From the Guidelines
Hemorrhoidal skin tags can be managed with conservative measures at home in most cases, focusing on keeping the area clean, using topical treatments, and preventing irritation. The most recent and highest quality study 1 recommends non-operative management as the first-line therapy for complicated hemorrhoids, which includes dietary and lifestyle changes such as increased fiber and water intake. For hemorrhoidal skin tags, this approach can be applied by keeping the area clean by gently washing with warm water after bowel movements and patting dry rather than rubbing. Over-the-counter topical treatments containing hydrocortisone (0.5-1%) can reduce inflammation and itching when applied 2-3 times daily for up to one week, as suggested by the american gastroenterological association medical position statement 1.
Some key points to consider in managing hemorrhoidal skin tags include:
- Using witch hazel pads or sitz baths (warm water soaks) for 10-15 minutes, 2-3 times daily, to provide relief from discomfort
- Wearing loose cotton underwear and avoiding prolonged sitting to prevent irritation
- For pain, acetaminophen (up to 1000mg every 6 hours, not exceeding 4000mg daily) is preferable to NSAIDs, which may increase bleeding risk, as noted in various studies on hemorrhoid management
- If the skin tag causes significant pain, bleeding, or grows larger, medical evaluation is necessary as surgical removal might be required, considering the guidelines for anorectal emergencies 1
It's essential to note that skin tags form as excess skin after hemorrhoid healing and won't disappear completely without intervention, but these measures can effectively manage symptoms and prevent complications. The american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1 provides detailed information on various treatment options for hemorrhoids, including rubber band ligation, bipolar diathermy, direct-current electrotherapy, and infrared photocoagulation, but these are more relevant to the treatment of hemorrhoids themselves rather than skin tags.
From the Research
Treatment Options for Hemorrhoidal Skin Tag
- Rubber band ligation is a common treatment for hemorrhoidal disease, including skin tags, with a success rate of 70.5% to 85% 2, 3.
- Sclerotherapy, including polidocanol foam sclerotherapy, is also an effective treatment for hemorrhoidal disease, with a success rate of 93.3% 2.
- Injection sclerotherapy with 50% dextrose in water has been compared to rubber band ligation, with rubber band ligation showing a higher success rate in terms of resolution of anal protrusion, but with higher pain scores 4.
- Medical management, including stool softeners, topical over-the-counter preparations, and dietary modifications, is often the first line of treatment for hemorrhoids, including skin tags 5.
Considerations for Treatment
- The choice of treatment depends on the severity of symptoms, degree of prolapse, and patient preference 5.
- Rubber band ligation and sclerotherapy are generally considered safe and effective, with low complication rates 2, 3, 6.
- More invasive procedures, such as hemorrhoidectomy, may be reserved for recurrent or higher-grade disease 5.
Complications and Recurrence
- Complications from rubber band ligation and sclerotherapy are generally mild and rare, but may include bleeding, thrombosed external hemorrhoids, and bacteremia 2, 3, 6.
- Recurrence rates vary depending on the treatment and severity of disease, but are generally lower with rubber band ligation and sclerotherapy 2, 3, 4.