In the lower ampullar part of the rectum are morganeve pillars and crypt, bordered by Crescent valves. On the free edge of these valves, one can often see a small triangular or rounded elevation — anal papillae. The presence of small (less than 1 cm in diameter) papillae at the level of the anorectal line — the phenomenon absolutely normal.
When digital examination unchanged papillae palpated in the form of a slightly firm painless nodules in the upper third of the anal canal. If anoscopy these papillae are pale pink in color, covered with stratified squamous epithelium. The papillae may be in the form of two types: some have a wide base and a triangular shape, others a narrow foot and globular body.
Sometimes hypertrophied papillae can become inflamed, which can develop papillitis. Most often this is due to the proliferation of inflammatory process in griptite, proctitis. Papillitis is characterized by edema, hyperemia and soreness of the papilla. With long-term existence of the inflammatory process in efficacy, constant trauma because of the loss of the anal canal may even be ulceration on its top.
Sometimes buds begin to hypertrophy, become polovinoy form and may fall out of the anus. Their sizes often reach 3-4 cm in diameter. The reasons for hypertrophy of the anal papillae few:
- mechanical and chemical irritation passing through the anal canal stool — tight or too weak;
- violation of the outflow of blood from the pelvic organs;
- inflammatory diseases of the anorectal area, where the first place is cryptic. Very often, the presence of hypertrophied anal papillae indicates the existence of inflammatory processes in the anal canal.
A thorough history, assessment of General condition of the patient, visual examination of the anus at rest and during straining of the patient, finger examination of the anal canal and rectum, ANO -, and sigmoidoscopy in order to recognize the presence of anal papillae, to assess their condition and size.
Differential diagnosis. Particularly important is the differentiation between the anal papillae and polyps. Many doctors, not knowing about the existence of a normal anal papillae and finding them in an exaggerated state, regard them as a polyp rectal polyp or the anal canal. Indeed, when buds hipertrofiada acquire the leg and begin to fall out of the anus, they resemble the polyp. A true polyp is located above the anorectal line, it has adenomatous structure and covered with a single layer of columnar epithelium, the color of his small size is same as the color of the surrounding mucous membrane of the rectum, the color of the large polyps most often dark red. Anal papillae are localized in the anal canal at the level of the anorectal line, is composed of loose collagen fibers containing a small amount of adipose tissue, in which are dilated capillaries. Anal papillae are covered by stratified squamous epithelium, papillae pale color, like the lining of the anal canal.
Hypertrophied anal papillae sometimes have to be differentiated from the patrol tubercles observed in chronic anal fissures, and hemorrhoids when the constant loss and trauma the surface node becomes thick and acquires a leathery look. Diagnosis usually is not difficult. The guard bumps are located at the upper and lower pole fissures: the outer tubercle in the form of loops or eyelets and usually more localized to perianal skin, internal tubercle is smaller, too, in the form of a lug, but it is below anorectal line. Internal hemorrhoids are located above the anorectal line, dark red color; this vascular formation, soft to the touch (no thrombosis).
The presence of anal papillae is the norm. If they are not hypertrophied and do not fall out of the anus, not cause inconvenience to the patient, curing them is not necessary. Hypertrophy of the papillae, loss their from the anus and pain they are removed, and the nipple should resect together with the crypt and the lunate plate.
With the development of papillitis is necessary to conduct conservative therapy, as in griptite, and after the elimination of edema and hyperemia, if there is hypertrophy of the papilla, it should be removed surgically.
Forecast. Hypertrophy and inflammation of the anal papillae do not create much of a threat to human health. But in itself neither acute nor chronic inflammation and hypertrophy of the papillae does not occur. It is necessary to establish the cause of these phenomena and to eliminate them to prevent the development of abscess, pectinase.