Anal Fissures and Skin Tags: Causes and Treatments

Anal fissure, a small piece of tissue between the perineum and the anus?

Hello Doctor, I have recently experienced a tearing sensation in the perineal area after bowel movements, particularly around the anus (it hurts when it comes into contact with water or urine).
However, there is no bleeding from the anus (no blood on the stool), and my stools are not hard.
Could this be a sign of hemorrhoids? Or could it be related to the way I wipe with toilet paper? Additionally, I have noticed a raised area of tissue between my anus and perineum (extending sideways), which does not hurt when pressed, and I do not feel it when sitting.
What could this be? (The tearing sensation seems to be located on this tissue.) I have previously experienced tearing during a vaginal infection, so could it be possible that frequent tearing has caused thickening at the site, resulting in this raised tissue? Lastly, how can I improve this condition, and are there any topical ointments I could use? Thank you, Doctor.

Niming, 20~29 year old female. Ask Date: 2022/04/21

Dr. Zhang Shuhao reply Surgery

The tearing pain sensation is mostly caused by anal fissures.
If anal fissures recur, they can lead to the formation of a skin tag (sentinel tag) on the outer side of the wound, which is a benign skin growth.
Typically, it does not cause discomfort unless it leads to pain or concerns about appearance, in which case excision may be necessary.

Reply Date: 2022/04/21

More Info

Understanding anal fissures and skin tags is essential for addressing the discomfort you are experiencing. Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, which can result in sharp pain, especially during and after defecation. The fact that you are experiencing pain in the perineal area after bowel movements, without any visible blood, suggests that you may indeed be dealing with an anal fissure.
Several factors can contribute to the development of anal fissures. While hard stools are a common cause, other factors such as prolonged diarrhea, anal intercourse, or even excessive wiping with toilet paper can lead to irritation and tearing of the anal tissue. Given that you mentioned your stools are not hard, it’s possible that the friction from wiping or other mechanical irritation could be contributing to your symptoms.

Regarding the raised area you described between the anus and the perineum, it could potentially be a skin tag. Skin tags are benign growths that can occur in various areas of the body, including the anal region. They are typically painless and may develop as a result of friction or irritation. In some cases, they can form in response to repeated trauma, such as from anal fissures or other irritations.
It’s also worth noting that if you have a history of vaginal infections and have experienced tearing in the past, this could lead to changes in the skin texture or the formation of skin tags in the affected area. The skin may thicken or form a tag as a protective response to repeated injury.

To improve your condition, consider the following recommendations:
1. Gentle Hygiene Practices: Instead of using rough toilet paper, consider using moist wipes or a bidet to clean the area gently after bowel movements. This can help minimize irritation.

2. Topical Treatments: Over-the-counter creams containing hydrocortisone or barrier ointments like zinc oxide can help soothe the area and promote healing. Additionally, topical anesthetics may provide temporary relief from pain.

3. Dietary Adjustments: Ensure you are consuming a high-fiber diet to promote softer stools and regular bowel movements. Staying well-hydrated is also crucial.

4. Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help relieve pain and promote healing by increasing blood flow to the area.

5. Avoid Straining: When using the bathroom, try to relax and avoid straining, as this can exacerbate fissures.

If your symptoms persist or worsen, it is advisable to consult a healthcare professional. They can provide a thorough examination and may recommend treatments such as prescription topical medications or, in some cases, surgical options if the fissures do not heal with conservative measures.

In summary, while your symptoms may be indicative of anal fissures, the presence of a skin tag or other benign growths is also possible. Implementing gentle hygiene practices, dietary changes, and topical treatments can help alleviate your discomfort. However, a medical evaluation is recommended for a definitive diagnosis and tailored treatment plan.

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