Colonic & Rectal Polyps

Colonic/Rectal polyps are outgrowths from the internal lining of the colon and rectum. In a normal colon/rectal lining, there should not be any development of polyps. Most polyps develop in later life as a result of damage to the lining. This damage can be due to the food we eat or due to the effects of ageing. As a result of the damage, changes occur in the genes of the cells forming the lining, and it is these changes that drive the development of polyps.

In a minority of individuals, polyps develop at a very early age from their late teens to early twenties. In such individuals, they usually have underlying inherited genetic diseases such as Familial Adenomatous Polyposis (FAP) or Peutz-Jeghers Syndrome. In the case of FAP, over a hundred polyps can be found in the colon and the individual is at a much higher risk of developing colorectal cancer. Thankfully, such genetic diseases are very uncommon in our local context and account for less than 1% of our patients who have diagnosed polyps.

It is important not to be overly worried about colonic polyps. Most polyps can be easily discovered and cleanly removed during a colonoscopy and are often still in a benign stage. This is the reason why a colonoscopy is being advocated by the Ministry of Health Singapore as one of the screening tests for the colon in individuals nearing the age of 50.

An individual can go for a colonoscopy either as a screening procedure or if there are worrying symptoms.

The symptoms that warrant a colonoscopic assessment include:

1. Bleeding on passing motion
2. Abnormal and sustained changes in bowel habits – usually manifesting as diarrhoea or watery stools
3. Unexplained and sustained abdominal pain
4. Unexplained weight loss
5. The sensation of incomplete passing of motion – feels as if there are more stools to be passed out

It is important to note that the above symptoms can occur singularly or as a combination.

For individuals with no symptoms but are in their mid-40s and above, there is a role for doing a colonoscopy as a screening test. The screening colonoscopy aims to allow early pick up of polyps or any cancerous tumours that may already be present. An early pick up of a cancerous condition may mean that the tumour is diagnosed at an earlier stage whereby it is potentially more curable. It is important to note that a screening colonoscopy is carried out the same way as a colonoscopy for a symptomatic patient.