Pseudopolyps In Inflammatory Bowel Disease

When Is A Polyp Not Actually A Polyp? When It's A Pseudopolyp!

Chronic Ulcerative Colitis
Pseudopolyps in a colon of a patient with ulcerative colitis after a colectomy. Image © Ed Uthman, MD

There is a type of polyp that may be found in the colon of a person who has inflammatory bowel disease (IBD), either Crohn's disease or ulcerative colitis, that is actually not really a polyp. These growths are called pseudopolyps because they are not true polyps at all, but are "false" polyps. Pseudo means "fake" or "phony," and while the structures themselves are very real, they are not the same type of polyp that is removed because it might cause colon cancer.

How Do Pseudopolyps Form?

People with IBD often have inflammation in their colon, which happens during flare-ups of the disease. For some, the inflammation can be severe and can go on for long periods of time. The inflammation leads to actual ulcerations (holes) in the wall of the colon. In ulcerative colitis those ulcers tend to be confined to the inner wall of the colon, but in Crohn's disease, the ulcers can go deeper into the intestinal wall. The cycle of ulceration and healing results in the creation of scar tissue. This is similar to how a cut on the surface of the skin may cause a scar that looks different than the surrounding, unbroken skin.

The scar tissue that forms in the colon when inflammation is present and then heals somewhat resembles polyps, but it is not like the classic polyp that is on a stalk. Pseudopolyps are flatter and look more like a bump.

Can Pseudopolyps Turn Cancerous?

A polyp is a growth inside the colon that can take on various shapes, but almost always carries a risk of developing into colon cancer.

For that reason, polyps are removed during a colonoscopy as a matter of routine. If the polyp is removed, so is the risk of it developing into cancer. Pseudopolyps, however, have no such risk of turning cancerous and therefore do not require removal.

How Does A Gastroenterologist Know It's A Pseudopolyp?

Within the colon of someone who has ulcerative colitis or Crohn's disease there could be various abnormal things happening that a gastroenterologist might call a "finding" or "pathology." Pseudopolyps and polyps, and in Crohn's disease, something called cobblestone sign.

Cobblestone sign is when parts of the colon look like a cobblestone street, and is only present when the diagnosis is Crohn's disease.

A trained and experienced gastroenterologist may know the difference between a polyp or a pseudopolyp on sight, but a biopsy of the area will also be taken. A biopsy, which is a sample of tissue, can be taken from inside the colon during a sigmoidoscopy or a colonoscopy. Biopsies will typically be taken from several different areas of the colon and sent to a pathologist for testing, in order to determine the diagnosis of any abnormalities that are found. In this way, any polyps or pseudopolyps can be positively identified as such.

How Are Pseudopolyps Treated?

There isn't usually any specific treatment needed for pseudopolyps that are a result of Crohn's disease or ulcerative colitis. Typically, it's recommended (as always) that if any inflammation is present from the IBD, treatment be continued or initiated to get it under control. Check with your gastroenterologist if you have questions about pseudopolyps and what they mean in the course of your disease.


D'Haens G, Rutgeerts P. Endoscopy in inflammatory bowel diseases. In: Waye J, Williams C, Rex DK, eds. Colonoscopy. Oxford: Blackwell Publishing. 2004.

Morris CJ, Dudnick RS. "The Bridges of Chronic Inflammatory Bowel Disease." Clinical Gastroenterology and Hepatology. 11:7;A26. 17 Sept 2013. DOI:

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