17569 Transanal Endoscopic Microsurgery Tems

Overview

Transanal Endoscopic Microsurgery (TEM) is a specialised operation. It removes abnormal growths from the rectum — the lower part of the bowel — through the anus, which is the opening at the back passage. The surgeon uses a thin tube with a camera and small instruments. This means there is no cut through the abdomen. TEM is a type of minimally invasive surgery, which usually means less pain and a faster recovery than open surgery.

TEM is a specialised procedure. It is not as common as routine tests like colonoscopy, but colorectal teams use it for selected rectal growths.

TEM is most often considered for adults with certain rectal polyps or early rectal cancer. It is more common in older adults because rectal growths become more likely with age. It is rarely used in children.

Symptoms

Common symptoms

• Bleeding from the back passage, or blood on toilet paper or in the stool
• A change in bowel habit that lasts a few weeks, such as looser stools or going more often
• Mucus coming from the back passage
• A feeling that the bowel has not emptied fully
• Tiredness or anaemia from slow blood loss

Symptoms in children

• TEM is very rarely used in children. A child with rectal bleeding or bowel changes should be checked by a children's doctor.

Symptoms in older adults

• Rectal polyps and early rectal cancers are more common with age. Symptoms can be mild, and anaemia may be the first sign, so it is worth asking for a check if something changes.

Causes

Main causes

• TEM is not caused by anything — it is a surgical treatment. It is used to remove rectal growths such as polyps, some early cancers, and some benign lesions.

Risk factors

• Older age
• A family history of bowel or rectal cancer
• Inherited conditions that increase bowel cancer risk, such as Lynch syndrome
• Long-standing inflammatory bowel disease
• Smoking, excess alcohol, obesity, and a diet low in fibre are linked to bowel growths

When to see a doctor

See a doctor urgently if:

• Heavy or ongoing rectal bleeding
• Severe belly pain, fever, or a swollen belly
• After TEM: worsening pain, fever, heavy bleeding, or unable to pass urine

Book a routine appointment if:

• Any blood in the stool or on toilet paper
• A change in bowel habit lasting more than three weeks
• Mucus from the back passage or a feeling of not emptying the bowel
• Unexplained weight loss or tiredness
• A strong family history of bowel cancer

Diagnosis

TEM is planned after a specialist examines your rectum and tests the growth. This usually includes a colonoscopy (a camera test of the bowel) and a biopsy (a small tissue sample). The team checks the size, position, and depth of the growth to see whether it can be removed safely through the anus.

Tests that may be done

• Colonoscopy to look inside the bowel
• Biopsy to check the tissue under a microscope
• MRI or endoanal ultrasound to see how deep the growth goes
• Blood tests, including a full blood count
• Pre-operative assessment to check your general health

What to expect at your appointment

You will be given instructions before the procedure, including bowel preparation. TEM is done under anaesthesia. You may go home the same day or stay overnight. Your team will explain what will happen and how to prepare.

Treatment

TEM is a surgical treatment. The surgeon passes a special scope through the anus and removes the growth with small instruments. There is no cut through the abdomen. For some early growths, TEM can be curative. Your team will discuss whether TEM is suitable for you.

Self-care at home

• Follow your bowel preparation and fasting instructions exactly
• Arrange for someone to take you home and stay with you for the first night if you are having a day procedure
• Take time off work and avoid heavy lifting while you recover
• Follow your team's advice on diet, pain relief, and wound care
• Avoid straining on the toilet; ask for advice if you feel constipated
• Keep follow-up appointments

Medical treatments

Before and after TEM, your healthcare team may use anaesthesia, pain relief, medicines to prevent infection if needed, and medicines to keep bowel movements soft. You will be given personal instructions. No specific medicine is right for everyone, so ask your team or pharmacist before taking anything new.

When is surgery considered?

TEM may be offered when the growth is in the lower rectum, is not too large or deep, and can be reached through the anus. It may also be an option for some early rectal cancers or when bigger surgery would carry more risk. Your specialist will explain the benefits and risks compared with other treatments.

Living with this condition

Most people have some soreness, light bleeding, or a need to rush to the toilet for a few days after TEM. Recovery varies. Follow your team's advice and build up activity slowly. Contact your team if symptoms get worse.

Lifestyle tips

• Eat a balanced diet with fibre and drink enough fluids
• Avoid constipation by following your team's advice
• Take gentle walks and build up activity as you feel able
• Avoid heavy lifting until your team says it is safe
• Do not smoke, and keep alcohol within recommended limits

Diet and exercise

Start with simple foods as advised, then return to your normal diet. Fibre and fluids help keep stools soft. Gentle movement, like walking, can help recovery. Ask your team when you can return to exercise, swimming, or heavy work.

Mental health and emotional wellbeing

It is normal to feel anxious while waiting for results or after treatment. Ask your team questions, write things down, and talk to someone you trust. If you feel overwhelmed or have thoughts of harming yourself, contact your local emergency number or a crisis support line right away.

Prevention

TEM itself cannot be prevented because it is a treatment. The need for it may be reduced by finding and treating rectal growths early through screening, and by healthy habits such as not smoking, staying active, and eating a balanced diet.

Vaccines

There is no vaccine that prevents the need for TEM. Routine vaccines recommended for your age or health can be discussed with your clinician.

Screening programmes

Bowel cancer screening is offered in many countries, often from around age 50 or older. If you have symptoms or a strong family history, do not wait for screening — ask a qualified healthcare provider for advice.

Complications

If left untreated

• Some polyps can grow and cause bleeding or anaemia
• Some early cancers can spread if not treated
• A large growth can cause a blockage, with pain, swelling, and vomiting
• Symptoms may affect daily life and cause worry

Long-term outlook

Many people recover well after TEM. For suitable early growths, it can be curative. Follow-up is important to check healing and to watch for new growths. Your team will explain what to expect for your situation.

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