The discovery of a growth or lump in the sensitive perianal area can cause anxiety and concern. Anal skin tags, also known as perianal skin tags or acrochordons, are a common, benign skin condition appearing as small flaps of excess tissue around the anus. These growths are typically flesh-colored or slightly darker, soft, and painless to the touch. While they are non-cancerous and medically harmless, they usually do not resolve or disappear on their own once formed.
Defining Anal Skin Tags
An anal skin tag is a piece of loose, elongated skin located on the outside rim of the anus. These growths are characterized by being soft, small, and generally the same color as the surrounding skin, though they may occasionally appear slightly hyperpigmented. Skin tags are essentially excess skin tissue that has stretched and remained; they are almost always benign and represent the structural aftermath of a past event.
It is important to distinguish a skin tag from other growths like active hemorrhoids, anal warts, or polyps. An active external hemorrhoid is a swollen blood vessel that is often painful, may bleed, and appears purple or red. Conversely, a skin tag is typically painless and does not bleed, only becoming irritated or itchy if hygiene is difficult or if there is excessive friction. Anal warts (caused by the human papillomavirus, or HPV) and polyps are internal growths that carry a different risk profile altogether.
The Question of Permanence
The most direct answer is that anal skin tags do not go away by themselves because they represent a permanent structural change to the tissue. Once the skin is stretched and the underlying cause of swelling resolves, the excess tissue remains. Skin tags are composed of connective tissue, collagen, and stretched skin that has lost its elasticity, similar to scar tissue.
Unlike temporary swelling, such as a fresh hemorrhoid that shrinks as the body reabsorbs fluid, a skin tag is a residual flap of tissue the body cannot dissolve. The perianal skin is naturally loose to allow for bowel movements, but when stretched past its limit, it stays permanently distended. The tag persists indefinitely unless it is surgically removed.
Factors Contributing to Formation
Anal skin tags commonly result from conditions that cause the perianal skin to swell and stretch. The most frequent cause is the resolution of a thrombosed external hemorrhoid. When the blood clot is reabsorbed, the acute swelling subsides, but the stretched overlying skin is left behind as a tag.
Chronic irritation and inflammation are also contributing factors. Conditions such as prolonged bouts of diarrhea or constipation cause persistent straining during bowel movements, which puts immense pressure on the delicate perianal tissue. Other factors include chronic anal fissures that result in a “sentinel tag,” inflammatory bowel diseases like Crohn’s disease, and the physical strain associated with pregnancy. Excessive wiping and friction can also contribute to skin tag formation.
Management and Removal Procedures
Management is typically considered only if skin tags cause symptoms, such as hygiene issues, irritation, or cosmetic distress. Tags can make cleaning difficult, leading to trapped moisture and fecal matter, which causes itching and discomfort. If the skin tag is asymptomatic, no treatment is required, but professional evaluation is recommended to confirm the diagnosis.
A specialist, such as a proctologist or colorectal surgeon, can offer several in-office removal procedures:
- Surgical excision, where the tag is cut away using a scalpel or surgical scissors under local anesthesia.
- Cryotherapy, which involves freezing the tag with liquid nitrogen so it eventually falls off.
- Electrocautery, which uses an electric current to burn the tag off.
Seeking professional advice is paramount, as attempting removal at home can lead to pain, bleeding, and infection in this sensitive area.