Juvenile polyps are common growths in the gastrointestinal tract, primarily affecting children. While the term “juvenile” refers to their microscopic characteristics, most individuals develop them before age 20. These benign growths are often discovered incidentally or due to symptoms like bleeding. Understanding juvenile polyps, their indicators, and management is important for parents and caregivers.
Understanding Juvenile Polyps
A juvenile polyp is a non-cancerous growth on the inner lining of the gastrointestinal tract. Classified as hamartomatous polyps, they consist of disorganized normal tissue. Though they can appear anywhere, they are most frequently located in the colon and rectum. Their “juvenile” designation comes from their microscopic appearance, characterized by specific tissue features.
Juvenile polyps are the most common type of intestinal polyp in children, accounting for over 90% of all colon polyps in this age group. They typically present as round or lobulated masses that often protrude from the bowel wall on a stalk (pedunculated). Sizes vary from a few millimeters to several centimeters. While generally solitary, multiple juvenile polyps can indicate Juvenile Polyposis Syndrome.
Common Indicators
Juvenile polyps are often asymptomatic. When symptoms occur, they relate to the polyp’s location and size. The most frequent sign is painless rectal bleeding, appearing as bright red blood in the stool or on toilet paper. This bleeding occurs when stool passes by the polyp, causing irritation or erosion.
Other indicators include changes in bowel habits, such as diarrhea or constipation. Abdominal pain or cramping may occur, particularly if the polyp is large or causes partial obstruction. A polyp may also prolapse, extending out of the rectum and becoming visible. While these symptoms can be concerning, bleeding from juvenile polyps is generally self-limited. If these signs are observed, medical attention is advisable.
How They Are Identified and Handled
When a juvenile polyp is suspected, an endoscopic exam is typically employed for diagnosis and treatment. A colonoscopy is the primary procedure for polyps in the large intestine. During this, a flexible tube with a camera is inserted to visualize the colon’s lining. For polyps in the upper gastrointestinal tract, an upper endoscopy might be performed.
Polyp removal, known as a polypectomy, is often performed during the same endoscopic procedure. Smaller polyps may be removed with a biopsy forcep, while larger ones typically use a snare (a wire loop that severs the polyp). This procedure is generally quick and well-tolerated. After removal, the polyp is sent for microscopic examination to confirm its benign nature.
Long-Term Considerations
Following juvenile polyp removal, the long-term outlook is generally favorable. Most juvenile polyps are benign and do not carry a significant cancer risk. For children with a single polyp, colon cancer risk is considered the same as the general population. However, recurrence after removal is relatively common, with some studies indicating a recurrence rate around 7.9% for solitary polyps and higher for multiple polyps.
Regular follow-up may be recommended, especially for individuals with multiple polyps or a family history of polyposis. In rare instances, multiple juvenile polyps can be part of Juvenile Polyposis Syndrome (JPS). While individual juvenile polyps are usually not precancerous, JPS is associated with an increased lifetime risk of gastrointestinal cancers, primarily colorectal cancer. Therefore, individuals diagnosed with JPS require careful monitoring and ongoing surveillance through endoscopic screenings.