such as a routine blood test and a stool test with occult blood may be recommended. The doctor may also use colonoscopy and barium meal X-rays to observe the intestinal condition.
Physical examination
Doctors perform a thorough abdominal examination. Any abnormalities, such as abdominal distension or masses, may indicate intestinal obstruction or intussusception. Doctors may also perform a digital rectal examination. If the polyp is located low in the rectum, the doctor may palpate a round, soft mass that is smooth and highly mobile. Polyps with long pedicles often appear and disappear intermittently. If the patient has multiple polyps, spherical masses of varying sizes, resembling a bunch of grapes, may be palpated within the rectum. The doctor’s fingertip used for examination may be stained with blood or bloody mucus.
Laboratory tests
1. Stool routine test + occult blood test
Doctors can perform this test on patients to determine whether they have bleeding in the intestines or other parts of the body.
2. Routine blood test
Doctors collect blood from patients for analysis and examination to assess whether the patient has anemia and the severity of the anemia. They can also determine whether the body has an infection.
Imaging examinations
Intestinal X-ray Barium Meal: Before the examination, the patient takes a certain dose of barium as prescribed by the doctor, and then undergoes an X-ray examination. Large small intestinal polyps can be found by small intestinal barium meal X-ray. Colonic barium enema can show most colon polyps.
Pathological examination
Pathological tissue biopsy is one of the main methods for diagnosing intestinal polyps. The doctor will take a small amount of tissue from the lesion under endoscopic examination and send it to the laboratory for analysis to evaluate whether it is a polyp, and further perform pathological histological classification to determine the type of lesion.
Other tests
Endoscopic examination: Doctors may select examinations such as colonoscopy, sigmoidoscopy, and proctoscopy based on the patient’s specific condition. Before the examination, patients are required to take medications such as compound polyethylene glycol electrolyte powder or perform an enema to cleanse their intestines. Endoscopic examination is the primary means of examining and rechecking intestinal polyps. The location, size, and morphology of polyps can be directly observed under the microscope. For polyps suspected of malignancy, biopsies are obtained under the microscope to further confirm the pathological diagnosis.
diagnosis
Diagnostic principles
Clinically, the diagnosis of intestinal polyps relies primarily on direct endoscopy and biopsy, but there is a certain rate of missed diagnosis for smaller polyps. During the diagnosis process, doctors will carefully rule out diseases such as hemorrhoids and intestinal cancer.
Diagnostic basis
1. History of long-term recurrent dull abdominal pain, blood in the stool or bloody stool with mucus.
2. Polyps are found during rectal examination or endoscopic examination.
3. Barium enema shows filling defect.
4. Pathological diagnosis excludes cancer.
Differential diagnosis
1. Hemorrhoids
Polyps located in the rectum can be confused with hemorrhoids located at the end of the rectum. Internal hemorrhoids are more common in adults and are round or oval in shape. Patients experience heavy bleeding in their stools, often as a drip. Doctors can differentiate internal hemorrhoids through a digital rectal examination.
2. Bowel cancer
Both intestinal cancer and intestinal polyps can cause changes in bowel habits. Intestinal cancer patients may experience thinner and flatter stools, blood in the stool, a dark purple color, a foul odor, and tenesmus. In rectal cancer, a digital rectal examination may palpate an uneven, firm, and immovable mass. Endoscopically, intestinal polyps are smooth, soft, and generally small, whereas intestinal cancer lesions are rough, firm, and larger. Physicians can confirm a differential diagnosis based on clinical manifestations and endoscopic pathological examinations.
3. Hypertrophy of anal papilla
Anal papilla hypertrophy occurs near the anal sinus at the dentate line, often occurs alone, is hard, grayish white, smooth, and usually does not cause blood in the stool. A biopsy can determine its nature.
treat
Treatment principles
Minimally invasive endoscopic treatment is generally the preferred approach for this condition, absent contraindications. This approach is safe, painless, and simple, making it the preferred method in clinical practice. For asymptomatic small polyps, close follow-up observation is recommended, with prompt treatment if any abnormalities are detected.
