To talk about the anal papilla, it is important to first talk about the anatomy of this part of the anal canal. In the previous lecture, it was mentioned that the dentate line is the anatomical landmark that separates the rectum from the anal canal, and on top of it, the sphincter muscle contracts to make the anal pillars. As the name suggests, it is like a pillar where pestles are located, usually 6-10 in number. And between the pillars there is a depression for the anal fossa (anal sinus), the anal sinus is connected to the anal glands, there is a layer of skin flap at the entrance for the anal flap, and it is the same level, the small cone or triangular protrusion at the base of the anal pillar is the anal papilla. Therefore, the anal papilla is a structure of the body itself and is not a pathological product. The anal papilloma is mostly caused by inflammation such as anal sinusitis and anal fissure, plus long-term constipation, prolonged defecation, excessive force, or diarrhea, resulting in excessive stimulation of the anal papilla and hyperplasia, which over time will become hypertrophy or even anal papilloma. Anal papilloma is insidious in origin and slow in course. In the early stage, it is mainly a manifestation of anal sinusitis or anal fissure: anal discomfort, falling sensation, stinging pain, and local irritation and burning pain when defecating. As the disease progresses, the papilla increases in size and causes a feeling of foreign body in the anus, a feeling of incomplete defecation, and a painful sensation when the enlarged papilla comes out of the anus during defecation, and occasionally blood in the stool. When the enlarged papillae are stimulated or broken, the anal glands secrete more and the area around the anus becomes moist and itchy, and over time, perianal eczema will develop. When a hypertrophic papilla prolapses outside the anus, it is often considered by patients to be a prolapsed hemorrhoid and is often disregarded because it is not painful, does not bleed, etc. Needless to say, it is really hard to distinguish between the two when there is no expertise. Although the symptoms of a prolapsed papilla are similar to those of a prolapsed internal hemorrhoid, the traits are different. The prolapsed papilla is mostly brown or white, hard, not smooth, a small cone or triangular protrusion with a large head and a tip. In contrast, internal hemorrhoids are elevated submucosal venous masses that are mostly dark red, soft, smooth, and mostly rounded protrusions without a tip when they are not embedded. Some people also mistakenly call anal papilloma as “rectal polyp”, in fact, although the two look somewhat alike, but there is a fundamental difference, rectal polyps from the rectal mucosa, located in the middle and lower rectum, pink, soft, painless, and divided into neoplastic polyps and non-neoplastic polyps, neoplastic such as tubular adenoma, tubular villous adenoma, villous adenoma, etc. The neoplastic ones, such as tubular adenoma, tubular villous adenoma, villous adenoma, etc., are prone to malignant transformation; non-neoplastic polyps, including inflammatory polyps and hyperplastic polyps, are prone to bleeding. Anal papillomas are born near the dentate line, covered by skin, smooth, painful, less likely to bleed, and harder in texture. The shape of the enlarged anal papilla can be very strange, varying from 1-7 cm in length, but of course longer ones are not uncommon, only rarely. In most cases, it is just a small cone or triangular protrusion, but when the disease is long, it may evolve into various shapes on top of that, even as ginger-like. In terms of treatment, it is quite simple, as long as the papillae are clamped at the base and then ligated and removed. Although it is called anal papilloma, it is a benign tumor and basically not cancerous. Even if it grows into a ginger shape, it is not the same as a malignant tumor like cauliflower, but of course, just in case, a pathological examination has to be done after surgery to confirm the diagnosis.