more perianal crohn's questions

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Regular Member

Date Joined Aug 2009
Total Posts : 377
   Posted 12/10/2009 7:51 AM (GMT -7)   
I'm sorry to beat this into the ground, but I just have so many questions regarding this. I have Crohn's colitis. My GI never mentioned anything about perianal Crohn's, but I've heard it was common to have it if you have Crohn's colitis. I just went to my GI's office, and I saw his Physician's assistant, because I've been having bleeding and pain when I have a BM, and sometimes just pain around my anus even not just following a BM. I wake up in the middle of the night with it throbbing.

Anyways, the P-AC examined me, and said I have a fissure and hemmies. I have no fistulas or abscesses, thankfully! Now I'm assuming since he works in a GI office and has seen many patients that he would know the difference between a hemmie and a Crohn's skin tag. From what I've read about Crohn's tags, it says they are normally flesh colored and painless, and they shrink when you are in remission. Well, mine have never shrunk (even after I went into remission) they're not skin colored- they're actually really red and look inflamed, and they're really painful. Does that possibly mean they really are hemmies?

So I guess my questions are:

1. How does your doctor know the difference between hemmies and tags?
2. Is it true that the skin tags don't hurt- what's your experience?
3. If I don't have fistulas or abscesses, does that probably mean I don't have perianal Crohn's?
4. For those of you who know you have perianal Crohn's, can the flare just feel like pain around your anus when you otherwise feel fine (no
fevers, good energy, no other feelings of sickness)
5. Since I haven't had anyone try to remove the tags or hemmies, if they really were tags, shouldn't they at some point shrink?
6. Can people with Crohn's just get hemmies, and not actual skin tags?

Sorry for the questions, I just don't know what to think. I thought the visit to my GI would clear things up, but I've actually become more confused.

Veteran Member

Date Joined Jan 2007
Total Posts : 656
   Posted 12/10/2009 8:11 AM (GMT -7)   
I don't have all your answers, but I do have one. My husband--who doesn't have Crohn's or any other chronic condition--has hemorrhoids and developed an incredibly painful fissure at one point. He let it go for so long that he had to have it surgically repaired. In addition, I had a perianal abscess and fistula--but was told by my colorectal surgeon that neither was connected to my Crohn's Disease (which has always been confined to my terminal ileum). He told me that many people with no chronic diseases can get perianal abscesses and fistulas.

So your fissure and hemorrhoids are not necessarily an indicator of Crohn's. Anybody can get them.

Veteran Member

Date Joined Oct 2008
Total Posts : 1343
   Posted 12/10/2009 1:10 PM (GMT -7)   
An anal fissure is generally accompanied by a "sentinel pile" (see Perhaps that's what you have?
34 years old, Crohn's disease for 15 of them
Resection of ileocecal valve on 09/22/09
Current Meds: Pentasa, Effexor XR, Zyrtec
Supplements: 3 kinds of Fish Oil, Multi-Vitamin, B-Complex, Vitamins D, E, & K, Calcium, Magnesium, Enzymes
SCD since 12/01/08 - eating Stage 3 foods

Regular Member

Date Joined Oct 2009
Total Posts : 253
   Posted 12/10/2009 1:22 PM (GMT -7)   
I also have a question about perianal crohns, as I've just kinda realized I must have it (with the discomfort after BMs and itching and skin tags etc.). I just went on prednisone last week and I'm feeling miles better, and have been having very normal, fully formed BMs. However they are accompanied by a tiny bit of fresh blood when I wipe and I think it's just cause that area isn't used to fully formed stuff coming out so it's irritating it a bit... is this likely?
Sorry if that's TMI!
female 19, diagnosed crohns december 2008
erythema nodosum
currently taking 40mg prednisone, then imuran or remicade when i taper
feeling scare about side effects but will be happy to feel better :)

Veteran Member

Date Joined Jan 2007
Total Posts : 656
   Posted 12/10/2009 3:08 PM (GMT -7)   
If you have a fissure, it will often bleed when you use the bathroom, particularly if you pass something firm. If the blood is red and fresh-looking, it's coming from your anus, and not from somewhere up inside your system. While you have the fissure, you may need to take stool softeners to prevent this from happening. You may also want to speak to your doctor about topical diltiazem (I think that's what it's called)--which helps to prevent your muscle from going into spasm when you poop. Using it may heal a new fissure and/or relieve some of the pain.

