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Old 11-02-2008, 04:54 PM   #1
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Has anyone had a hypertrophical anal papilla removed?

My gastro doc tells me this is the third stage of an acute (reoccuring) fissure. He says sometimes they dont bother people and if it does bother over time, its a simple inoffice visit to remove it. I think mine is bothering since it seems its putting pressure on BMs that if it was removed, the fissure would be heal better. I'm now confused that i either tore the fissure again or its an enlarged papilla and it needs to come out. Wondering if anyone just had a papilla removed without doing the LIS/surgery and got better???

I've been dealing with this for over 3 yrs and its terrible! thanks for all the info on this site, very helpful to know there are others out there.

 
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Old 11-02-2008, 06:58 PM   #2
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Re: Has anyone had a hypertrophical anal papilla removed?

Your story sounds similar to mine...

I have been dealing with an enlarged/hypertrophied papillae for about 3 years. I actually thought I had hemorrhoids, talked to my GP about hemorrhoids and she said to wait until they became bothersome to treat them.

Well, 2 weeks ago I had a bout with an anal fissure and the pain was too much to handle. I had never been through this type of pain so I made an appointment with a colo-rectal surgeon at a colon rectal clinic to finally treat what I thought were hemorrhoids.

Well to my surprise he told me I did not have hemorrhoids but enlarged papillae which he could remove right now but since I also had a chronic fissure he recommended surgery because the papillae would enlarge again without the fissure being healed. I also had an external skin tag which is yet another indicator of a chronic fissure. After much research I have discovered that enlarged papillae and an external skin tag are part of the triad of a chronic fissure. I did not know I had a chronic fissure as I had very few flare ups and when I did that were not that painful.

The enlarged papillae and the skin tag could have been removed in his office but to cure the fissure I needed LIS which is an outpatient surgery procedure. I opted for the LIS and removal of both the papillae and the external skin tag. I have done much research and it does seem that if you have been suffering from an enlarged papillae you probably have had a chronic fissure as well. Yes, the papillae does put a lot of pressure on BM's and you would probably find relief after having it removed but they may come back if your fissure doesn't heal.

I had surgery on Thursday. I am experiencing very little pain. I have some discomfort but it is bearable. You mention a gastro doc...I would recommend you see a colon rectal surgeon if possible. Good luck.

 
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Old 11-03-2008, 02:41 PM   #3
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Re: Has anyone had a hypertrophical anal papilla removed?

Sorry, yes he is a board cert. colon/rectal surgeon. I have had a chronic fissure that healed pretty well over the last year or so. And you have exactly what I had. It's the final result of an acute fissure. I also have a small skin tag around the area. That does not bother me so much. I guess my concern is should I take step one and just remove the papilla to see if that takes care of the problem? I'm really unsure of whether the papilla is the issue since its enlarged a bit I think or if i broke the fissure open again. And of course trying to get the doc to discuss this over the phone before I come in yet again is a nightmare. I'm just concerned with getting the LIS because of what it "might" lead to. If I lose control of BM movements and that is a risk so my doctor tells me. Either way, this is a continuing nightmare in my life and im so over it! Do you think if it looks like I opened up the fissure again, I should have the whole thing done? I had the test done to see if my muscles were overly tight down there which usuallly is indictator that the doc could cut alittle (LIS)and I would be fine but the results showed a very normal pattern of movement, hence his concern with surgery. Did you have this test done? It was quite painful as they basically blow up a small ballon to see the pressure it creates. Just typing it again makes me hurt Either way, I want this to go away but I'm scared to have LIS done for fear it could turn out bad.

 
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Old 11-03-2008, 04:07 PM   #4
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Re: Has anyone had a hypertrophical anal papilla removed?

No, I did not have the balloon test... and in all of my research regarding the LIS procedure never came across this as a test to perform before having surgery. Though it makes sense. Here is a link to a study regarding anal fissures and anal resting pressures: [url]http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1357726[/url]

It sounds as though you and I have the same symptoms. I can tell you that having these symptoms generally indicates the presence of a chronic fissure. Chronic fissures are very difficult if not impossible to treat conservatively. LIS has shown to be the most effective solution for healing a chronic fissure.

That being said, it seems as though you would be more comfortable taking it one step at a time and there is nothing wrong with that. Your doctor may even be able to remove the papillae in his office. Do what you are comfortable doing. Start small and if you need to progress to the surgery you will find comfort in the fact that you tried the conservative route first.

Is your doctor suggesting any treatment (nitroglycerine or botox) for relaxing your anal sphincter after you have the papillae removed to aid in the healing of the fissure?

