Anal Polyps: Specialists & Information

An anal polyp is a benign enlargement of the anal papillae, which occur in the area of the linea dentata at the anus as small, leaf-shaped folds of mucous membrane. If they are irritated by chronic irritation, an injury, or another medical condition, they can enlarge. This enlarged mucosa is referred to as a hypertrophic anal papilla or anal fibroma.

Histologically, such growths consist of connective tissue (stroma) and are covered by squamous epithelium. They can range in size from just a few millimeters to several centimeters. Despite this potential size, anal polyps remain benign and do not become malignant. 

In the Proctology Atlas, the typical shape is vividly compared to a “cat’s tooth.”

Such a polyp may remain asymptomatic for a long time. As the growths enlarge, typical symptoms appear:

• Discharge or soiling of underwear
• Itching and irritation in the anal area
• Feeling of a foreign body
• Discomfort during bowel movements
• Traces of blood on the stool or toilet paper
• Irritation of the surrounding mucous membrane
• Palpable nodules that occasionally prolapse
• In rare cases: painful, due to an inflammatory reaction

The severity of symptoms is closely related to the size and location of the polyp.

The polyps may appear broad-based, pedunculated, fibrotic, or have smooth borders. This variability in appearance explains why patients often suspect hemorrhoids. Marisks, anal thromboses, hypertrophic folds, a true rectal polyp, or squamous cell carcinomas are also considered in the differential diagnosis.

Only an examination by a specialist allows for a definitive classification of the findings. 

Anal polyps develop from natural structures that react to various stimuli. The most important causes include:

• mechanical irritation or pressure
• local inflammation
• anal fissure
• Injuries or surgical procedures
• persistently loose stools or repeated straining

Repeated strain leads to an enlargement of the mucosal folds, which can result in the development of a polyp. In rare cases, a chronic inflammatory bowel disease such as Crohn’s disease may be a factor. 

Location of anal fissures at the anus © bilderzwerg | AdobeStock

In proctology, the diagnosis of an anal polyp is made through several steps:

First, the patient describes the symptoms that are affecting them. This is followed by an inspection of the anus to assess any visible changes. The subsequent digital examination (palpation) allows the physician to feel for a firm or pedunculated mass.

Proctoscopy, which provides a direct view of the anal canal, yields the most reliable results. It allows for a clear distinction from hemorrhoids or other mucosal changes. 

If necessary, a tissue sample is taken and examined under a microscope. This allows for a definitive diagnosis of whether the lesion is benign and whether further measures are required. Only in rare cases are ultrasound, MRI, or colonoscopy (intestinal endoscopy) performed to rule out additional conditions. 

Intestinal polyps (as shown here) and anal polyps can be easily removed using an electric loop © SciePro | AdobeStock

Not every anal polyp requires immediate treatment. Small, asymptomatic lesions can be monitored by a doctor over an extended period so that the treating physician can initiate alternative measures if the condition worsens. However, symptoms such as oozing, bleeding, functional limitations, or persistent irritation indicate that removal is necessary. The goal of treatment is to safely remove the excessive mucosal growth and improve quality of life.

Wound healing in the anal canal usually proceeds without complications, but takes some time due to the strain caused by movement, moisture, and bowel movements. An appropriate diet, rich in fiber and fluids, promotes soft stools and protects the wound.

Gentle hygiene and avoiding straining support the healing process. If irritation or inflammation persists, a new polyp may develop.

Effective prevention primarily involves reducing irritating factors in the anal canal area. This includes a high-fiber diet, adequate fluid intake, proper bathroom habits, and gentle cleansing of the anal area. Treating existing conditions, such as an anal fissure or inflammatory changes in the mucous membrane, reduces the risk of additional polyps.

Can an anal polyp be dangerous?

No, they are harmless, benign, and do not become cancerous. If there is any uncertainty, a biopsy can provide additional clarity.

How do you distinguish between anal polyps and hemorrhoids?

This is virtually impossible for laypeople. Only a diagnosis by a specialist can provide a definitive distinction.

Is the removal procedure painful?

The procedure is performed under local anesthesia and is well tolerated. Mild discomfort afterward is possible but short-lived.

If you experience discharge, itching, bleeding, or persistent problems with bowel movements, it is recommended that you see a doctor.