not creative
Regular Member

Date Joined Mar 2007
Total Posts : 469
   Posted 12/10/2009 4:48 PM (GMT -7)   

I have crohn’s colitis and skin tags. I have had many many (almost every) non-GI doc think they were hemmies- they are not. Here’s what I can give you based on my experience/knowledge:


1. I would say it’s likely they are tags because they are just so common with perianal crohn’s. They can get bigger or smaller due to the level of disease- but mine have only ever gotten bigger or stayed the same.


2. My don’t hurt unless I have a fissure on them or I have a rash from the moisture. They are just there and mine are very extensive, they surround my entire anus and look like little mountains. Still, they don’t generally hurt. They are flesh colored and are a pain to keep clean. Sometimes, they will throb after I use the bathroom, especially in a flare. They can also be very itchy (if this is very bothersome, prep-h works wonders).


3. Not at all- I now have three fistulas with setons, but that just happened this year, I went many years without anything worse than a fissure. Unfortunately, in my case at least, the development of the fistulas/abscesses coincided with a significant progression of the severity of my disease. I went from Asacol tablets to biologics pretty quickly.


4. A flare is different for everyone- I’ve been flaring constantly for the past 3 or so years. My disease just keeps getting worse. I measure by how much medication I need- about 4 years ago, even though I had already been diagnosed, I didn’t take any meds. I would just have some paid and D if I ate really badly but otherwise that was it. Now, the Cimzia is helping but I still have some issues. I guess that’s not a very good answer, but it’s my experience.


5. If they are tags, they should shrink down (maybe not completely) when the inflammation lessens. If they are hemmies, they could probably shrink too, but hemmies are treatable, tags are not. Every Dr I’ve ever asked said it’s a bad idea to try and remove the tags because they comprise of sphincter muscle.


6. I’m guessing they could the same as anyone.


Laurenne, 25 Graduate from University of California, Davis. BA-Anthropology
Dx'd w/ IBS and CD in 2002. Three abscesses that are now fistulas, with three setons!
On: 6MP, Zoloft, Cimzia (working so well, I'm on Miralax too!), folic acid, b12
Tried: LDN- Did nothing good, Remicade- allergic, Humira- no reaction

Julia Hill
Veteran Member

Date Joined Mar 2008
Total Posts : 560
   Posted 12/10/2009 6:39 PM (GMT -7)   


I say that all of the above are a pain in the butt haha!  I have a crohn's ulcer the size of a 50 cent piece in the rectum area.  This is very painful and hard to heal.  Remicade is the only med that helped me with that.  I also have an abscess that forms a  rectal/vaginal fistula pops, drains, the humira heals the fistula and the abscess pools again.  Lots of fun!  Ask as many questions as you need to, because there always seems to be a piece of the puzzle missing.  You certainly aren't alone in this venture.

All the best,



Elite Member

Date Joined Feb 2004
Total Posts : 20577
   Posted 12/14/2009 12:53 PM (GMT -7)   
1. A good GI or colon and rectom surgeon will know the difference betwen the 2 (have you seen the link I've posted before that shows pics of hemmies and pics of perianal crohn's skin tags? They are quite different from one another).

2. My skin tags often hurt, some people have no pain issues with them, alot depends on the severity and if they're in a flare or not.

3. No, perianal crohn's can consist of fissures/fistulas/anal tags.

4. Yes

5. Yes, they can shrink up on their own (often depending on how active your disease is will depend on if they'll shrink up on their own or not) rectal meds can also help shrink them down too. All my specialists warned me not to attempt getting mine removed (they are in a severely flared state since getting them banded when they were mis-DX as hemmies) I was told that they woulndn't likey heal and instead would remain an open wound leading to constant infections and such.

6. Yes, and people with just hemmies can end up with an anal tag left behind from the hemmie, but again, those tags are not the same as perianal crohn's skin tags.

Hope this helps :)
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