General treatment
Patients with intestinal polyps are generally advised to correct their bad living and eating habits, such as smoking, drinking, high-fat diet and high intake of red meat.
Drug treatment
There is no specific medication for patients with intestinal polyps. Clinically, doctors sometimes prescribe medication based on the patient’s actual condition. For example, antibiotics may be given for gastrointestinal infections.
Surgical treatment
1. Endoscopic polypectomy and endoscopic mucosal resection can be used for intestinal polyps without contraindications.
Polyps within 30 cm of the anal verge can be removed via sigmoidoscopy. Those with a pedicle can be ligated with a snare and then removed; those with a wider base require electrocautery. Polyps located higher in the colon can be removed via fiberoptic colonoscopy.
3. Symptomatic small intestinal polyps, colon polyps suspected of malignancy, and colon polyps that are difficult to treat endoscopically should be treated by laparotomy for simple polypectomy or intestinal segment resection.
Traditional Chinese Medicine treatment
Once the disease is discovered, it should be removed and treated early, supplemented by traditional Chinese medicine for internal use according to the condition. For patients with multiple polyps, doctors will also use traditional Chinese medicine liquids with astringent, softening and dispersing properties for enema treatment.
1. Wind-damaged intestinal tract syndrome
(1) Symptoms: bright red blood in the stool, dripping blood, or bloody blood; the surface of the polyp is obviously congested, and it may or may not be protruding from the anus; the tongue is red, with a thin white or thin yellow coating, and the pulse is floating and rapid.
(2) Treatment method: Clear away heat, cool blood, dispel wind and stop bleeding.
(3) Prescription: Huaijiao Pills with modifications. Common ingredients include Huaijiao, Huaihua, Areca, Scutellaria, and Hedgehog peel. For heavy bloody stools, add Paeonia lactiflora, Rehmannia root, and Platycladus orientalis charcoal.
2. Qi stagnation and blood stasis syndrome
(1) Symptoms: The tumor protrudes from the anus and cannot be retracted, causing severe pain. The surface of the polyp is dark purple; the tongue is purple and the pulse is sluggish.
(2) Treatment method: Promote blood circulation and remove blood stasis, soften and disperse nodules.
(3) Prescription: Shaofu Zhuyu Decoction with modifications. Common ingredients include fennel, dried ginger, Corydalis yanhusuo, myrrh, Chuanxiong, cinnamon, red peony root, stir-fried aconite root, raw pollen, and Chinese angelica. If polyps are large or multiple, add Scutellaria barbata, Lobelia chinensis, and Hedyotis diffusa.
3. Spleen Qi Deficiency Syndrome
(1) Symptoms: The tumor is easy to protrude from the anus, the surface is rough and hyperplastic, or there is a small amount of bleeding, and the anus is loose; the tongue is pale, the tongue coating is thin, and the pulse is weak.
(2) Treatment method: Nourish the spleen and stomach.
(3) Prescription: Shenling Baizhu powder with modifications. Common ingredients include white lentils, ginseng, white atractylodes, white poria, roasted licorice root, Chinese yam, lotus seeds, platycodon, coix seed, and amomum villosum. If the amount of bleeding is heavy, donkey-hide gelatin and Millettia reticulata can be added.
Treatment cycle
The time required for intestinal polyp treatment depends on the patient’s actual condition. Patients who undergo surgical treatment generally need several weeks or even months to recover.
Treatment costs
The specific costs are related to the selected hospital, individual treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
Single intestinal polyps generally have a good prognosis after surgical treatment, but adenomatous polyps have a greater risk of cancer. Patients with a family history of cancer or a genetic predisposition need regular checkups to be vigilant for the development of intestinal cancer.
Hazards
1. Some intestinal polyps have a certain genetic susceptibility and may be passed on to the next generation.
2. Intestinal polyps are often complicated by bleeding and infection, and long-term blood loss can easily lead to anemia.
