What are the side effects of polyp removal?

Polyps are abnormal tissue growths that form on the inside of the colon, stomach, nose, uterus, or other areas of the body. Polyps are often removed through procedures like colonoscopy, polypectomy, hysteroscopy, and endometrial ablation. While polyp removal is generally safe, some side effects can occur.

Bleeding

Bleeding is one of the most common side effects of polyp removal. Small amounts of bleeding are normal following polyp removal procedures. However, excessive or prolonged bleeding may indicate a more serious issue.

During colonoscopy and polypectomy, the gastrointestinal (GI) tract is examined and polyps are removed by cutting them off at the base or destroying them with heat. This can irritate the GI tract lining and cause minor bleeding. Most post-polypectomy bleeding stops on its own. Up to 6% of patients experience significant bleeding that requires treatment or hospitalization.

With uterine polyp removal procedures like hysteroscopy and endometrial ablation, instruments are inserted into the uterus which can cause bleeding from the uterine lining. Mild bleeding or spotting can last for several days or weeks. Heavy or prolonged bleeding may signify uterine or cervical trauma and the need for further treatment.

Infection

Infection is a possible side effect of any invasive procedure. The risk of infection is increased with polyp removal techniques that involve insertion of scopes or instruments into normally sterile areas of the body.

During colonoscopy, bacteria from the colon can be introduced into the bloodstream, leading to bacteremia or sepsis in rare cases. Antibiotics may be given before or after colonoscopy in high-risk patients to help prevent infection.

Uterine infections like endometritis are also a potential complication of hysteroscopy. Symptoms include fever, foul-smelling vaginal discharge, uterine pain and tenderness. Antibiotics are used to treat post-hysteroscopy infections.

Damage to Surrounding Tissue

During polyp removal, nearby healthy tissue can sometimes be injured.

With colon polypectomy, the colon wall can get burned or perforated by the heat or electrical current used to destroy polyps. This may cause abdominal pain or infection in the abdominal cavity. Colon perforation requires hospitalization and often surgery to repair.

Uterine perforation is also a risk with hysteroscopy. The surgical instruments can puncture through the uterine wall into surrounding tissues, causing pain and bleeding. Laparoscopic surgery may be needed to repair a uterine perforation.

Scarring

Any surgery that involves cutting or removal of tissue can lead to internal scarring as the area heals. Scarring is a possible long-term complication of polyp removal.

In the colon, scarring can cause strictures or narrowing of the GI tract, which may result in cramps, diarrhea or obstruction. Repeat colonoscopy and surgery may be needed for treatment.

Asherman syndrome is a condition characterized by uterine adhesions and scarring. Trauma from uterine surgery like polypectomy can trigger the excessive growth of scar tissue inside the uterus. This may lead to menstrual abnormalities, infertility and pregnancy complications.

Incomplete Polyp Removal

If a polyp is not fully removed during the procedure, any remaining tissue can continue to grow. Follow-up procedures may be necessary to fully remove the polyp if initial treatment was incomplete.

After colonoscopy and polypectomy, up to 26% of polyps may have residual tissue. Small fragments left behind have the potential to become cancerous over time if not fully excised.

For uterine polyps, hysteroscopy with direct visualization helps ensure complete removal. Any residual tissue can be monitored with follow-up pelvic exams, imaging tests or repeat hysteroscopies.

Reaction to Anesthesia

Some polyp removal procedures like polypectomy and hysteroscopy utilize general anesthesia or conscious sedation to keep patients comfortable. Side effects and adverse reactions may occur due to anesthesia use.

Anesthesia side effects can include nausea, vomiting, sore throat, fatigue, drowsiness and headache after the procedure. More serious risks include allergic reactions, breathing difficulties, heart disturbances and blood pressure fluctuations.

Risks are greater with general anesthesia compared to conscious sedation. Patients are monitored closely throughout procedures that involve anesthesia to detect and treat any concerning reactions.

Damage to Nearby Organs

In some cases, instruments used during polyp removal can directly damage neighboring organs and tissues.

During colonoscopy and polypectomy, looping of the scope can exert pressure on and injure the spleen. This may cause painful splenic rupture or hematoma requiring hospital care.

With hysteroscopy, the uterine instruments can potentially lacerate the cervix or vaginal walls. The bladder or bowels are also at risk if uterine perforation occurs. Laparoscopic surgery may be needed to repair any organ damage.

Chronic Pain

Rarely, chronic abdominal or pelvic pain may develop after polyp removal procedures. This can be due to nerve damage, organ trauma, or scarring from surgery.

Pain that lasts for months after colonoscopy may signal an undiagnosed perforation or other complication requiring additional treatment. Chronic uterine or vaginal pain can occur after hysteroscopic polyp removal as well, often improving over time.

Recurrence of Polyps

One of the realities of polyp treatment is that new polyps often develop after removal. Recurrence rates depend on the type of polyp and location.

For colon polyps, one study showed recurrence rates around 30% at 3 years and 50% at 5 years after initial polypectomy. Certain types like sessile serrated polyps have recurrence rates up to 50% after 1 year.

Uterine polyps also have high recurrence tendencies. Up to 25% of women may have new uterine polyp growths within 2 years of surgery. Ongoing surveillance can help detect and treat any recurrent polyps.

Infertility

In rare instances, polyp removal procedures involving the uterus can lead to intrauterine scarring and adhesions (Asherman syndrome) which may contribute to infertility issues. Damage to the cervix or uterus that occurs during surgical polyp treatment could potentially impact future pregnancies as well.

Menstrual Changes

Women may notice changes in their menstrual cycles following uterine polyp removal procedures like hysteroscopy and endometrial ablation.

Heavy menstrual bleeding often improves after endometrial ablation since this surgery destroys the uterine lining. However, increase in bleeding can occur if scarring develops.

Other possible menstrual changes include timing of periods, duration of bleeding and intensity of cramps. Symptoms often regulate within a few months but mention any persistent menstrual abnormalities to your doctor.

Blood Clots

Formation of blood clots, or thromboembolism, is a possible risk accompanying any surgical procedure. Lower extremity clots such as deep vein thrombosis (DVT) may travel to the lungs causing a dangerous pulmonary embolism (PE).

Those undergoing uterine polyp removal have increased risk of post-op venous thromboembolism (VTE). Aspirin or anticoagulant medication may be prescribed to help reduce clotting risks.

Bowel Problems

Temporary bowel issues like constipation or diarrhea can arise after colonoscopy with polypectomy. This is due to irritation of the gastrointestinal tract.

Rarely, if the muscular layer of the colon gets damaged during polyp removal, it may lead to long-term problems with colon motility and bowel function. Repeat procedures or even colon resection surgery may be required in severe cases.

Conclusion

Polyps are extremely common, and polyp removal procedures like colonoscopy, polypectomy, hysteroscopy and endometrial ablation are generally safe and effective. However, like with any medical procedure, some risks and side effects can occur.

The most frequent polyp removal side effects are short-term issues like bleeding, infection, cramps, bloating and pain at the surgery site. More serious risks that may need additional treatment include perforation, scarring, damage to other organs and incomplete polyp removal.

Talk with your doctor about the benefits and risks of polyp removal. Be sure to follow all pre- and post-procedure instructions carefully. Report any concerning symptoms or side effects promptly after surgery. Staying vigilant about follow-up and surveillance can help minimize risks and achieve the best outcome from polyp treatment.

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