Medscape is available in 5 Language Editions – Choose your Edition here.


Colonic Polyps Clinical Presentation

  • Author: Gregory H Enders, MD, PhD; Chief Editor: BS Anand, MD  more...
Updated: Sep 28, 2015


History of present illness

Most patients with colonic polyps are asymptomatic. In symptomatic patients, the most common presenting symptom is rectal bleeding. Other symptoms include diarrhea or constipation, often with decreased stool caliber.

Villous adenomas of the rectum and distal colon can occasionally manifest as a syndrome of severe diarrhea with massive fluid and electrolyte loss.

Chronic bleeding from colonic polyps may cause iron deficiency anemia.

Family history

Although colonic polyps are a disease of older individuals, a positive family history of polyposis should prompt referral for screening in younger individuals and, in some cases, at more frequent intervals. A common practice is to begin screening in a patient 5 years earlier than the age at which colonic polyps were diagnosed in a first-degree relative.


Physical Examination

Distal rectal polyps can be detected by digital rectal examination. Otherwise, physical examination findings are typically normal.

Occult blood in stools (detected by guaiac and antibody-based tests) may be found in a minority of patients with colonic polyps. Although nonspecific, this finding should prompt a colon evaluation in most patients. Such evaluations have had similar yields of clinically significant findings whether the stool sample was obtained by digital rectal examination or was retrieved from spontaneously passed stools.

Contributor Information and Disclosures

Gregory H Enders, MD, PhD Associate Professor, Fox Chase Cancer Center

Gregory H Enders, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American Gastroenterological Association, American Medical Association, Massachusetts Medical Society

Disclosure: Nothing to disclose.


Wafik S El-Deiry, MD, PhD Rose Dunlap Professor of Medicine, Chief, Division of Hematology and Oncology, Penn State Hershey Medical Center

Wafik S El-Deiry, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Clinical Investigation, American Society of Gene and Cell Therapy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Manoop S Bhutani, MD Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.


Research on colon neoplasia in the author's laboratory has been supported by NIH grant #R01DK64758.

  1. Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013 Sep 19. 369(12):1095-105. [Medline]. [Full Text].

  2. Kiesslich R, Goetz M, Lammersdorf K, et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology. 2007 Mar. 132(3):874-82. [Medline].

  3. Spring KJ, Zhao ZZ, Karamatic R, et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology. 2006 Nov. 131(5):1400-7. [Medline].

  4. Ferlitsch M, Reinhart K, Pramhas S, et al. Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA. 2011 Sep 28. 306(12):1352-8. [Medline].

  5. Stryker SJ, Wolff BG, Culp CE, et al. Natural history of untreated colonic polyps. Gastroenterology. 1987 Nov. 93(5):1009-13. [Medline].

  6. Powell SM. Direct analysis for familial adenomatous polyposis mutations. Mol Biotechnol. 2002 Feb. 20(2):197-207. [Medline].

  7. Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. 2007 Oct 4. 357(14):1403-12. [Medline].

  8. Benson M, Dureja P, Gopal D, Reichelderfer M, Pfau PR. A Comparison of Optical Colonoscopy and CT Colonography Screening Strategies in the Detection and Recovery of Subcentimeter Adenomas. Am J Gastroenterol. 2010 Dec. 105(12):2578-85. [Medline].

  9. Shah JP, Hynan LS, Rockey DC. Management of small polyps detected by screening CT colonography: patient and physician preferences. Am J Med. 2009 Jul. 122(7):687.e1-9. [Medline].

  10. Liedenbaum MH, van Rijn AF, de Vries AH, et al. Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening. Gut. 2009 Sep. 58(9):1242-9. [Medline]. [Full Text].

  11. FDA Clears Colon Camera Pill. Medscape. Feb 3 2014. Available at Accessed: Feb 11 2014.

  12. Hagel AF, Gabele E, Raithel M, et al. Colon capsule endoscopy: Detection of colonic polyps compared with conventional colonoscopy and visualization of extracolonic pathologies. Can J Gastroenterol Hepatol. 2014 Feb. 28(2):77-82. [Medline].

  13. Van Gossum A, Munoz-Navas M, Fernandez-Urien I, et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med. 2009 Jul 16. 361(3):264-70. [Medline].

