Skin tags, lesion, lump at anus

There are a variety of ‘things’ that a patient may discover at the anal area, often during wiping or showering, that can cause concern.  The vast majority of these are harmless.

Skin tag
A skin tag is a piece of skin that sticks out at the edge of the anus.  These are sometimes referred to as ‘external hemorrhoids’, a term that should be discarded.  Sometimes a skin tag can be the external part of an anal fissure.  When this is the case, the patient may experience anal pain and the skin tag can get quite tender.  A tender skin tag associated with an anal fissure is also called a ‘sentinel pile’ since it is a sentinel (sign of) trouble (the fissure) within the anal canal.  So a tender skin tag usually indicates that there is something going on deeper in the anal canal and that needs to be attended to.  Removing a tender skin tag on it’s own does not solve the deeper problem.  Skin tags that are not tender are really just a cosmetic problem.  They can be removed surgically under local anesthetic.  They cannot be removed by elastic band ligation (‘banding’) because they are covered by skin, and so elastic banding would be just too painful.

Perianal Hematoma
A common cause of a lump that suddenly appears at the anal edge is a perianal hematoma.  This is due to a broken blood vessel under the surface.  The usual cause is excessive straining.  Treatment is usually non-surgical although emptying the clot out early can speed resolution.  See Disorders.

Thrombosed Internal Hemorrhoid
A thrombosed internal hemorrhoid can lead to significant swelling at the edge of the anus and feel like a lump.  These are very painful for a week or so but generally resolve with time.  See Disorders.

Perianal Abscess
A perianal abscess can present as a very painful lump adjacent to the anus.  An abscess contains pus and should be drained surgically.  Sometimes an abscess will drain spontaneously and leave a small lump behind.  This may be the external opening of a tunnel from the skin to the anal canal, called a fistula.  See Disorders.

Anal Cancer
An anal cancer can grow into a lump at the anus.  These are hard and can vary from being non-tender, to very painful.  They need prompt capable surgical assessment.  See Disorders.