Anal Skin Tag

However, the previously used term external hemorrhoids is incorrect and should no longer be used, as hemorrhoids are vascular cushions and not skin folds. As a rule, they are always harmless and only very rarely cause discomfort. The diagnosis is made by sight, no further examinations are necessary.

A distinction is made between primary and secondary anal skin tags.

The most common are primary mariscus, which are tumor-like skin thickenings and have no actual cause. The presence of proctological diseases does not favor the development of mariscus. They are therefore not remnants of past anal vein thromboses, as is often assumed.

On the other hand, secondary anal skin tags develop, for example, as a result of a chronic anal fissure. Due to a continuous state of irritation of the existing anal fissure, a thickening of the skin forms on the outer edge of this fissure, which corresponds to an anal skin tag and is referred to as an outpost fold. Skin tags can also develop after surgical procedures such as haemorrhoid surgery and initially appear as an acute, painful swelling.

Anal skin tags can occur at any age. In women, they begin to occur more frequently from the age of 20 and in men from the age of 40. Over 70% of people develop skin tags in the course of their lives, with younger people more likely to develop individual tags. There is no spontaneous regression.

The localization at the anus is usually referred to as the lithotomy position (SSL). The patient sits on an examination chair with their legs spread apart and the doctor in front of the patient. The position is now indicated from the doctor's point of view, like a clock. The majority of skin tags are located at 12 o'clock SSL (43%) and less frequently at 6 o'clock SSL (29%). Primary skin tags tend to be broad-based and secondary tags are often pedunculated with a narrow base. 

Anal skin tags are generally harmless, cause no discomfort and are more of a cosmetic or hygienic problem. Some patients report a temporary, painful swelling, especially when they are subjected to intense anal hygiene, as a result of which the mariscus loses its soft consistency and excessive rough skin formation can occur.

As a result, the skin tags can itch, burn and tear painfully, which in addition to the pain can lead to minor bleeding on the toilet paper. 

Anal tags that are asymptomatic, i.e. do not cause any symptoms, do not require treatment. However, if there are recurring inflammations and problems with anal hygiene, mariscus can be removed. This can usually always be done by outpatient surgery.

Individual anal skin tags should be removed under local anesthesia by a proctological surgeon. The resulting wounds always remain open and heal after 2-6 weeks. If the wound is cleaned with water twice a day, there is no risk of infection.

If there are several skin tags or they extend deeper into the anal canal, it is better to perform the removal under short anesthesia due to the extensive local anesthesia. 

In the case of an anal tag ring, caution is always required due to possible narrowing caused by scarring and sufficient skin bridges must be left in place.

Before an operation, a complete proctological examination such as a proctoscopy and, if necessary, a rectoscopy should always be carried out to rule out other diseases in the anal region.

Important: The removal of anal tags that are only aesthetically disturbing is not covered by statutory health insurance and must be paid for as a self-payer service in accordance with the GOÄ. In the case of complaints, however, there is always a medical indication and the costs are covered in full by the health insurance companies. 

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