After polyp removal
In short
Most people feel normal within a day of having polyps removed, and most small polyps leave behind a wound that heals without anyone noticing. The main thing to know about is delayed bleeding. It is uncommon, but it can happen up to about two weeks after the procedure, and it is more likely after removal of a large polyp or if you take blood thinners. A small streak of blood once is common. Repeated passages of red or maroon blood, clots, or dizziness need urgent care. Severe or worsening abdominal pain, especially with fever, also needs urgent care. Your written discharge instructions, especially the date for restarting any blood thinner, take priority over anything general on this page.
What this page covers
- What the removal site is, and how it heals
- What is normal in the days afterwards
- Delayed bleeding: who is at higher risk and what to do
- Restarting blood thinners and antiplatelets
- Pain relief, food, showering, exercise, and travel
- Clips and tattoos
What is left behind
When a polyp is removed, it leaves a shallow, flat wound in the lining of the bowel. Small polyps removed with a cold snare leave a wound a few millimetres across. The bowel lining has no pain-sensing nerves of the kind skin has, so you do not feel the wound itself. Larger polyps, especially those removed piecemeal by endoscopic mucosal resection (EMR), leave a bigger wound. The endoscopist may close it with clips or treat the edges to reduce the chance of the polyp regrowing.
Over the following one to two weeks, a scab-like layer forms and then falls away as the lining heals underneath. That is the period when delayed bleeding can happen.
What is normal
- Wind and bloating for the rest of the day, especially if air rather than carbon dioxide was used
- Mild cramping that settles with walking and passing wind
- A small amount of blood on the paper or a streak in the first motion or two, particularly if haemorrhoids were irritated by the prep
- No bowel movement for a day or two, because the bowel is empty
- Feeling tired on the day, mostly from sedation and the prep
For more detail on the first day, see the first twenty-four hours.
Delayed bleeding
Bleeding that starts hours to days after the procedure is the most common complication of polyp removal. Published rates are well under one in a hundred for small polyps. The risk is higher, up to several in a hundred, after removal of large polyps.
Who is at higher risk
- Polyps of 20 mm or more, especially in the right colon
- Removal with electrical current (hot snare) rather than cold snare
- Anticoagulants such as warfarin, apixaban, rivaroxaban, edoxaban or dabigatran, especially when restarted soon after the procedure
- Antiplatelets such as clopidogrel, prasugrel or ticagrelor
- Older age and some heart and kidney conditions
When it is urgent
Seek urgent care through your unit's emergency number, out-of-hours service, or emergency department if you have any of these:
- More than a small amount of red or maroon blood, or clots, especially more than once
- Black, tarry stools
- Light-headedness, fainting, a racing heart, or unusual breathlessness
- Severe or worsening abdominal pain, a hard or swollen abdomen, fever, or vomiting
Take your discharge letter with you if you can. It tells the team what was removed and where. Most delayed bleeds stop by themselves or are treated with a repeat coloscopy and clips. Surgery is rarely needed. For a broader list of symptoms, see when to call your doctor afterwards.
Pain and fever after a hot snare
Uncommonly, removal with electrical current causes a burn through the wall without a hole. This is called post-polypectomy coagulation syndrome, or electrocoagulation syndrome. It typically shows up between a few hours and five days later as localised abdominal pain, sometimes with fever. It usually settles with rest and treatment, but it needs assessment because it can look like a perforation. Do not wait it out at home.
Restarting blood thinners and antiplatelets
This is the single most important individual instruction you will receive, and it should be written down for you before you go home. If it was not, call the unit the same day.
- Aspirin taken for heart or stroke prevention is usually continued throughout, or restarted the next day.
- Warfarin is often restarted the same evening or the next day at the usual dose, with an INR check planned.
- Direct oral anticoagulants (apixaban, rivaroxaban, edoxaban, dabigatran) are commonly restarted one to three days after removal of larger polyps. Sometimes they are restarted sooner after small ones.
- Clopidogrel, prasugrel, and ticagrelor restart dates depend on why you take them and on the size of what was removed.