  14. Itzkowitz SH, Jandorf L, Brand R, et al. Improved fecal DNA test for colorectal cancer screening. Clin Gastroenterol Hepatol. 2007 Jan. 5(1):111-7. [Medline].

  15. Heresbach D, Chauvin P, Hess-Migliorretti A, Riou F, Grolier J, Josselin JM. Cost-effectiveness of colorectal cancer screening with computed tomography colonography according to a polyp size threshold for polypectomy. Eur J Gastroenterol Hepatol. 2010 Jun. 22(6):716-23. [Medline].

  16. Zafar A, Mustafa M, Chapman M. Colorectal polyps: when should we tattoo?. Surg Endosc. 2012 Nov. 26(11):3264-6. [Medline].

  17. Beach R, Chan AO, Wu TT, et al. BRAF mutations in aberrant crypt foci and hyperplastic polyposis. Am J Pathol. 2005 Apr. 166(4):1069-75. [Medline].

  18. Burke CA, Choure AG, Sanaka MR, Lopez R. A comparison of high-definition versus conventional colonoscopes for polyp detection. Dig Dis Sci. 2010 Jun. 55(6):1716-20. [Medline].

  19. Bussey HJ, DeCosse JJ, Deschner EE, et al. A randomized trial of ascorbic acid in polyposis coli. Cancer. 1982 Oct 1. 50(7):1434-9. [Medline].

  20. Cohen LB. A color atlas of colorectal lesions. Pazdur R, Hoskins WJ, Wagman L, Coia LR, eds. Cancer Management: A Multidisciplinary Approach. Huntington, NY: Publisher Research & Representation, Inc; 2000. 301-305.

  21. Coia LR, Ellenhorn JDI, Ayoub JP. Colorectal and anal cancers. Pazdur R, Hoskins WJ, Wagman L, Coia LR, eds. Cancer Management: A Multidisciplinary Approach. Huntington, NY: Publisher Research & Representation, Inc; 2000. 273-299.

  22. Cotran RS, Kumar V, Robbins SL. Tumors of the small and large intestines. Cotran R, Kumar V, Robbins S, eds. Pathologic Basis of Disease. 5th ed. Huntington, NY: WB Saunders Company; 1994. 809-822.

  23. Giardiello FM, Offerhaus GJ, DuBois RN. The role of nonsteroidal anti-inflammatory drugs in colorectal cancer prevention. Eur J Cancer. 1995 Jul-Aug. 31A(7-8):1071-6. [Medline].

  24. Itzkowitz SH, Kim YS. Colonic polyps and polyposis syndromes. Feldman M, Sleisenger MH, Scharschmidt BF, eds. Sleisinger & Fordtran's Gastrointestinal and Liver Disease; Pathophysiology, Diagnosis, Management. 6th ed. Philadelphia, Pa: WB Saunders Company; 1998. Vol 2: 1865-1905.

  25. Kinzler KW, Vogelstein B. Lessons from hereditary colorectal cancer. Cell. 1996 Oct 18. 87(2):159-70. [Medline].

  26. Ladabaum U, Song K. Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand. Gastroenterology. 2005 Oct. 129(4):1151-62. [Medline].

  27. Logan RF, Grainge MJ, Shepherd VC, et al. Aspirin and folic acid for the prevention of recurrent colorectal adenomas. Gastroenterology. 2008 Jan. 134(1):29-38. [Medline].

  28. Powell SM, Petersen GM, Krush AJ, et al. Molecular diagnosis of familial adenomatous polyposis. N Engl J Med. 1993 Dec 30. 329(27):1982-7. [Medline].

  29. Regueiro CR. AGA future trends committee report. Colorectal cancer: a qualitative review of emerging screening and diagnostic technologies. Gastroenterology. 2005 Sep. 129(3):1083-103. [Medline].

  30. Rex DK, Kahi CJ, Levin B, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2006 May. 130(6):1865-71. [Medline].

  31. Swan MP, Bourke MJ, Alexander S, Moss A, Williams SJ. Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service (with videos). Gastrointest Endosc. 2009 Dec. 70(6):1128-36. [Medline].

  32. Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006 May. 130(6):1872-85. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.