by Jason Wasserman MD PhD FRCPC
March 30, 2026
A hyperplastic polyp is a common benign (non-cancerous) growth that develops on the inner surface of the colon or rectum. Hyperplastic polyps are not precancerous. They do not contain the abnormal cells that lead to cancer, and in most cases, finding one does not change your cancer screening schedule at all. If this finding is in your report, it is reassuring news.
The word hyperplastic means overgrown — the cells in these polyps have multiplied more than usual, producing a small bump on the colon lining. Despite that overgrowth, the cells themselves look essentially normal under the microscope. This distinguishes hyperplastic polyps from precancerous polyps, such as adenomas or sessile serrated lesions, in which the cells exhibit abnormal features.
What are the symptoms?
Most hyperplastic polyps cause no symptoms. They are usually small — typically less than 5 mm — and discovered incidentally during a colonoscopy performed for routine cancer screening or for an unrelated reason. Rarely, a large hyperplastic polyp may cause rectal bleeding or a change in bowel habits, but this is uncommon.
Where are hyperplastic polyps found?
Hyperplastic polyps are most commonly found in the rectum and sigmoid colon — the lower left part of the large intestine. They are much less common on the right side of the colon (the ascending colon and cecum).
Location matters for one specific reason: hyperplastic polyps in the right colon can be difficult to distinguish from sessile serrated lesions under the microscope, which are precancerous. When a pathologist identifies what appears to be a hyperplastic polyp in the right colon, your doctor may recommend a somewhat earlier follow-up colonoscopy than would otherwise be needed — not because the polyp itself is dangerous, but to make sure the diagnosis is accurate and that nothing is missed.
What causes a hyperplastic polyp?
Hyperplastic polyps form when cells in the colon lining begin to grow and divide more than usual, producing a small overgrowth. This is typically harmless. The exact cause is not fully known, but factors that increase the likelihood of developing hyperplastic polyps include:
- Ageing. Hyperplastic polyps become increasingly common with age and are rarely found in people under forty.
- Smoking. Smoking is one of the most consistently identified risk factors. People who smoke are more likely to develop hyperplastic polyps than non-smokers.
- Obesity. Excess body weight is associated with a modestly higher risk of hyperplastic polyps and other colon polyps.
- Diet. A diet low in fibre and high in red or processed meat may contribute, though the evidence is less definitive than for other risk factors.
- Previous polyps. People with a history of any colon polyp have a higher likelihood of developing further polyps, including hyperplastic ones, in the future.
How is the diagnosis made?
The diagnosis is made by a pathologist who examines the removed tissue under a microscope. The polyp is removed during a colonoscopy using a polypectomy — removal with a small wire loop — or biopsy forceps for very small polyps.
The pathologist looks for the features described below and confirms that the cells lack the abnormal changes that would make the polyp precancerous.
What does the pathology report describe?
Microscopic appearance
Under the microscope, a hyperplastic polyp shows tightly packed glands with a serrated (saw-tooth) pattern near the surface of the lining. The cells are mature and well organised. They produce mucin, the substance that normally lubricates the colon. The base of the glands — unlike in sessile serrated lesions — looks entirely normal, with straight, regularly spaced crypts. There are no signs of dysplasia (abnormal cell changes that could lead to cancer).
There are two main subtypes of hyperplastic polyp, distinguished by their microscopic appearance:
- Microvesicular hyperplastic polyp. The most common subtype. The cells contain small mucin-filled bubbles (vesicles) and have nuclei located at the base of the cell. This subtype is most often found in the left colon and rectum.
- Goblet cell-rich hyperplastic polyp. Contains a higher proportion of goblet cells — the mucus-producing cells normally found throughout the colon lining.
These subtypes behave the same way and have the same clinical significance. The distinction is noted for classification purposes and does not affect your treatment or follow-up.
Margin
The margin is the edge of the tissue that was removed. The pathologist examines it to determine whether the entire polyp was taken out.
- Negative margin (clear margin). No polyp tissue is found at the cut edge. This means the polyp appears to have been completely removed.
- Positive margin. Polyp tissue is present at the very edge of the specimen, suggesting some may have been left behind. Because hyperplastic polyps are benign, this is less concerning than a positive margin in a precancerous polyp — your doctor will advise whether any follow-up of the removal site is needed.
- Cannot be assessed. If the polyp was small or removed in fragments, the margin may not be evaluable. This is common and generally not a concern for hyperplastic polyps.
What happens next?
In most cases, no additional treatment is needed after a hyperplastic polyp is removed. Because these polyps are benign and not precancerous, finding one or a few small hyperplastic polyps in the rectum or sigmoid colon does not change your standard colorectal cancer screening schedule. Your doctor will typically recommend continuing with the same interval they would have used, regardless of this finding.
There are two situations where closer follow-up may be recommended:
- Large or right-sided hyperplastic polyps. A hyperplastic polyp larger than 10 mm, or one found in the right colon, warrants a somewhat earlier follow-up colonoscopy — usually within 3 to 5 years — because of the difficulty distinguishing these from sessile serrated lesions and the higher-risk profile of right-sided serrated growths.
- Multiple hyperplastic polyps. If many hyperplastic polyps are found — particularly if they are numerous, large, or located throughout the colon rather than just in the rectum — your doctor may consider whether you meet criteria for a condition called serrated polyposis syndrome. This is a rare condition associated with a higher lifetime risk of colorectal cancer. It requires referral to a gastroenterologist, more frequent colonoscopy surveillance, and consideration of genetic counselling and family screening.
If other types of polyps — such as adenomas or sessile serrated lesions — were found during the same colonoscopy, those findings will take priority in determining your follow-up schedule, since they carry more clinical significance than a hyperplastic polyp.
Questions to ask your doctor
- Was the polyp completely removed?
- Where in the colon was the polyp found — left side or right side?
- Were any other types of polyps found during my colonoscopy?
- Does this finding change my follow-up or screening schedule?
- How many polyps were found in total, and does the number change the recommendations?
- Should I make any lifestyle changes — such as quitting smoking or adjusting my diet — to reduce my risk of future polyps?
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