Anal skin tags are common, benign growths of excess skin that form around the anal opening. These soft protrusions are generally harmless but can sometimes lead to irritation or hygiene issues. Understanding their nature and origin is important. Although they may resemble other conditions, anal skin tags are not associated with serious health risks.
Defining Anal Skin Tags
An anal skin tag, medically known as an acrochordon or a perianal fibroma, is a fold of skin remaining after underlying tissue has stretched and contracted. These growths consist of connective tissue covered by the normal skin of the anal canal’s exterior rim. They typically appear as flesh-colored or slightly darker protrusions, ranging in size from a few millimeters to about a centimeter, and often have a flatter appearance.
The texture is usually smooth, and the tag maintains a consistent size once fully formed. They are generally painless unless irritated by friction, aggressive wiping, or the accumulation of moisture and stool residue. This irritation can cause mild itching, burning, or discomfort. Since they are excess skin, they do not contain engorged blood vessels and rarely bleed unless physically injured.
Primary Causes and Formation
Anal skin tag formation is linked to the swelling, stretching, and subsequent healing of the skin around the anal opening. The most common cause is the resolution of a previous external hemorrhoid, especially a thrombosed one. When the swollen blood vessels shrink after healing, the stretched overlying skin fails to fully retract, leaving behind a permanent fold of skin.
Chronic local inflammation is another precursor to development. Conditions causing persistent irritation, such as long-term diarrhea or constipation, lead to repeated stretching and straining during bowel movements. This continuous trauma encourages the body to form excess scar tissue, resulting in a skin tag. Inflammatory bowel diseases, like Crohn’s disease, frequently cause chronic inflammation, which is a known factor in forming multiple or larger tags.
Any event causing significant pressure or stretching in the pelvic region can also contribute to their appearance. This includes heavy lifting, strenuous exercise, and the increased pressure associated with pregnancy. In some cases, a skin tag may develop at the site of a healed anal fissure, often referred to as a sentinel pile or tag.
Differentiating from Other Anal Lumps
Correct identification of an anal skin tag is important because several other anal lumps require medical attention. External hemorrhoids, a frequent cause of skin tags, are swellings containing blood vessels. Unlike skin tags, hemorrhoids typically cause pain, bleed easily, and may appear red or purple due to vascular tissue. A thrombosed hemorrhoid is an acutely painful condition where a blood clot forms inside the swelling, resulting in a hard, tender, bluish lump.
Anal warts, caused by the human papillomavirus (HPV), also appear as external growths but have distinct features. Warts often have a rough, cauliflower-like texture and tend to appear in clusters that spread over time, whereas skin tags are smooth and stable in size.
Anal fissures are small tears in the anal lining that cause sharp, intense pain during and after a bowel movement, often accompanied by bright red blood. While a skin tag may form next to a chronic fissure, the tag itself does not cause this sharp pain.
Skin tags are distinct from polyps, which typically form inside the rectum and require internal examination. A lump that is suddenly red, swollen, intensely painful, and warm may indicate an abscess or boil, an infection requiring prompt medical drainage. Any growth that changes rapidly in size or color, or bleeds spontaneously, should be evaluated by a healthcare professional.
Management and When Professional Removal is Needed
Most anal skin tags do not require medical treatment because they are benign and asymptomatic. Conservative management focuses on maintaining good anal hygiene to prevent irritation. Keeping the area clean and dry, avoiding aggressive wiping, and using gentle washing minimizes friction and reduces fecal matter trapping, which can lead to itching. A high-fiber diet and adequate hydration ensure soft bowel movements, avoiding straining that irritates existing tags or contributes to new ones.
When a skin tag becomes persistently symptomatic, causing chronic irritation, difficulty with hygiene, or cosmetic concern, professional removal may be considered. The procedure is typically a simple office visit, often involving surgical excision after numbing the area with a local anesthetic. Other methods include cryotherapy (freezing) or electrocautery (heat). Home removal methods are strongly discouraged due to the risk of severe pain, bleeding, and infection.
A medical consultation is advised before removal to confirm the growth is a skin tag and not another condition, such as an anal fissure or hemorrhoid. Removing a tag without addressing the underlying cause can lead to the tag regrowing or the condition worsening. Sudden new bleeding, discharge, unexplained pain, or rapid change in size or color are red flags requiring immediate medical consultation for an accurate diagnosis.