What are Hypertrophied anal papillae and when do they become a problem?

Anal papillae are essentially skin tags that project up from the dentate line, or the junction between the skin and the epithelial lining of the anus. They are usually small, but sufficiently visible to give the catenoid line a jagged line on anoscopy.

Nipples are normal structures that do not cause symptoms unless they become overgrown or irritated. They are usually covered by skin, pale pink or off-white in color, and have a broad base and fibrous tip. Hypertrophic nipples may elongate and prolapse from the anal opening during defecation, which may require finger retraction.

Sometimes, the papillae may become painful and redden. Inflammation of the papillae or crypts is often associated with anal fissures, fistulas, Crohn’s disease, itching in the anus and/or internal hemorrhoids. Inflammation of the papillae can also be caused by trauma or chemical irritation, such as hard stools or irritating wet stools.

What are the symptoms of Hypertrophied anal papillae?

The signs and symptoms of Hypertrophied anal papillae can be anal discomfort, itching, burning sensation and sometimes pain that intensifies with defecation. There may also be discomfort and an immediate need to empty the bowel (tenesmus), but without any bowel movements taking place.

Nipples must be separated from polyps, which they resemble. A biopsy can be quite enlightening in this regard. Polyps are covered by mucosa, may bleed, but do not hurt. Nipples are covered by skin, squamous epithelium, do not bleed, may be painful and may come out of the anus if they elongate. Polyps are often precancerous, while nipples are not.

Although elongated papillae can be palpated by the doctor, they are best examined by rectoscopy. Inflammation or a pustule caused by an adjacent crypt should be examined best to rule out an abscess or fistula.

What is the therapeutic approach?

Treatment should be directed to the underlying condition, since very often, papillomas are secondary to other inflammatory orthoprotective problems. Symptomatic nipples are removed by excision. If elongated anal papillae are associated with internal hemorrhoids, they should be removed during hemorrhoidectomy.