Perianal skin tags: Perianal skin tags are small folds of skin around the anus—a harmless condition, but one that is often confused with hemorrhoids and anal folds

Marisks are small skin folds in the anal area that are partially visible from the outside. These skin folds usually consist of soft or loose skin. However, they can also swell and develop into firm lumps—especially in cases of chronic inflammation, straining during hard bowel movements, or other pressure on the anal ring.

They are often perceived as a cosmetic or hygienic problem, although they are generally harmless from a medical standpoint. Nevertheless, they can make anal hygiene more difficult. The skin may form a single marisken or several. 

They are widespread in the general population: skin tags are very common. Many people develop skin tags over the course of their lives without really noticing them. 

Anal tags do not require treatment, but they often occur alongside other conditions such as anal fissures or chronic anal fissures; therefore, a thorough evaluation is important to identify any potential underlying causes.

The causes of the development of skin tags—harmless folds of skin at the anal opening—are only partially understood.

In general, diseases and conditions involving increased pressure in the rectal area (e.g., chronic constipation, pregnancy, childbirth) are risk factors for the development of skin tags. In some cases, they are a concomitant symptom of the following proctological (rectal) conditions:

• anal fistulas (pus-filled drainage channels),
• anal fissures (tears in the anal mucosa),
• anal vein thrombosis (lumps at the anal opening), or
• Crohn’s disease or ulcerative colitis (chronic inflammatory bowel diseases)
• Genital warts

Generally, these skin tags occur in about 60 percent of the population—more frequently in women, typically starting as early as age 20, and in men, starting around age 40. 

THERE ARE TWO TYPES OF SKIN TAGS:

Primary anal tags develop without any apparent cause. Genetic predisposition plays a role here.

Secondary skin tags often occur as a result of other changes in the anal area. 

Pregnancy and childbirth are also particularly relevant factors. Hormonal changes and pressure on the pelvic floor cause many women to develop marisks. 

In fact, about 75 percent of women and approximately 70 percent of men develop this condition at some point in their lives.

It is not uncommon for non-medical professionals and those affected to confuse marisks with enlarged hemorrhoids. However, they are different conditions affecting the anal region.

Hemorrhoids are ring-shaped vascular cushions supplied by arteries beneath the rectal mucosa. They are not a disease but rather ensure the fine closure of the anus and continence—that is, the controlled retention of stool. Only a significant enlargement of hemorrhoids is considered pathological, particularly when they protrude from the anal canal and are visible externally. In this context, medical professionals refer to this as hemorrhoidal disease.

Unlike hemorrhoids, marisks are not vascular cushions but merely flaccid, prolapsed portions of the anal canal skin and do not require treatment. However, in cases of hemorrhoidal disease, the skin of the anal canal can be displaced outward. Accordingly, skin changes around the anal opening may be an indication of underlying hemorrhoidal disease. Marisks can be a consequence of hemorrhoids.

Marisken (small fold) at the anal opening © Armin Kübelbeck, CC-BY-SA, Wikimedia Commons

Anal folds are generally harmless and usually do not cause any symptoms. They therefore tend to be more of a hygiene and cosmetic issue.

However, if anal hygiene is severely impaired by these skin folds, marisks can also lead to problems. This is because poor anal hygiene increases the risk of infections, such as those caused by bacteria or fungi. 

Typical symptoms caused by marisks may include:

• Itching
• Burning
• Skin rashes (anal eczema)
• Sores in the anal canal
• Spotting that may be visible on underwear or toilet paper
• Difficulty with anal hygiene

The symptoms are usually mild, but they can interfere with daily life and cause discomfort.

Marisks are very easy to diagnose, as they are diagnosed by visual inspection. They are usually visible to the naked eye and can be diagnosed by a proctologist during an inspection (the medical term for an examination by simple visual observation). Consequently, no further diagnostic tests are necessary to diagnose marisks.

However, since marisks, as mentioned, are sometimes associated with other conditions of the rectum, the anal and rectal areas are nevertheless carefully examined. A digital rectal exam (palpation with a finger) is therefore recommended to identify any abnormalities. This may help identify any additional hemorrhoids or hidden tears (anal fissures). Anal thromboses, anal carcinomas, and benign connective tissue tumors may also be associated with marisks.

If suspicious findings—such as palpable wall thickening, pain, or bleeding—are noted during the digital rectal exam alone, a rectal examination (rectoscopy) or an examination of the entire large intestine (colonoscopy) is usually ordered. 

Anal tags are usually harmless, so treatment is only necessary in rare cases. In any case, careful and gentle hygiene of the anal area is recommended. You should clean your anal region with a damp cloth after each bowel movement. Use plain water (on toilet paper or a disposable washcloth) and avoid soaps or disinfectants. Even moist toilet paper can cause skin irritation due to the preservatives and fragrances it contains. Also, always pat the anal area dry gently.

If you experience discomfort, zinc ointment can be used temporarily. If anal eczema has developed, you can treat it with hemorrhoid ointment or sitz baths containing oak bark or chamomile.

See a proctologist if your symptoms do not improve, persist, or if you are prone to large skin tags. Surgical removal of soft marisks (marisk excision) is recommended only in cases of impaired anal hygiene with secretion buildup and diseases of the anal skin. During the procedure, the skin flaps are removed with an electric scalpel under local anesthesia. Even in the rare cases where anal tags 

• become painful or 
• become trapped or 
• obstruct bowel movements or lead to 
• lead to continence problems (inability to control bowel movements), 

surgical intervention may be necessary.

The removal of skin tags is a minor procedure. Skin tags only require surgical treatment if they cause severe discomfort or become repeatedly inflamed. The procedure is performed under local anesthesia. It involves the straightforward removal of excess skin.

Healing proceeds without complications in most cases. The prognosis for skin tags is very good. Sitz baths, rest, and careful wound care support the healing process.

To prevent marisks and reduce the risk of new ones forming, the following are recommended:

• a diet rich in fiber
• adequate fluid intake
• Physical activity
• Caution when straining (during bowel movements)
• good anal hygiene

Complete spontaneous resolution of hemorrhoids is possible, but not guaranteed.

Both are usually harmless; skin tags are benign skin lesions

Yes, especially with prolonged pressure or repeated irritation, multiple skin tags can develop at the same time. 

Marisks often develop during pregnancy because the tissue softens and there are changes in pressure distribution.

When do skin tags need to be removed?

Hemorrhoids need to be surgically removed only if they cause significant impairment or chronic symptoms.