Anal Skin Tags: Treatment Options and Concerns

Issues related to anal masses?

Hello doctor, recently I noticed a visible lump at my anal opening.
It varies in size, sometimes soft (like a flesh ball) and other times slightly harder.
Its color can be flesh-toned or sometimes purplish.
Someone mentioned that it might be hemorrhoids, and said that if it is visible at the anal opening, it should be an "external hemorrhoid" that requires surgery rather than rubber band ligation.
I discovered this while my boyfriend and I were considering anal intercourse, but it doesn't affect my daily life; I don't experience bleeding or pain when using the restroom.
However, for aesthetic reasons, I would like it to go away.
I have tried applying topical ointments, increasing my intake of fruits and vegetables for fiber, and finishing my bathroom visits quickly, but I haven't noticed any significant improvement; it still fluctuates in size.
So, I would like to ask the doctor, if this lump doesn't cause any issues or pain, and is even numb, is surgery really the only option to make it disappear? Can I request rubber band ligation instead (since I prefer not to be hospitalized)? Also, after either ligation or surgery, will the anal area lose elasticity and become more prone to injury? Thank you, doctor.

Lin De Kai, 10~19 year old female. Ask Date: 2023/01/16

Dr. Zhang Shuhao reply Surgery

It could be hemorrhoids; the position of internal and external hemorrhoids relative to the anal dentate line needs to be examined to confirm the diagnosis.
Regular warm sitz baths and the application of topical ointments can help the thrombosed blood vessels within the hemorrhoids to gradually absorb and reduce swelling, but the proliferated hemorrhoidal tissue will not disappear.
Generally, if there are no symptoms, no treatment is necessary; however, if cosmetic appearance is a concern, surgical excision may be required (for internal hemorrhoids, ligation can be attempted first).
The procedure can be performed under local anesthesia in an outpatient setting.
Surgical excision will not affect anal function, but the postoperative appearance and healing process are related to individual factors and may not meet everyone's aesthetic standards.

Reply Date: 2023/01/16

More Info

Understanding anal skin tags can be a source of concern for many individuals, especially when they are first noticed. Based on your description, it seems you are experiencing a skin tag or possibly an external hemorrhoid. Skin tags are benign growths that can appear around the anal area and are often flesh-colored or slightly darker. They can vary in size and may change in appearance based on factors such as swelling or irritation.

Treatment Options
1. Observation: If the skin tag is not causing any discomfort, pain, or bleeding, many healthcare providers may recommend simply monitoring it. Since you mentioned that it does not affect your daily life or cause pain, this may be a valid approach.

2. Topical Treatments: You mentioned using topical ointments. While some over-the-counter treatments claim to reduce skin tags, their effectiveness is often limited. These treatments may not provide the desired results, as you've experienced.

3. Surgical Options: If you are seeking removal for cosmetic reasons or if the skin tag becomes bothersome, surgical options are available:
- Excision: This is a minor surgical procedure where the skin tag is cut away. It is typically performed under local anesthesia.

- Cryotherapy: This involves freezing the skin tag with liquid nitrogen, causing it to fall off over time.

- Electrosurgery: This method uses electrical currents to remove the skin tag.

4. Rubber Band Ligation: This technique is more commonly used for hemorrhoids rather than skin tags. It involves placing a rubber band around the base of the tag to cut off its blood supply, leading to its eventual fall-off. However, its use for skin tags is less common and may not be recommended by all practitioners.

Concerns Regarding Surgery
You expressed concerns about the potential loss of elasticity and the risk of injury to the anal area post-surgery. Generally, if performed by a qualified healthcare provider, surgical removal of skin tags should not lead to significant changes in anal elasticity or function. However, as with any surgical procedure, there are risks involved, including infection, bleeding, and scarring.

When to Seek Medical Advice
If the skin tag changes in appearance, begins to bleed, or causes discomfort, it is essential to consult a healthcare professional. They can provide a proper diagnosis and recommend the most appropriate treatment options based on your specific situation.

Conclusion
In summary, while skin tags are typically harmless and may not require treatment, options are available if you wish to have them removed. Surgical methods are effective and safe when performed by experienced professionals. If you are considering any treatment, it is advisable to discuss your options with a healthcare provider who can guide you based on your individual needs and concerns.

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