LEARN ABOUT ANAL SKIN TAGS FROM THE EXPERTS AT BESPOKE SURGICAL
What is an Anal Skin Tag?
Skin tags are extra-folds of anal tissue. They are also commonly referred to in the medical community as sentinel, rectal, and perianal skin tags. They may develop from the stretched overlying skin of a thrombosed external hemorrhoid or the way in which the tissue in an anal fissure fails to heal properly.
But the main impetus lies with some type of localized injury. Skin, and its healing capacity, has limitations, specifically as it relates to the anal region. Defecation and intercourse are high pressure actions that continuously irritate a wound, especially as it is attempting to close. And clearly we have to defecate.
Because of this persistent trauma and the skin attempting to heal, it gets frustrated. It basically lays down a scar as best as it can and then grows out with extra skin — hence the anal skin tag. This healing is beyond common, with anal tears or fissures that attempt to mend with a skin tag in the region (many think it’s actually from a hemorrhoid, but in fact it’s how that tear healed.)
Is it a Hemorrhoid or Skin Tag?
As stated above, skin tags are just extra tissue, whereas hemorrhoids are swollen veins. While not the same thing, they are related–skin tags can be caused by hemorrhoids. With hemorrhoids (or dilated veins), the blood actually stretches the skin and, after the hemorrhoid resolves itself, the skin does not rebound back to its original shape, leaving a tag. So unfortunately, there are many different ways to wind up with a skin tag in the anal region and many have functional and/or aesthetic limitations that require surgical attention.
What are the Symptoms of an Anal Skin Tag?
Anal skin tags can cause localized irritation, discomfort, itching, and can be considered aesthetically unpleasant. They may cause hygiene problems, and also interfere with anal intercourse.
How are they Diagnosed?
Anal skin tags are diagnosed by a doctor through visual inspection. An anosocopy is performed as well to ensure there are no other associated issues, specifically a connection to hemorrhoids that may change the surgical approach.
How to Get Rid of Anal Skin Tags
Some tags may resolve on their own over time, while utilizing sitz baths and Proctozone 2.5%, a prescription topical ointment. In most cases, however, anal skin tag surgery is required.
Anal Skin Tag Surgical Treatment at Bespoke Surgical
Skin tags range from small to extra-large in size, and many have both physical and psychosocial ramifications. These limitations set the stage for surgical treatment with several options available, all depending on the severity. Skin tags are either removed via laser/electrocautery or surgical excision, with thought given to both functional and cosmetic goals.
While skin tags appear on the exterior of the body, they may actually be connected to something deeper. That’s why a thorough internal and external anal examination is key, prior to removal, as what looks to only be superficial is usually only the tip of the (anal) iceberg.
If a skin tag is found to be purely external, a simple in-office removal under local anesthesia can be performed with a quick recovery to follow. The pain is limited and most irritation occurs while wiping post-defecation. There are no limitations for exercise; however, bottoming or any kind of receptive anal play should be avoided for two weeks so that appropriate healing can take place. The good news is: topping is allowed.
When external anal tags have an internal component, it stems from the healing of an anal tear (aka an anal fissure) or a dilated vein (aka a hemorrhoid). Regardless, you should take care of the skin tag in its entirety in order to see appropriate results. That means removing the skin tag and the pathology at hand.
Many times, we add Botox to help aid the healing process because this relaxes the muscle sphincters. Additionally, there are times when we leave the wound open (meaning we do not suture it closed) for two reasons: first, it heals quite well when left open and secondly, in many people, we do not want to make the hole any tighter because this may limit normal defecation and/or sexual activity in the future.
Regardless of how the area is left after surgery, the healing process is similar. The first 3-5 days will be the most difficult, with feelings of constant annoyance and/or a sense of local spasm. Pain can be controlled with narcotics and Ibuprofen, combined with suppositories, lotions, and daily Epsom salt baths. Using a bidet during this time can be a gentler method of cleansing the area.
