Anal fissure skin tags: identification and treatment

This is my story of living with skin tags caused by anal fissures for five years, across two different surgeries and many providers- some more understanding than others

During these five years, many doctors would listen to my complaints about the pain and discomfort from the anal fissures and be very dismissive— one male doctor going as far as suggesting that any fissure repair was only a “cosmetic” procedure. These responses led me to wonder if maybe I wasn’t even feeling the pain that I was feeling, and I really was someone so concerned with my physical appearance that I even cared that the skin around my butthole be smooth.

There is, of course, a cosmetic concern around how I would be perceived by an intimate partner with what looked like tendrils of skin coming out of my anus. But there is also the very real and debilitating pain associated with that skin. There were many times I had to stop a long run earlier than I wanted to because of the friction and chafing of having such a flap of flesh trapped between my butt cheeks, and during this time, I really limited how much I would walk anywhere because even walking created that same sense of very severe discomfort.

I am going to give here my experience with anal fissure skin tags, with the hope that the reader can use this information to more confidently push back if their doctor dismisses them as external hemorrhoids.

When mine first started, they did look a lot like an external hemorrhoid. I had only one skin tag (looks more like a “skin flap,” but they’re still called skin tags), and it did not protrude very far at all. I was told by my physician that it was a hemorrhoid, and that the bright red blood was nothing to be concerned about.

What then differentiated my experience from that of someone with a hemorrhoid was that my skin tag started elongating, and a friend skin tag appeared next to it, and then two more friends on the opposite side of the anus. While this was happening, I was also in extreme pain whenever I had a bowel movement. Passing stool was excruciating, and I would remain in extreme pain for up to 30 minutes afterwards.

I did not go back to my physician and tell them, “Hey, the thing that you said is a hemorrhoid is actually now propagating itself, and no longer even looks like a hemorrhoid, and my main is increasing significantly.” I didn’t go back because it is an embarrassing thing to share, especially in my case to a male doctor. It put me in a weird place going into a medical establishment and saying, “Please, I want you to look into my butthole.”

Lesson #1: If they’re getting a lot worse, or even a little worse, or even just not going away and you want them to go away, you are entitled to go back to your doctor and have them give another look to what might be a hemorrhoid or what might be a fissure that is easier to treat sooner than later

When I eventually did go back in, I was told I had anal fissures which had made skin tags, and I was going to go in for a Botox injection to the skin around the anus, and they were going to cut off the skin tags. This was the winter of 2018-2019, and my Crohn’s disease was not yet diagnosed. None of my providers asked about my symptoms or stool consistency, which would have led them to a colonoscopy and IBD diagnosis. Instead, I met with a colorectal surgeon who scheduled the procedure without much conversation.

This first surgery failed. When they cut out the old skin tags and put in sutures in their place, the perianal skin (which was flaring with active Crohn’s disease) did the thing that perianal skin does when you have Crohn’s with perianal disease, which is that it doesn’t heal open wounds, and instead forms skin tags as it is trying to heal. The immense pain I was in from having sutures in a halo around my anus every time I sat or moved or passed stool was all for nothing because I had undiagnosed Crohn’s disease when this surgery happened.

Lesson #2: Getting your skin tags operated on when you have active IBD is not recommended, and can actually make your anal fissures worse. If you’re thinking about having a perianal operation, please ask to talk to a gastroenterologist first who can holistically analyze your fissures in the full picture of your bowel health

Because of this failed surgery, I was then sent to a gastroenterologist, who immediately took in my past 4 years of diarrhea with abdominal cramping and my family history of IBD as a clear suggestion of a possible IBD diagnosis in my future, and sent me to get a colonoscopy. When the colonoscopy showed severe ileitis, I was relieved to have an answer. I graduated college and moved to grad school, and started seeing doctors in a new hospital who got my Crohn’s under control.

My first GI in the new hospital was a man, and he was passable at his medical knowledge, but absolutely inadequate on anything to do with patient interaction. When I told him that now, two years after my first surgery, the grown-back skin tags were really bothering me, he is the person who accused me of cosmetic concerns. At this point, I had been sufficiently passed around enough providers to know that there surely was another provider out there who would listen to me, and that I did not need to put up with being told, “We do not do cosmetic surgery on the anus.”

I went to an outside hospital, didn’t like that provider either, and then came back to the first hospital, but to a woman in the practice instead of the man I had originally been referred to. She has been so endlessly wonderful. She listened to me when I told her how hard it was to keep the skin tags clean, and how they got really aggravated whenever I ran or hiked or did the things I love. With my Crohn’s disease no longer being active in the perianal skin, and my fissures having healed in this time, I was able to get a referral from my GI to a colorectal surgeon.

Lesson #3: If you are not getting the care that you are looking for, you can switch providers. Medical providers are are providing you a service in exchange for payment. As in any other transaction, you can and should shop around to get the best service.

This surgeon was again so understanding, and she knew about the Crohn’s disease, and she knew I was worried about the tags coming back again (and coming back worse) if the surgery did not work. She had a very long and encouraging conversation with me, and we scheduled the surgery. There were some small complications (one of the sutures ripped through a lot of skin a few days post op), but she supported me through it all, and the skin tags did not come back. I’ve been anal fissure and anal skin tag free since April of 2021, and I absolutely love it.