These are typical patterns from British, European, and American guidance, not rules for you. Your endoscopist balances bleeding risk against clot risk for your specific situation. Never stop or restart these medicines on general advice. See blood thinners and antiplatelets.
Everyday life in the two weeks after
Pain relief
Paracetamol (acetaminophen) is the usual choice. Many units ask you to avoid ibuprofen, naproxen, diclofenac and similar anti-inflammatories for several days after removing larger polyps, because they can increase bleeding. Ask what applies to you.
Food and drink
Most people can return to a normal diet straight away. Some units suggest something light for the first meal. Drink well, because the prep will have left you short of fluid. Avoid alcohol for at least 24 hours after sedation.
Showering and bathing
You can shower or bathe the same day or the next. There is no external wound, so there is nothing to keep dry.
Exercise and lifting
Walking is fine and helps with wind. After removal of small polyps, normal activity can usually resume the next day. After large polyp removal, many units suggest avoiding heavy lifting and strenuous exercise for a few days to a week.
Travel
After removal of large polyps, especially if you take blood thinners, many units advise staying within reach of medical care for about two weeks and avoiding long-haul flights or remote travel during that time. If you have a trip booked, mention it before the procedure.
Work
Most people return to work the next day. Do not drive, operate machinery, or sign legal documents for 24 hours after sedation.
Clips and tattoos
Clips are small metal devices that close the wound or stop bleeding. They usually detach and pass in the stool within days to a few weeks, and you will not notice them. Most modern clips are considered safe for MRI, but tell the radiology team if you need a scan within a few weeks of the procedure.
A tattoo is a small injection of carbon-based ink next to the removal site. It is permanent and harmless. It lets a future endoscopist or surgeon find the site again. It does not mean cancer was found.
Waiting for the results
Removed polyps are sent to a pathologist. Results typically take one to three weeks. The pathology decides when you need your next coloscopy. If you have not heard within the time you were given, ask. See how and when you get your results and reading the pathology report.
What to ask your clinician
- How many polyps were removed, and how large was the largest?
- Was a hot or cold technique used, and were clips placed?
- On what exact date do I restart each of my blood thinners or antiplatelets?
- Should I avoid anti-inflammatory painkillers, and for how long?
- Are there restrictions on exercise, lifting or travel, and for how long?
- Who do I call out of hours if I bleed, and which hospital should I go to?
- When and how will I get the pathology result?
Common worries, briefly addressed
I saw a little blood on the toilet paper the next day. Is that bleeding from the polyp site?
Possibly, but a small streak once is common and is often from haemorrhoids irritated by the prep. Keep an eye on it. Repeated or larger amounts, clots, or feeling faint need urgent attention.
It has been ten days and I suddenly passed blood. Can that still be related?
Yes. Delayed bleeding can occur up to about two weeks afterwards, as the scab separates. Treat it as you would bleeding on day one, and contact your unit or seek urgent care.
Can I take a shower the day after polyp removal?
Yes. There is no external wound.
Do I need a special diet?
Usually not. Eat normally, drink well, and avoid alcohol for the first 24 hours after sedation.
Will I feel the clips coming out?
No. They are tiny and pass unnoticed with normal stool.
Does having polyps removed mean I had cancer?
No. The great majority of polyps are benign. Removing them is how coloscopy prevents cancer. See understanding polyps.
Sources
- European Society of Gastrointestinal Endoscopy: colorectal polypectomy and endoscopic mucosal resection guideline
- U.S. Multi-Society Task Force on Colorectal Cancer: endoscopic removal of colorectal lesions
- British Society of Gastroenterology and European Society of Gastrointestinal Endoscopy: guideline on endoscopy in patients on antiplatelet or anticoagulant therapy (2021 update)
- American Society for Gastrointestinal Endoscopy: management of antithrombotic agents for patients undergoing GI endoscopy; adverse events of colonoscopy
- American College of Gastroenterology and Canadian Association of Gastroenterology: management of anticoagulants and antiplatelets during acute GI bleeding and the periendoscopic period