- Age: The likelihood of developing rectal polyps increases after the age of 50. Ageing leads to gradual changes in the colon’s lining, making it more prone to abnormal growths.
- Family History of Colorectal Polyps or Cancer: A family history of these conditions significantly raises the risk, particularly in cases of inherited syndromes such as familial adenomatous polyposis (FAP).
- Dietary and Lifestyle Factors: High consumption of processed or red meats, low fibre intake, smoking, and frequent alcohol use are linked to a higher risk of polyp formation.
- Inflammatory Bowel Diseases (IBD): Chronic conditions such as ulcerative colitis and Crohn’s disease increase the likelihood of developing polyps due to prolonged inflammation of the intestinal lining.
Rectal Polyps

Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Rectal polyps are abnormal growths that develop on the inner lining of the rectum. These growths can vary in size and shape, ranging from small and flat to larger, stalk-like formations. While most rectal polyps are benign, some have the potential to develop into colorectal cancer if left untreated. Regular screenings and timely removal of polyps can help reduce potential risks and complications.




Symptoms of Rectal Polyps
Some rectal polyps may not cause noticeable symptoms, making regular screenings especially beneficial. When symptoms occur, they may include:
- Rectal Bleeding: Blood may appear in the stool, on toilet paper, or in the toilet bowl. This is often one of the most noticeable signs of rectal polyps, as irritation of the rectal lining can lead to bleeding.
- Changes in Bowel Habits: Persistent diarrhoea, constipation, or a sensation of incomplete bowel movements may indicate the presence of polyps, especially if these changes are unexplained and long-lasting.
- Abdominal Pain or Discomfort: Large polyps may partially block the rectum or bowel, causing cramping, bloating, or general discomfort in the lower abdomen.
- Anaemia: Chronic blood loss from bleeding polyps can lead to iron-deficiency anaemia, resulting in symptoms like fatigue, weakness, or pale skin.
Causes and Risk Factors
Rectal polyps develop due to a combination of genetic predisposition and lifestyle-related factors. Several risk factors contribute to their development:
Types of Rectal Polyps
Rectal polyps can be classified into distinct types based on their structure and potential to progress into cancer.
Adenomatous Polyps
These are the most common type of rectal polyps and are considered pre-cancerous. Subtypes include tubular adenomas (generally less aggressive), villous adenomas (higher risk of cancer), and tubulovillous adenomas (a mix of both). Regular monitoring is recommended.
Hyperplastic Polyps
These are usually small, with a lower likelihood of becoming cancerous. However, large hyperplastic polyps, especially in the rectum, may require closer observation.
Inflammatory Polyps
Often linked to inflammatory bowel diseases like ulcerative colitis, these polyps develop due to long-standing irritation of the rectal lining. While not inherently cancerous, their presence may signal underlying bowel conditions requiring management.
Diagnosis of Rectal Polyps
Colonoscopy
A colonoscopy involves using a long, flexible tube equipped with a camera to visually inspect the entire colon and rectum. This procedure allows the doctor to identify polyps, take tissue samples, and often remove the polyps during the same session. Polyps removed are sent for biopsy to determine if they are benign, precancerous, or malignant.
Digital Rectal Examination (DRE)
This is a hands-on examination where a doctor inserts a gloved, lubricated finger into the rectum to feel for abnormal growths or irregularities. While it is a quick and basic assessment, it may help detect larger rectal polyps or other abnormalities in the lower rectum.
Stool-Based Tests
These non-invasive tests analyse stool samples for hidden (occult) blood or specific DNA changes linked to colorectal abnormalities. Examples include the faecal immunochemical test (FIT) and stool DNA tests. While these tests do not provide a definitive diagnosis, they can indicate the need for further investigations, such as a colonoscopy, to identify potential sources of bleeding or abnormal growths.
Flexible Sigmoidoscopy
This diagnostic procedure is similar to a colonoscopy but is limited to examining the rectum and the lower part of the colon. It uses a shorter, flexible tube with a camera. Flexible sigmoidoscopy is typically used as a preliminary or more targeted investigation when full colonoscopy is not immediately required.
Treatment Options
The treatment of rectal polyps is determined by their size, number, and biopsy results. Both non-surgical and surgical approaches are used.
Non-Surgical Treatment
- Polypectomy During Colonoscopy: Most rectal polyps can be removed during a colonoscopy using specialised tools, such as snares or forceps, to excise the growth. This minimally invasive outpatient procedure typically does not require a hospital stay, and patients can resume normal activities shortly afterward. The removed polyps are sent for laboratory analysis to determine their type and potential risk.
Surgical Treatment
- Segmental Resection: When polyps are too large, too numerous, or located in difficult-to-access areas for removal via colonoscopy, surgical removal of a portion of the colon or rectum may be required. This procedure, often performed under general anaesthesia, targets areas with high-risk polyps or recurrent growths to reduce potential complications.
- Proctocolectomy: For individuals with genetic conditions such as familial adenomatous polyposis (FAP) or those experiencing recurrent polyps, surgical removal of the rectum and, in some cases, parts of the colon may be necessary. This procedure is a preventive measure to reduce the risk of developing colorectal cancer in high-risk patients. Depending on the extent of removal, a stoma or ileoanal pouch may be required for waste elimination.
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Prevention and Management
Adopting healthier habits may help reduce the likelihood of developing rectal polyps. Eating a diet that includes plenty of fruits, vegetables, and whole grains while reducing processed and red meat consumption can support overall bowel health. Regular physical activity, avoiding smoking, and limiting alcohol intake are also beneficial.
Individuals with risk factors, such as a family history of polyps or chronic bowel conditions, should consider routine screenings to detect and address polyps early. Managing conditions like inflammatory bowel disease can further help minimise potential complications.
Frequently Asked Questions
How often should I undergo screening for rectal polyps?
The frequency of screening depends on age, medical history, and risk factors. For individuals aged 50 or older with no additional risks, a colonoscopy every 10 years is commonly advised. Those with a family history of colorectal conditions or previous polyps may require screenings every 5 years or more frequently, as determined by their doctor.
Can rectal polyps recur after treatment?
Yes, rectal polyps can recur after removal, especially if risk factors like an unhealthy diet, smoking, or family history persist. Regular follow-up colonoscopies are usually recommended, with intervals based on previous findings, to monitor and address any new growths.
Are there risks associated with polyp removal?
Polyp removal is generally safe, but like any procedure, it carries some risks. These include bleeding, infection, or perforation of the colon, though such complications are rare. Your doctor will discuss these risks and provide guidance on post-procedure care.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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