Anal skin tags are benign skin growths around the anus. These are generally caused by various pathologies of the anus, most commonly hemorrhoids and anal fissures. Some people are unaffected and unbothered by these tags but for others, these little growth can cause cosmetic concerns or problems with cleanliness.
In my practice, the first step in treating patients with skin tags is to figure out the specific symptom caused by the tags. For some people it is purely cosmetic. For others, tags can be associated with itching and irritation, difficulty keeping their bottom clean, or swelling and pain. A thorough anal exam allows me to determine if there is more to the problem than just the tag.
For example, patients with painful tags often have a chronic anal fissure, a tear inside the anus which has actually caused the tag growth. Since the pain is caused by the fissure, removing the tag alone, without treating the fissure will simply lead to regrowth of the tag, or worse, exacerbation of the fissure. A combined approach however, to treat the fissure and associated skin tag can allow resolution of both the pain, and the bothersome growth!
Another situation I see commonly are skin tags associated with a history of hemorrhoids. People who have had hemorrhoid flares will frequently be left with these skin growths once the hemorrhoid flare has resolved. When hemorrhoids swell, the overlying skin stretches to create a skin tag. After resolution of the painful hemorrhoid, the skin overlying the area never really shrinks back down. These tags can stay around eternally and be quite bothersome for patients. This situation is very common after pregnancy and its not uncommon to see patients seeking treatment for their anal skin tags many years postpartum. For skin tags associated with hemorrhoids it is important to determine if there is any ongoing hemorrhoidal swelling or symptoms before removal of the tags. Removing the tag without treating the hemorrhoids can result in swelling of the hemorrhoids and recurrence of the tag. A combined approach to treat the hemorrhoids using office-based hemorrhoid treatments followed by tag excision results in the best outcomes.
In some patients anal skin tags get in the way of keeping the anus clean. Wiping after a bowel movement can be ineffective when skin tags are in the way. Residual stool can sit on the skin and irritate the area, which then leads to pain and irritation. Alternatively, aggressive wiping to get around this problem can result in tearing and irritation of the skin tags and surrounding area. Chronic itching is common and scratching the area can perpetuate symptoms. Many individuals resort to using wet wipes to help clean up. Unfortunately, chronic use of wipes also comes with side-effects – ingredients in the wipes themselves can cause thinning and irritation of the perianal skin. This vicious cycle can be difficult to escape. Through a patient-centered approach, I can help patients identify the underlying cause for their symptoms to achieve the best results and stop the annoying symptoms associated with anal skin tags.
Whether you are bothered by the swelling and itching caused by your anal skin tags or just hate the cosmetic appearance of the tags, there is a solution to make you feel your best when it comes to your bottom!
For patients desiring excision of the tags - this is a quick in-office procedure. Anesthetic is used to numb the area so the excision is painless. Postoperative pain is generally bearable and worst for the first couple of days. It is important to manage any constipation or diarrhea especially in the immediate pre- and postoperative setting to avoid recurrence of a fissure or hemorrhoids that may have caused the problem in the first place. Caring for the wound requires washing with water, and for many, I will prescribe a topical muscle relaxing agents to improve postoperative healing. Lifestyle changes including good toileting habits (i.e. don’t read on the toilet), washing after bowel movements, and getting plenty of fiber and water will help prevent recurrence.
Please remember this post is not medical advice. If you have symptoms you think are caused by a skin tag, hemorrhoids or other anal pathology, please get evaluated to make sure you are on the correct path to recovery. Karen Zaghiyan, MD is an experienced colorectal surgeon offering treatments for anal skin tags in her clinical practice in Los Angeles.