After this period comes 1-2 weeks of more localized pain during bowel movements. This time, using non-narcotic pain meds and continuing with the other aforementioned remedies will aid in recovery and minimizing discomfort. After another 2-3 weeks, the pain should be mostly resolved, though full healing will come after roughly 6-8 weeks post-surgery.
As for getting back to normal daily activities, clients can start exercising after 5 days and begin topping or engaging in non-anal play after one week. If used, the stitches are dissolvable; however, if the wound is left open, in-office cauterization of the wound with silver nitrate will aid in healing. At the eight-week mark, we start using anal dilators to assist in healing and restoring the anal architecture. This fully allows for our clients to achieve their anal desires, if that’s part of their goal.
Preventing Anal Skin Tags
This is such a multifactorial answer as it relates to all ailments that can occur anally. However, one answer that is not true is to stop having anal intercourse. Why would anyone ever suggest that to you? The key is to understand the science of both defecation and anal sex with the hopes of minimizing trauma to the region. This will of course decrease the incidence of any associated pathology that may cause anal tags.
Some other ways to help avoid the development of anal skin tags include:
Regular soft stools through an increase in fiber intake
Not sitting on the toilet bowl for too long
Taking standing breaks or working at a standing desk at work
Doing squats or leg exercises (and making sure to only contract your glutes and not your asshole)
The final suggestion is to see a physician soon after an injury or if the symptoms are persisting. It’s key to see a physician who understands our community and has the knowledge to support appropriate treatments. Early interventions can help with a complete resolution or at least minimize any long term consequences.
“I am a bottom through and through and can only climax when penetrated. However, lately, I have noticed more and more hesitation (and even a gasp or two) when my sexual partners get sight of my hole. Thinking it was just my imagination, my worst fears were confirmed when a recent partner made a more direct comment about what was going on back there aesthetically. I immediately went to my *straight* primary care physician for advice and was told it was simply a skin tag and that it should be left alone as it didn’t pose a major health concern. Obviously, it was something I couldn’t shake and because of that, I fell into a sexual depression thinking that I would have to live with it forever. And without that confidence, it was unlikely I could ever fully enjoy bottoming again.
Regardless of whatever I felt, the sexual partners I encountered may or may not be comfortable with my skin tag. Everyone is so focused on aesthetics and so anything that may not look perfect is met with disgust or hesitation. As you can imagine, I started to withdraw from pleasurable acts and naturally began down a path towards sexual isolation.
Some may see this as a purely superficial issue, but sexual health has everything to do with total mind and body wellness for me. That’s when I found Dr. Goldstein and was quickly assured that not only could he help me, but there was a simple, straightforward procedure available. With a same-day procedure, which entailed not only strategic removal and closure of those extra skin folds in the region, but also laser use to resurface, Dr. Goldstein resolved all of my related psychological and medical issues. On top of this, with the associated tightening, it has also allowed heightened sexual pleasures for both me and my sexual partners. I should have gone to Bespoke Surgical years prior, but am still grateful for its completion.”
Don’t let other surgeons or physicians tell you it can’t be done or that it will heal right back with another skin tag. If it’s done correctly and with someone who has the proper knowledge, this won’t happen. Another disclaimer: don’t let someone simply excise the tag if there are other associated issues. Your surgeon needs to take care of the primary pathology first in order to ensure an appropriate outcome.
Some anal tags may even need 2-3 surgeries to accomplish the task at hand. Form, function, and aesthetics go hand-in-hand and should be weighed equally in the decision-making process.
At Bespoke Surgical, we can handle all sizes and types of skin tags and we will tailor our medical and surgical management to fit the unique needs of each client. This bespoke treatment helps navigate our clients successfully through their recovery.
Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical, NYC’s leading sexual health private practice. He received his osteopathic doctorate from the University of Medicine and Dentistry School in 2002 and completed his residency in General Surgery at Maimonides Medical Center. In 2020, he was named one of NYC’s top LGBTQ+ business leaders by Crain’s New York and he is involved with GLSEN, ACRIA, HRC, and Callen-Lorde’s Howard J. Brown Society. All of these experiences and affiliations have shaped his whole-life approach towards the practice of private surgical care and sexual wellness.