Colonic Polyps Clinical Presentation

Updated: Mar 09, 2020
  • Author: Gregory H Enders, MD, PhD; Chief Editor: BS Anand, MD  more...
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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 the 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.