The Skin Tag You Are Ignoring Might Be Telling You Something

Most people who discover a small lump or tag of skin near their anus either panic immediately or quietly ignore it. Both responses miss the point. This is usually not cancer, it is not dangerous, and it is telling you something useful if you know what to look for.

What Is an Anal Skin Tag?

A small, soft flap of skin near the anal opening. Unlike the skin tags that sometimes appear on the neck or armpits, anal skin tags almost always have a specific origin story. They are not random. They are a sign that something has happened in that area - usually repeated inflammation or a healed fissure.

What Is a Sentinel Tag?

A sentinel tag is a specific type of skin tag that forms at the top of a chronic anal fissure. It develops over months or years of recurring inflammation - the repeated irritation gradually stretches the skin until a small, floppy flap forms. It is called a sentinel tag because it stands guard at the site of the fissure, marking where the problem is.

A sentinel tag is what Dr. Urquhart describes as pathognomonic of a
chronic fissure - meaning its presence alone is a strong indicator of the underlying condition, even before any examination.

Does a Skin Tag Mean I Have a Fissure?

Not necessarily - but it is a strong signal worth paying attention to. The different origins include:

• Sentinel tag from a chronic or recurring fissure - the most common cause described by Dr. Urquhart 
• Residual tag from a previously resolved haemorrhoid
• Post-surgical tags can form after haemorrhoid treatment in some cases

The honest answer: you cannot diagnose the origin from the outside. If you have noticed a tag and are uncertain where it came from, a GP or colorectal surgeon can give you a clear answer quickly.

Is It Dangerous?

The tag itself is not. It is a cosmetic and symptomatic issue - it may cause mild discomfort, make wiping more difficult, or occasionally become irritated. It is not pre-cancerous and does not become cancerous.

What matters is what the tag might be signalling underneath. If there is an active or chronic fissure that has not been treated, that is what needs attention - not the tag itself.

What About the Fissure Underneath?

If a sentinel tag is present, there is almost certainly a fissure at some stage of its history. That fissure may be:

• Still active and causing pain - in which case treatment is needed
• Healing or healed - in which case the tag may remain as a remnant even after the fissure resolves
  

If the fissure is left untreated, Dr. Urquhart outlines what can develop: fistulas (abnormal tunnels between the inside and outside of the anal canal), and perianal abscesses, which require more complex intervention. This is not meant to alarm - it is meant to motivate action before things progress.

Should I Get It Removed?

In most cases, removal is not necessary unless the tag is causing significant discomfort or hygiene difficulties. If the underlying fissure is treated, the tag may reduce in size over time as inflammation settles. A colorectal surgeon can advise based on examination. 

What Should I Do If I Notice One?

• Do not panic - a skin tag near the anus is almost never something serious on its own
• Do pay attention to whether it is accompanied by pain, bleeding, or changes in bowel habit
• Do see a GP or colorectal surgeon if it is causing discomfort, or if you are unsure of its origin
• Do take care of the surrounding skin - keep the area clean, wipe gently, and consider a barrier ointment to reduce ongoing irritation
• Do not attempt to remove it at home

Want to hear it straight from the surgeon?

This article is based on our interview with Dr. Hamish Urquhart on The Hole Conversation, the Happie Holl podcast. Tune in to hear the full conversation - including the bits that did not make it into print.

Listen now at happieholl.com.au or search "The Hole Conversation" wherever you get your podcasts.