Anal skin tags are common. They represent a kind of “wear and tear” of the anus. The skin and subcutaneous tissue of the anus is malleable and flexible, as it needs to stretch to accommodate the passage of formed stool and then shrink to close itself in the interests of continence. However, one consequence of the unusual elasticity of the perianal tissues is a propensity to swell. “Normal” swelling occurs because of defecatory distension of the external hemorrhoidal plexus, while “abnormal swelling” happens with external hemorrhoidal thrombosis, sepsis, surgical or traumatic wounds, and the edema of fissures. If perianal swelling is chronic, repeated, or severe, the stretched skin may not return completely to its normal contour when the swelling has gone. The residual stretched skin becomes a tag. Anal skin tags are not really a disease. They may be the results of a disease, but they do not have to be removed unless they are symptomatic. However, when they occur in patients with Crohn’s disease, surgeons are often reluctant to remove even symptomatic anal skin tags. What is your opinion?