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Recommended surgical removal for poly like mass. Any complications?

Apr 2013
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Answered by

General Surgeon
Practicing since : 2009
Answered : 5665 Questions
I have just seen a colorectal surgeon for rectal pains and what I thought was a haemorrhoid on the left side of the anus. However, the surgeon said it felt as if it were a polyp-like mass and recommended surgical removal, due to risk of cancer development.

What is the difference between a haemorrhoid and polyp and are polyps normally surgically removed as a matter of course, even before biopsy or further screening. I am also doing an MRI of the rectum and wonder if this will help to determine the risk of the mass.

Posted Thu, 3 Oct 2013 in Abdominal Pain
Answered by Dr. Ivan R. Rommstein 3 hours later
Brief Answer:
Hi and welcome to XXXXXXX

Detailed Answer:
Hemorrhoids are actually prolapsed veins which become congested and then it can be lead to pain, bleeding and discomfort during defecation. Hemorrhoids dont show malignant alteration(it cant become cancer) , although sometimes it is hard to differentiate hemorrhoids, anal polyps or even cancers since all these lesions can manifest with pain and bleeding. However,in most cases hemorrhoids are easily noticable by examination and this is most common cause of blood in stool and rectal pain in your age.
Polyps are usually located in rectum or higher in sigmoid colon. Polyps are common, but benign lesions and only sometimes(actually relatively rarely especially in you age) it can become malignant(cancer). There are several types of polyps of which some are less or more XXXXXXX considering risk of malignancy. This risk cant be evaluated without biopsy. Mri can show only is there infiltration of colon wall and in this case it would already be serious malignant disease.
Much better would be if you could do colonoscopy which will check entire colon and other possible polyps since polyps are usually multiple.
During colonoscopy polyps can be easily removed and sent to analysis. your anal polyp(if this is polyp) can be removed without colonoscopy and it is much better to remove it completely than just do partial biopsy since these procedures are actually similar.
Of course, this all can be treated conservatively, you just need to do follow up every 6 months to see polyp or hemorrhoidal size progression. In every case, this is up to you. some institutions recommend routine polyp removal and some do it only if bleeding or pain occur.
WIsh you good health. Feel free to ask.
Above answer was peer-reviewed by
Follow-up: Recommended surgical removal for poly like mass. Any complications? 1 hour later
Thanks Dr. Romic for the detailed response.

Would you recommend a second opinion to see if the mass is a polyp or hemorrhoid, as based on the medical report the doctor doesn't appear completely certain (polypoid-like mass). I am aware that polyps are quite uncommon in the area described and are also uncommon for my age.

Also, could an option be to use steroids on the affected area to see if there is any improvement, as a polyp would not shrink with steroid usage but hemorrhoids respond much better.

Answered by Dr. Ivan R. Rommstein 10 hours later
Brief Answer:

Detailed Answer:
well, you can do both. Try to treat this as this is hemorrhoid. so you can use special hemorrhoid creams including mild steroids, sitz baths, high fibre diet and see will there be improvement. If yes, then this is obviously henorrhoids since polyps wont show regression on such treatment.
also you can find another proctologist who can do rectoscopy and give opinion.
Anal polyps are not so rare actually.there are 4 types of anal polyps and can be found in your age. But malignant polyps are very rare in your age.
Thirs option is to remove this lesion whatever it is and then hystologic analysis can show what it was. This is what I suggest because probably both polyp and hemorrhoids will cause symptoms in future if left untreated.

Above answer was peer-reviewed by
Follow-up: Recommended surgical removal for poly like mass. Any complications? 6 hours later
Thanks Dr. Romic,

I wonder if either polyps or hemorrhoids ever resolve on their own or with treatment such as application of steroid creams but excluding the option of surgical excision? Is it really possible to apply steroids to the hemorrhoids located within the rectum but not really on the exterior?

Answered by Dr. Ivan R. Rommstein 6 hours later
Brief Answer:

Detailed Answer:
Hemorrhoids can resolve on conservative therapy and decision about surgical removal is up to you. When you start to experience too much discomfort and pain ,then it can be managed surgically or if it can be come emergency if there is strangulation or excessive bleeding. Steroids can be applied for XXXXXXX hemorrhoids too,but it should be used in consultation with proctologist. Steroids and other topical agents should be associated with dietary changes.
Polyps cant resolve spontanesouly,it can only persist or progress. Usually it wont cause any symptoms,but it can bleed from time to time. All in all,you can wait and see.this is nothing serious and not emergency. try with noninvasive methods first and if there is no improvement,consult surgeon. Removal is easily done today.some institutions use lasers and it is always done under anasthesia so it wouldnt be painful.
Above answer was peer-reviewed by
Follow-up: Recommended surgical removal for poly like mass. Any complications? 22 minutes later
Thankyou for the information, Dr Romic. I am quite aware of the options now.

Lastly, are there any complications from the removal of the polyp or hemorrhoid, as my mother once had hemorrhoids removed which resulted in bleeding, significant pain for a few months and required a sitz bath for a few months. Are these complications to be expected or do some polyp removals result in a quick recovery period?

Answered by Dr. Ivan R. Rommstein 56 minutes later
Brief Answer:

Detailed Answer:
Polyp removal usually doesnt have any complication niether bleeding or pain. This is similar to peduncular nevus removal.
Hemorrhoids is bit more complicated since there is venous involvement and complications rate depend on type and size of hemorrhoids. Although,if even some minor bleeding or pain occur,it will pass in 1-2 weeks postoperatively and you wont have problems with it after. So this is not something that you should be worried about. So just remove it when it becomes too annoying,this is my advice:)
Above answer was peer-reviewed by
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