What’s the difference between an anal skin tag and a haemorrhoid (pile)?

What are the main indicators of skin tags?

Both conditions are felt externally as a lump around the anus by the patient and it can be difficult for patients and non-specialist doctors to tell the difference.

Skin tags are floppy pieces of skin originating externally. They do not prolapse outside from within and cannot be pushed back inside like prolapsing haemorrhoids. They can be solitary or multiple, and can be a consequence of:

• Long-standing haemorrhoids
• Chronic anal fissure (“sentinel tag”)
• Previous surgery to the anus
• Chronic inflammation of perianal skin (Crohn’s disease or dermatological conditions)
• Previous pregnancies/deliveries
• Human Papilloma Virus (genital warts)
• Age related
• Sporadic

Symptoms from anal tags can include:

• Itching
• Intermittent swelling and discomfort
• Blood on wiping
• Hygiene issues
• Cosmesis

How should skin tags be treated?

The first step in their management is accurate diagnosis by a specialist colorectal surgeon. Following this, reassurance and conservative management may be appropriate for those with minimal symptoms, such as judicious use of steroid creams when painful and swollen, barrier creams etc. If more symptomatic they can be surgically removed under deep sedation with local anaesthetic in the operating theatre under sterile conditions. Recovery is usually less than a week. The rare but recognised risks of surgical removal include:

• Pain (up to 7 days typically)
• Bleeding
• Delayed wound healing (>6 weeks)
• Failure to heal (Chronic fissure)
• Recurrence

What are the main indicators of haemorrhoids?

External haemorrhoids (piles), also known as 4^th degree piles, are swellings comprised of blood vessels rather than simple skin. These usually have an internal anchorage and can pop out either after bowel movement, or sometimes spontaneously. They can often be pushed back inside. Discomfort and rectal bleeding are usually more prominent with 4^th degree piles compared with simple skin tags. For symptoms and management of piles please read this article.

Written by Mr Jonathan Wilson, Consultant Colorectal and General Surgeon at OneWelbeck Digestive Health.