An anal skin tag (AST), also known as a perianal skin tag or fibroepithelial polyp, is a common, non-cancerous overgrowth of excess skin that forms around the anus or rectum. These benign growths typically develop when the sensitive perianal skin is stretched and fails to return to its original shape. This often happens after the swelling of an external hemorrhoid subsides or following injury from an anal fissure. While generally harmless, they can cause irritation, hygiene difficulties, or cosmetic concerns. The decision to remove an anal skin tag and the method used requires a medical diagnosis to ensure safety and effectiveness.
Identifying the Growth
An anal skin tag is characterized by its soft, flesh-colored, or slightly darker appearance, generally remaining painless and not prone to bleeding on its own. These growths are essentially flaps of skin, often attached by a small stalk, and can range in size from a few millimeters to potentially several centimeters. The presence of a painless, soft bump is a general indication of a skin tag, but this visual check is not sufficient for a diagnosis.
Any lump or growth in the perianal area must be examined by a healthcare professional. This examination is required because several conditions can mimic the appearance of an anal skin tag but require different treatment. For instance, a thrombosed external hemorrhoid, which is a blood clot within a vein, presents as a painful, hard, purplish lump that requires immediate medical attention.
Anal warts, caused by the human papillomavirus (HPV), typically have a rougher, cauliflower-like texture and may spread. An anal fissure, a small tear in the lining of the anal canal, can cause a sentinel skin tag to form at its outer edge; the underlying fissure must be treated to prevent recurrence. A proper diagnosis, sometimes involving an anoscopy to view the interior of the anal canal, ensures the growth is benign and determines the most appropriate course of action.
Why Home Removal Is Not Recommended
Attempting at-home methods like tying off the growth with dental floss (ligation), commercial freezing kits, or cutting the tag with scissors or a razor poses serious risks. The skin around the anus is richly supplied with blood vessels, meaning that attempting to cut the tag can result in excessive, difficult-to-control bleeding.
The anus contains a high concentration of bacteria from the digestive tract, and introducing an open wound from a non-sterile home procedure elevates the risk of severe infection. An infection in this area can quickly escalate into a perianal abscess, a painful collection of pus requiring urgent surgical drainage. Non-professional removal methods like chemical applications or freezing kits are not formulated for the sensitive, moist tissue of the anal area and can cause chemical burns, nerve damage, or disfiguring scarring. Scarring can even lead to anal stenosis, a narrowing of the anal canal that can make bowel movements difficult.
Professional Medical Removal Options
Removal of an anal skin tag is considered a minor surgical procedure performed by a specialist, typically a colorectal surgeon or a dermatologist. While skin tags are medically harmless, removal is often justified if the tag causes chronic irritation, interferes with proper hygiene, or presents a cosmetic concern. The choice of procedure depends on the size, location, and number of skin tags being addressed.
The most common and definitive method is surgical excision, where the skin tag is cut away using a scalpel or surgical scissors. This procedure is generally performed as an in-office treatment under local anesthesia. For larger or multiple tags, a mild sedative may be offered, though general anesthesia is rarely necessary for this minor procedure.
Other methods include electrocautery, which uses a high-frequency electrical current to burn and remove the excess skin tissue, and cryotherapy, which involves freezing the tissue with liquid nitrogen to cause it to fall off. Electrocautery offers the advantage of simultaneously cauterizing the wound, which minimizes bleeding, while cryotherapy is typically reserved for smaller tags.
Post-procedure care is focused on wound management and ensuring a smooth healing process, which typically takes one to two weeks. Patients are advised to keep the area clean and dry and may be instructed to take warm sitz baths to soothe the area and promote healing. Pain control is managed with over-the-counter pain relievers, though a prescription may be provided for the initial days following the procedure. Managing underlying conditions like constipation or diarrhea is also emphasized post-removal to prevent further irritation and reduce the likelihood of new skin tags forming.