 
Old 11-03-2008, 04:14 PM   #5
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Re: Has anyone had a hypertrophical anal papilla removed?

Forgot to mention that enlarged papillae are not the causes of fissures, rather they and external skin tags are results or pathologies of chronic fissures. My doctor said removing the papillae without fixing the fissure would result in the papillae enlarging again.

 
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Old 12-06-2008, 06:57 PM   #6
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Re: Has anyone had a hypertrophical anal papilla removed?

Hello Sissyleightjune,

I have been reviewing the thread between you and Rubydee12 and it was so helpful to me. I am hoping you can answer some questions I have. I'll tell you my story first. I ended up with an awful anal fissure in March, after trying many things and NOT wanting to have surgery, I finally was able to heal it using a great ayurvedic treatment from lifespa.com. I consulted with the doctor there and he really helped me get control of it. But then after 6 weeks I had a relapse and then another after 6 more weeks (after doing great each time, one day I would just get an explosive BM) and then when I thought I had a third relapse another 6-8 weeks later, it turned out the fissure really was healed (confirmed by my medical doctor who is also pretty holistic for an MD). She felt that I did have an allergic reaction. Just a few weeks ago I had started doing NAET treatments for allergies I never knew I had, and after this first reaction they kept coming out one after another as a result of my immune system being so low. I also had two terrible bouts of parasites, it was horrible. I have been working through and actually eliminating each allergy (if you are not familiar with NAET go to naet.com) but each allergy affected my digestive system because that is my weakest point right now. So each time I had an allergic reaction I would get a very major adrenaline attack, lots of gas and then the next day a not so great BM. Then after being treated for the allergy the BM would quickly go back to normal, until the next allergic reaction. After several of these attacks over a two month period, I started feeling severe pain and burning again when passing stools again, but it didn't feel like the fissure so I did not recheck it, I thought it was related to the allergy attacks and my NAET practitioner kept working on things that would help it, it seemed to help in some ways but not with the burning pain. I went several weeks hoping it would clear up, then somehow I convinced myself I had colitis. I scheduled a colonoscopy and the night before (just a few days ago now) I had a breakthrough in my mind while going through the prep and though, oh my IT IS the fissure again. Well, my colonoscopy went great in the sense that they said I had no fissure, no colitis, and no polyps so no cancer. BUT they found a 1/2 or so "nodule" as the gastro called it, he said he had never seen one before. (surprising that a gastro would say this but that is what he said). The next day I got them to fax my medical record and this is what he wrote in addition to saying the colon was normal and in great shape "the digital rectal exam was abnormal. Finding include tender movable nodule" which is what he had told me. But next to the photo it said "Rectum: abnormal, movable nodule? - ?hypertrophied papilla vs other". So at least I had something to search for
it sounds like you are like me, had a fissure that had healed. I have been told my fissure is not there anymore but this hypertrophical papilla is and in the Gupta article is sounds like "they can be found in isolation" so that I believe means that you can have one without the fissure being broken open again? Did you doc do an exam to see if your fissure had broken open again? It sounds like he may not have and that is why you are not sure.

My concern is from all the research that I have done is that I can't find anything to say that the surgery for taking off the papilla is any different from a full fissure surgery which I really prefer not to do. I have the same concern you do about losing control of my BMs, but did find in one article that with the way most docs do it now there is only a 5% chance of that. Overall I just don't want surgery because it is trauma on top of trauma, and I wish there was a holistic approach and will talk on Tuesday with my ayurvedic doc and see what he says, he healed the fissure, so maybe???

I too am scared to have the LIS done for fear it could turn out bad and am trying to find if the surgery for the HP only is the same? Do you know?

My gastro was not very good, first he told me he had never seen one and didn't know what it was, just called it a nodule and said I needed to see a surgeon and have it "taken off". Luckily I asked for the report to see he seems to have known what it might be in his writeup, but maybe he has no experience with anal fissures or this level of an anal fissure? Then he referred me to a GENERAL surgeon instead of a colon/rectal surgeon, I am shocked about that and will cancel the appt on Monday and drive across the state 4.5 hours to go to a good colon/rectal surgeon. I am going to make a bunch of calls on Monday am and ask enough questions of each to find someone who has a lot of experience in this procedure and maybe can explain that it is a different procedure if you don't still have a fissure. Was it hard for you to find someone who really knew what they were talking about and who had done a lot of this surgery?

Finally, what have you decided to do? I have to do something quick because mine is very painful and is really wrecking havoc on my day to day life and ability to get anything done at work or home.

