Anal skin tags are common, benign findings, representing excess folds of skin around the anus. They are essentially flaps of non-cancerous tissue that form on the outside edge of the anal opening. While they can be a source of concern, these growths are generally harmless. Understanding their nature helps provide clarity on this frequently encountered physical trait.
Defining Anal Skin Tags and Their Prevalence
Anal skin tags are small, soft protrusions of tissue that typically match the color of the surrounding skin, though they may sometimes be slightly darker. They vary in size from a few millimeters to a few centimeters and often have a smooth texture and elongated shape. Unlike active conditions that cause swelling, skin tags are composed primarily of fibrous connective tissue that remains after the initial cause of tissue distension has resolved.
These growths are highly common, affecting 50% to 75% of adults at some point in their lives. They can occur individually, but it is also common for people to have multiple skin tags clustered in the perianal area.
The presence of anal skin tags does not indicate an ongoing disease process, and they are not contagious. Because they are residual tissue, they are typically painless and do not bleed unless they are severely irritated.
Primary Causes and Risk Factors
Anal skin tags typically form as a consequence of the skin in the perianal area being stretched and then failing to retract completely. The most common underlying factor is the resolution of a thrombosed external hemorrhoid. When the swelling and blood clot of a hemorrhoid subside, the stretched skin is left behind as a permanent flap of tissue.
Chronic inflammation and localized trauma are other significant etiological factors. Conditions that cause frequent swelling and irritation, such as inflammatory bowel diseases like Crohn’s disease, can predispose a person to developing these tags. Up to 29% of patients with Crohn’s disease may have anal skin tags due to persistent inflammation in the area.
Straining due to chronic constipation or the repeated wiping associated with chronic diarrhea can also cause sufficient friction and irritation to prompt skin tag formation. Risk factors that increase pressure or irritation include pregnancy and obesity. Anal fissures, which are small tears in the anal lining, can also heal and leave a sentinel tag of excess skin.
Differentiating Skin Tags from Other Anal Conditions
Because anal skin tags are usually asymptomatic, it is important to distinguish them from other conditions that cause lumps or growths in the same area. A benign skin tag is typically soft, pliable, and the same color as the surrounding skin, causing no pain or active bleeding. They also do not change color or swell up when pressed.
In contrast, a thrombosed external hemorrhoid is an acute condition that is often intensely painful and feels firmer to the touch. These hemorrhoids appear dark red, purple, or bluish due to the trapped blood clot, and they commonly cause bright red bleeding during or after a bowel movement. Unlike skin tags, hemorrhoids are swollen blood vessels, not just excess skin.
Anal warts, caused by the Human Papillomavirus (HPV), are a different entity and are contagious. Warts often start as dome-like bumps but can grow into clusters that may resemble cauliflower, and they can cause a burning itch and discharge. While anal skin tags rarely bleed, anal warts can bleed with friction.
Any growth that is hard, rapidly changing in size or color, or associated with severe pain, discharge, or unexplained bleeding should prompt an immediate consultation with a healthcare professional to rule out more serious issues, such as anal polyps or, rarely, malignancy.
Medical Management and Removal Options
Most anal skin tags do not require medical intervention because they are harmless and generally do not cause symptoms. A doctor may recommend leaving the tag alone if it is small, painless, and does not interfere with daily life. However, removal may be considered if the tag causes persistent hygiene difficulties, chronic irritation, itching, or significant psychological distress.
The standard professional procedure for removal is a simple surgical excision, often performed in an office setting under local anesthesia. The area is numbed with an injection, and the excess skin is carefully cut away using a scalpel or surgical scissors. Other methods like electrocautery or laser removal may also be used.
It is strongly advised to seek professional medical removal and avoid any attempts at home remedies or non-medical methods. The anal area is sensitive and prone to infection due to its proximity to bacteria. Attempting to cut, tie off, or freeze an anal skin tag at home risks severe pain, uncontrolled bleeding, infection, and potential damage to the surrounding tissue.