Anal Papilloma: Surgical Options and Recovery Concerns

Surgical issues related to anal papillomatosis?

Hello, Dr.
Ko.
I would like to ask you about a concern I have.
Every time I have a bowel movement, a lump protrudes, but it retracts automatically after I'm done.
I have had it checked, and the doctor said it is a "papillary hyperplasia" caused by an anal fissure.
Since it is not painful or itchy, the doctor suggested that I coexist peacefully with it.
Recently, I asked the doctor again about the possibility of removing this papillary hyperplasia, and the doctor said it would require surgery and a one-day hospital stay.
Although the doctor mentioned that this is different from common hemorrhoid surgeries and is not as complicated, the location of my papillary hyperplasia is along the posterior midline, which is the area under the most pressure, so the recovery time may take two to three weeks.
I don't quite understand, and the doctor didn't explain clearly how this surgery differs from typical hemorrhoid surgeries (both traditional and circular).
Will I experience "fecal incontinence" as a complication like some patients do after hemorrhoid surgery? During the recovery period, will the pain be as severe as that experienced after standard hemorrhoid surgery? Will bowel movements during recovery lead to recurrent anal fissures, resulting in the formation of new papillary hyperplasia? (Wouldn't that create an endless cycle?)
My doctor has made it sound very easy, but I am afraid it might be as frightening as some of the postoperative experiences I found online.
I am a bit hesitant about whether to go through with the surgery or to follow the doctor's advice to coexist peacefully.

ssclarity, 20~29 year old female. Ask Date: 2011/11/24

Dr. Ke Fangxu reply Surgery

The question of whether to perform surgery on anal lesions is one of the most frequently asked questions I receive.
I often respond by asking the patient whether the condition affects their daily life.
If it does, then surgery should be considered to improve their quality of life.
If it does not affect their life and is not a malignant lesion, then what is the purpose of surgery?
Anal fissures leading to the proliferation of anal papillae is a common issue.
The fundamental solution is to improve bowel habits and to take warm sitz baths.
Simply excising the papillae using a sawtooth technique is merely a superficial fix.
However, I believe your physician will likely also perform an anal sphincterotomy, which is the standard treatment for anal fissures.

That said, most physicians would not recommend proceeding with surgery unless the symptoms are severe.
Instead of seeking such an aggressive treatment option, why not consider improving the condition through dietary and lifestyle adjustments? Of course, if the patient's desire is to eliminate the papillae, then surgery is the only option.
However, one must ask, what is the purpose of removing the papillae?
Your correspondence did not mention any discomfort or symptoms, so why endure several weeks of pain and bleeding after surgery? The information available online is vast and often difficult to filter.
I hope patients can trust their physician's advice and choose their treatment options carefully.

Reply Date: 2011/11/24

More Info

Anal papilloma, also known as anal warts or condyloma acuminatum, is a benign growth that can occur in the anal region. It is often caused by the human papillomavirus (HPV) and can manifest as small, soft, and fleshy growths. In your case, it seems that the growth you are experiencing is related to anal fissures, which can lead to the development of these papillomas due to irritation and trauma in the area.

When it comes to surgical options for treating anal papillomas, there are several approaches that can be considered. The choice of procedure often depends on the size, location, and number of papillomas present. Common surgical methods include excision, electrosurgery, and laser therapy. Each of these techniques has its own benefits and risks, and your surgeon will choose the most appropriate method based on your specific situation.

In terms of recovery, it is important to understand that while the surgery for anal papillomas is generally less complex than traditional hemorrhoid surgery, it still requires careful post-operative care. The recovery time you mentioned—two to three weeks—is typical, but individual experiences may vary. During this period, you may experience some discomfort, swelling, or pain, especially during bowel movements. It is crucial to follow your surgeon's post-operative instructions to minimize discomfort and promote healing.

One of your concerns is the potential for complications such as fecal incontinence, which can occur after any anal surgery. However, the risk of this complication is generally low when the procedure is performed by an experienced surgeon. The key is to ensure that the surgery is done carefully, preserving the surrounding tissues and nerves as much as possible. Discussing your concerns with your surgeon can help clarify the risks involved and what measures will be taken to prevent complications.

Regarding the fear of recurrent anal fissures leading to new papilloma formation, it is valid to be cautious. Maintaining a healthy bowel regimen is essential to prevent straining during bowel movements, which can exacerbate fissures and irritation. Your surgeon may recommend dietary changes, such as increasing fiber intake and staying well-hydrated, to facilitate smoother bowel movements and reduce the risk of recurrence.

If you are feeling uncertain about the surgery, it may be beneficial to seek a second opinion from another colorectal surgeon. This can provide you with additional perspectives on your condition and the necessity of surgical intervention. Ultimately, the decision to proceed with surgery should be based on a thorough understanding of your condition, the potential benefits of surgery, and the risks involved.

In conclusion, while the idea of surgery can be daunting, it is important to weigh the potential benefits against the risks. If your anal papilloma is causing you concern or discomfort, and if your doctor believes that surgical intervention is warranted, it may be worth considering. Open communication with your healthcare provider is key to ensuring that you feel comfortable and informed about your treatment options.

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