Since you have been dealing with this for three years, have you ever considered that you may have allergies? I would check out naet.com and adrenalfatigue.org which have really helped me get control of my allergies, and therefore control of my bowels. I am convinced the reason I have this level three part of the fissure but no actual fissure (after all the reading I have done and with what my ayurvedic and NAET docs have said) is this -- (1) I was very worn out early this year from years of working too much and it dramatically lowered my immune system and adrenals, (2) resulting in an awful cough that wouldn't go away for 2 months, (3) then I had hemorrhoids for months, (4) then the fissure so, (5) my digestive system and usually normal bowels were now totally out of wack. The ayurvedic doctor helped me immensely (lifespa.com) but it didn't get to root of the problem which is I that (6) have had all these food and toxic allergies and parasites for years and I was able to fight them when I was stronger, but after the bout with the bad cough I could not longer fight them because (7) my adrenals were no longer responding to the stress of allergies and everything else, and they started coming out. I would get totally back to normal after each relapse, have totally normal BMs and then one day it would be horrible, so I went to see the NAET specialist and my MD thought that was what I needed too and my ayurvedic doc also agreed that that might help me get to the "root" of the problem. While I have been getting control of my allergies, it is just that all the allergic reactions and the horrible two bouts with parasites just beat up my rectum so bad that it caused this terrible inflammation and the papailla to become enlarged. My NAET doc also said so many of my cells and tissues were just not working problem (she calls them broken) but she has worked on all that and I feel great in general, except for this pain.

I am also trying a formula called ALOEetlite found on aloeelite.com which sounds worth trying as it is a great anti inflammatory but totally natural without side effects. Check out aloeelite.com. I just started it today based on my NAET docs suggestion that aloe is an amazing healer and this one is totally for digestive and rectal issues like colitis, etc. I can tell I have a lot of inflammation and even though I am taking ayurvedic and Chinese herbs it is not enough to battle what I have had to battle.

So long story short, I thought I would share with you what I am going through and see if this is any help to you and if you can answer those questions I posed above.

Also do you understand the that the hypertrophied papilla can then also become a fibrous polyp if the inflammation continues to build up.. I have read about that but don't really understand if that is a fourth stage or what? I have only had this for about a month so believe I am not at that stage.

Stay positive, keep researching and read the book "The Secret" if you haven't already, that has also helped me get through this as I know I will be healed soon because I totally believe I will be, but just need to determine the right way to go and get a better understanding and hearing what others have gone through is very helpful.

Last edited by Administrator; 01-05-2010 at 11:19 PM.

 
Old 12-06-2008, 07:36 PM   #7
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Re: Has anyone had a hypertrophical anal papilla removed?

cocoajoe, My colo-rectal surgeon removes HP's in his office..he uses local anesthetic and then cuts the papillae off. The procedure for removing a papillae is not the same procedure as LIS.

In my case, I believe I had my initial anal fissure in my 20's, it basically remained dormant for years with maybe a few flareups here and there. After the initial fissure I developed the external skin tag which made me think I had hemorrhoids. So I then attributed any pain or flare up to having hemorrhoids.

Fast forward 20 years to now when I had a severe flare up with the anal fissure which led me to having LIS. I also had the HP and the external skin tag removed. The HP was not painful for me on a day to day basis. It did grow in size over the last few years to the point that it would prolapse during a BM. I believe that there is no way to reduce their size. The removal procedure does sound uneventful. I have also been told that an HP will return if a fissure is not completely healed.

Good luck. I am sure you will get sound advice with a colo-rectal surgeon.

 
Old 12-06-2008, 11:05 PM   #8
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Re: Has anyone had a hypertrophical anal papilla removed?

Hello Sissyleighjune, thanks for great feedback, I am so glad to hear that the removal of the HP is not the same as the full LIS. So it should be pretty easy, is what it sounds like. I wonder if they will do it right then and there on the day I go in or if I will have to make another appt after the consult. I think I will ask each doctor I call to make the appt. Beause I have such a long drive it would be nice to get it over with in one trip. Thanks for taking the mystery out of that big quesion, no matter how much I researched and read that never became clear to me. I think the reason why my HP is so painful is that it has been traumatized so mahy times with the allergic reactions and because most of my allergic reactions my whole life (starting with antibiotics when I was a kid all had burning sensation reactions). Sounds like you are doing well after the procedure and finally here's to perfect health and staying fissure-free for the rest of ouir lives!

 
Old 12-08-2008, 09:01 AM   #9
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tarik HB User
Re: Has anyone had a hypertrophical anal papilla removed?