3. When polyps are too large, they can easily induce intestinal obstruction or intussusception.
4. Colorectal adenoma is one of the most common colorectal polyposis diseases and is generally recognized as a precancerous lesion of colorectal cancer. Polyps larger than 2 cm, especially broad-based and adenomatous polyps, have a significantly increased rate of malignant transformation. Colorectal adenoma usually takes 5 to 15 years to develop into adenocarcinoma and can occur in various parts of the colon [8] .
Self-healing
Intestinal polyps generally cannot heal on their own and require active treatment or regular follow-up observation.
Curative
This disease can be cured through endoscopic polypectomy, endoscopic mucosal resection, laparotomy, simple polyp resection or intestinal segment resection.
Cure rate
There is no exact data available for reference.
Recurrent
Some research data show that intestinal polyps are usually removed by endoscopic electrocoagulation and resection, but postoperative follow-up found that the recurrence rate can be as high as 60%.
daily
Overview
Good daily care can alleviate the patient’s discomfort to a certain extent and help promote recovery. Patients should pay attention to maintaining a positive attitude in their daily lives, develop good living habits, and follow the doctor’s advice for regular checkups.
Psychological care
1. Psychological characteristics
Doctors sometimes recommend surgical resection for patients with intestinal polyps. Endoscopic surgery involves entering the intestinal cavity through the body’s existing cavities. Patients are unfamiliar with the procedure and may experience fear and anxiety. Furthermore, recurring discomfort can lead to excessive worry about their condition, leading to negative and pessimistic emotions.
2. Nursing measures
Family members and patients can discuss the methods, procedures, and objectives of endoscopic surgery with their doctors. Understanding the procedure can alleviate fear and anxiety. Doctors and family members can share successful surgical cases with patients to boost their confidence in endoscopic surgery. During the recovery period, frequent communication with patients can help alleviate anxiety and encourage them to actively cooperate with follow-up treatment and daily care.
Postoperative care
1. Dietary guidance
Patients should abstain from food or drink after surgery. The duration of this period will be determined by the surgeon and should be followed accordingly. Generally, patients should abstain from food or drink for 24 hours after surgery. A small amount of cold water may be consumed after the first 24 hours. If no discomfort is present, patients may consume light, easily digestible foods such as thick rice soup or porridge in cold liquid form. Avoid milk or soy products. Vegetable purees, cakes, and soft noodles may be consumed within the second 24 hours after surgery. A soft diet is recommended for the first week after surgery.
2. Activities and Rest
Patients should rest in bed for 24 hours after surgery as directed by their doctor. Within 24 hours, they may move around in bed, turning slowly on their own, but avoiding getting out of bed. Patients with numerous or large polyps should rest in bed for 2–3 days, avoiding increased abdominal pressure, heavy lifting, and forceful coughing. Maintain bowel movements to prevent increased abdominal pressure during straining for constipation. Avoid strenuous activity for 2 weeks.
3. Hygiene care
After the operation, family members should pay attention to the hygiene of the patient’s recuperation area, and the patient should pay attention to keeping the wound clean and dry to avoid infection.
Life Management
1. Increase physical exercise, and obese patients should lose weight appropriately.
2. Develop good bowel habits in daily life to prevent constipation.
Follow-up Instructions
Patients with intestinal polyps typically undergo one to two follow-up examinations. For patients with multiple colon polyps or polyps with a diameter greater than 1 cm, the interval between initial examinations is typically less than 12 months. As the number and diameter of polyps increase, the frequency of follow-up examinations should increase. The interval between initial and subsequent postoperative examinations should be shortened based on physician recommendations, and follow-up examinations should primarily focus on endoscopic examinations. In practice, follow-up examinations strictly adhere to physician recommendations.
diet
Dietary adjustment
Diet is a controllable factor in the development of colorectal polyps. Poor eating habits can irritate the intestines, leading to the appearance of polyps. However, adopting a low-protein diet, increasing the intake of fruits and vegetables, and increasing physical exercise can reduce the incidence of intestinal polyps.
