Hypertrophied 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. These are often found as part of the classical triad of a chronic fissure, namely the fissure itself, hypertrophied papilla above and a skin tag below. These are also found in isolation. They may be firm and palpable on a digital examination of the anus. In this situation, these must be differentiated from polyps, hemorrhoids, or other new growths.
With passage of time, papillae continue to grow in size. A papilla is liable to acquire considerable fibrous thickening over a period of time when it gets a rounded expanded tip, which is known as a fibrous polyp. This is due to piling up and consolidation of chronic inflammatory tissues at the proximal part of the fissure, at the dentate line. As many as 16% of the patients having chronic fissure in-ano record presence of papillae turned into fibrous polyp. These papillae are presumed to be caused by edema and low-grade infection.