Hi All,

I had LIS+fissurectomy operation 8 months ago.I have internal hemorrhoid.
But since I had anal pain left side (LIS side).Painful is like sting,hard burning on dentata line and inside.

MRI result no fistula or abscess.
Rectoscopy result is internal hemorrhoid and pile or papillae on hemorrhoids.
Anoscopy result is hipertrophic pile on dentata line and pain with touch.

What is hipertrophic pile? Is pile equal papillae?
My rectoscopy picture is same hipertrophic papillae picture on internet.

Hi Rubydee12,
What your symptoms before remove papillae ?. Had you sting,hard burning?
After remove papillae completely healed?

Please help me!
Sorry,I not enough know English.

Last edited by tarik; 12-08-2008 at 09:04 AM.

 
Old 12-08-2008, 05:58 PM   #10
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Re: Has anyone had a hypertrophical anal papilla removed?

There are a lot of terms in your post...

Pile is another term for hemorrhoid. A papilla is not a pile. I am not sure what a hypertrophic pile means. A hypertrophied papilla is a structure that arises off the base of columns of tissue at the dentate line in the rectum. They enlarge in response to congestion, irritation, injury, or infection.

I did not have any pain or burning before having the papilla removed though I believe they can be painful. My papilla would prolapse during a BM and while that was not painful for me it can be painful if it twists or becomes trapped. There is also a condition called cryptitis where there is an associated infection with the enlarged papilla. I also believe these conditions may occur in conjunction with hemorrhoids. Enlarged papilla are pale in color which differentiates them from hemorrhoids.

After having the papilla removed, all of my symptoms are gone. It is a relatively easy procedure and can be done in the doctor's office under local anesthetic.

 
Old 12-09-2008, 09:36 AM   #11
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Re: Has anyone had a hypertrophical anal papilla removed?

Rudydee, you really have a good understanding of this issue and explain it very well thanks, I think you may have solved why I have more burning pain, possibly I have cryptitis too. did a little more research and one article explains what is done during the surgery to eliminate this too, but do you know if by adding in cryptitis to the hypertrophied papilla (no fissure) that the surgery can still be done in the doc's office?

Tarik it sounds to me like your symptoms aer similar to mine, that your pain is more severe than what others have had so it may be cryptitis on top of the enlarged papilla. I have an appt with a colon-rectal surgeon tomorrow so will know more and will let you know what I find out. I also know that some of my pain intensity is from allergic reactions, when I am having one the pain is even more intensified, when the allergy is "cleared" during NAET treatments the pain is not as severe. If you think there is any chance you have any type of food, environmental or emotional allergies, you may find as I have that the root of the overall problem (why you even got the fissure in the first place) has to do with allergies. allergies always manifest themselves in your weakest point of your body.

Last edited by moderator2; 12-10-2008 at 07:25 AM. Reason: posted disallowed website(s)

 
Old 12-10-2008, 08:30 AM   #12
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tarik HB User
Re: Has anyone had a hypertrophical anal papilla removed?

Hi,
Thanks for replays

My previous doctor (associate professor) said crypt infection (cryptitis).But he write "fissure papillae" at diagnosis form.

Also I search pile or pili terms at internet but not found disease appertaining pile term.I think pile is Turkish term.
My pain always left side localized and to inside.

What is treathment cryptitis and/or enlarge papillae.Surgical ?
Does this disease couse complaints?

Thank you

 
Old 12-10-2008, 10:28 PM   #13
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Re: Has anyone had a hypertrophical anal papilla removed?

Hello Tarik , I had an appt with a rectal - colon surgeon today and the end result is I do have a fissure again. the other doctor did not diagnose it correctly because he did nto do a physicla exam, the colonoscopy does not always show the fissure. My new doc said no way woudl you have the kind of pain I am having , and sounds like you are having, without it being the fissure again. So I would get a second opinion. I have the LIS surgery tomorrow, at this point with the enlarged papilla I need to do it. If it was just the fissure I woudl do ayurvedic treatment again now that I have control of my allergies.
I also did not have cyptitis, or at least he has not mentioned that, just a fissure with a hypertropied papilla and some skin tags. I will write again after I have the surgery and let you know. Just make sure you get a good doc that you feel good about. Make sure they explain fully. Some just don't and when they don't I would question if they know what they are talking about. My gastro definitely didn't and didn't even find the fissure even though I told him that is what I thought it was. he also sent me to a regular surgeon which is not right either. I am positive things will go really well tomorrow.

 
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