Anal skin tags: symptoms and removal

Anal skin tags are soft folds of skin around the anal opening. They are common and usually entirely benign. Some people notice them by chance, while others experience itching, irritation or difficulty keeping the area clean.

What are anal skin tags?

An anal skin tag is a fold of excess skin around the anus. There may be one or several. Skin tags are not the same as haemorrhoids, although they often remain after an external haemorrhoid or a previous blood clot in an external haemorrhoid.

A skin tag may also be associated with a chronic anal fissure. In this setting, it is sometimes called a sentinel tag because it lies beside the fissure.

What symptoms can they cause?

Many anal skin tags cause no symptoms. When they do, possible problems include:

• difficulty cleaning after a bowel movement
• moisture or minor soiling that irritates the skin
• itching or stinging around the anal opening
• local irritation with movement or wiping
• cosmetic concern

An uncomplicated skin tag does not typically bleed. Rectal bleeding should therefore not automatically be attributed to a skin tag.

Is it a skin tag or a haemorrhoid?

A skin tag is a soft fold of skin without a swollen blood vessel inside it. An external haemorrhoid may become swollen, tense and painful, particularly when a blood clot forms. Internal haemorrhoids may bleed or protrude during bowel movements.

Other conditions, including genital warts, an anal fissure, inflammation or less common skin lesions, can resemble a skin tag. Examination is therefore important, especially if the lesion is new, growing, firm, irregular, ulcerated or bleeding.

How are anal skin tags examined?

The doctor inspects the skin around the anal opening. Depending on the symptoms, this may be supplemented by a digital rectal examination and a short examination of the anal canal with a small scope.

The purpose is both to confirm that the lesion is a benign skin fold and to identify a possible cause such as haemorrhoids or an anal fissure. If there is bleeding, the need to examine further into the bowel is assessed separately.

What can you do yourself?

If a skin tag does not cause significant problems, treatment is usually unnecessary. For irritation, the following may help:

• rinse gently with lukewarm water
• avoid excessive washing, perfumed soap and vigorous wiping
• pat the skin dry instead of rubbing
• keep bowel movements soft and regular
• treat any associated anal itching, fissure or haemorrhoidal disease

Creams may relieve irritation in selected situations but do not remove the skin fold. Prolonged use of different topical products without a firm diagnosis may worsen irritation.

When can anal skin tags be removed?

Removal may be considered if a skin tag causes persistent hygiene difficulties, irritation or other significant symptoms, and examination confirms the diagnosis. Cosmetic concerns alone are assessed individually.

The procedure is usually performed under local anaesthesia. The wound is in a sensitive area and may be painful while it heals. Risks include bleeding, infection, delayed wound healing, scarring and recurrence of a skin fold. If there are several or broad tags, removing all of them at one time may be inappropriate.

If the tag is related to an active fissure or haemorrhoidal disease, the underlying condition should be included in the treatment plan.

When should you seek medical advice?

Arrange an assessment for bleeding, persistent pain, pus or swelling, a new or rapidly growing lump, ulceration, or a firm and irregular lesion. You should also seek advice if you are uncertain whether it is actually a skin tag.

Assessment at the clinic

The examination assesses both the skin fold and any associated changes in the anal canal. Removal is recommended only when the expected benefit is considered greater than the discomfort and risks of wound healing.

Frequently asked questions

Are anal skin tags dangerous?

Anal skin tags are usually benign. New, growing, firm, irregular, ulcerated or bleeding lesions should be examined.

Are anal skin tags the same as haemorrhoids?

No. A skin tag is excess skin, whereas a haemorrhoid consists of enlarged vascular tissue. A skin tag may, however, remain after an external haemorrhoid.

Can anal skin tags disappear on their own?

An established skin fold rarely disappears completely. If it causes no problems, it usually needs no treatment.

Can an anal skin tag bleed?

An uncomplicated skin tag does not typically bleed. Rectal bleeding should be assessed so that the correct cause can be identified.

Is anal skin tag removal painful?

The procedure is usually performed under local anaesthesia, but the area may be sore or painful during healing.

Can anal skin tags return?

Yes. A skin fold may recur, especially if an underlying fissure or haemorrhoidal disease remains.