Dietary recommendations
1. Eat more vegetables, fruits, meat, etc., pay attention to the rationality of food combination to ensure balanced nutrition.
2. Eating more potassium-rich foods such as apples, fish, oranges, etc. will help promote recovery.
3. It is advisable to eat warm food, which is beneficial to protecting the patient’s gastrointestinal mucosa.
4. Patients can eat light noodles, buns and other foods. These foods will not irritate the patient’s gastrointestinal tract and will help promote the recovery of intestinal function.
5. Patients with intestinal polyps can eat more porridge in their daily life. When cooking porridge, they can appropriately add some vegetables and fruits, such as red beans, radishes, apples, etc. This can ensure that the food is light and its nutritional value can be ensured, which is conducive to further promoting the patient’s physical recovery.
Dietary taboos
1. Try not to eat raw, cold, spicy or other irritating foods in daily life.
2. Quit smoking and limit alcohol consumption, and maintain smooth bowel movements by not smoking or drinking.
3. Patients should not eat foods that have been left out for a long time or are cold, such as noodles, milk, egg soup, etc., and should not eat hard, raw or cold foods.
4. Eat less sugar, milk, beans, purple sweet potatoes and other easily fermented foods.
5. In daily life, pay attention to your ability to adapt to various types of food. If you feel uncomfortable after eating some food, don’t eat it anymore.
6. Pay attention to food hygiene, don’t always eat out, and eat less at street stalls.
prevention
Preventive measures
1. Develop good living and eating habits, exercise appropriately, maintain a healthy weight, and avoid excessive drinking and smoking.
2. Actively treat primary diseases such as ulcerative colitis and Crohn’s disease.
3. Those with a family history of cancer and a genetic predisposition should be actively screened for early detection and treatment. Patients with familial polyposis should begin examinations during adolescence.
Medical Guide
Outpatient indications
1. Recurrent dull abdominal pain.
2. You find that the color of your stool has changed in daily life.
3. The patient’s stool contains blood, mucus, etc.
4. The patient suffers from repeated diarrhea, constipation, etc.
5. Unexplained anemia, loss of appetite, weight loss, etc.
6. Physical examination revealed foreign matter in the intestines.
7. Other abnormal situations occur.
All of the above require prompt medical consultation.
Treatment department
1. Patients with stable condition should consult gastroenterology department.
2. Patients who require surgical treatment should seek treatment at the gastrointestinal surgery or general surgery department.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. The doctor may perform a physical examination on your abdomen. Wear loose clothing that easily exposes your abdomen for easier examination.
3. If you are considering a colonoscopy, be sure to prepare for intestinal cleansing in advance according to the doctor’s instructions.
4. If you have taken any medicine recently, you can record the name, usage and dosage to facilitate communication with your doctor.
5. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
6. Family members may accompany the patient to the clinic and should be prepared with questions they wish to ask.
Questions your doctor may ask
1. What symptoms do you have? When did they start? How long have they lasted?
2. When do your symptoms improve? When do they get worse?
3. Is your bowel movement normal? Do you have black stools or changes in stool characteristics?
4. Do you have regular eating habits? Do you like to eat greasy food? Do you like to eat vegetables and fruits?
5. Have you ever had gastrointestinal disease? Have you ever received treatment?
6. Do you usually drink alcohol or smoke?
7. Do you have a family history of digestive tract diseases?
8. Have you taken any medication on your own? Did the symptoms improve after taking the medication?
What questions can patients ask?
1. Is there a clear diagnosis now? Do I have intestinal polyps?
2. What are the causes of my disease?
3. Is my condition serious? Will it turn into cancer?
4. Do I need a colonoscopy? Will it cause any harm?
5. Can I take medication? Do I need surgery? Are there any side effects?
6. How long does treatment take? Can it be cured? Will it recur in the future?
7. What should I pay attention to? Should I stop smoking or drinking?
8. Do I need a follow-up examination? How long will it take? What items should be reviewed?