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Anal warts first appear inside and around the anus in the form of tiny spots or growths, report doctors at the american society of colon and rectal surgeons 1. Anal warts, also referred to as condyloma acuminata, can start as small as a pinhead and grow to about the size of a pea. surgical removal is an option for those who are struggling with anal warts. anal warts are found inside and around the area of the anus. They start as small bumps that may be no larger than the head of a pin. Anal wart removal there are different methods of anal wart removal. Oftentimes, doctors will recommend a topical treatment if the warts are small and located only on the area around the anus. In these cases, there are a few topical medications that remove those small warts. However, anyone with external warts needs to be examined for internal anal warts. Treatment may involve topical medications, liquid nitrogen, or surgical removal. Visible genital warts on the penis or vagina or around the anus are removed by excision, which means cutting the warts off with a surgical knife (scalpel). Warts on the cervix may be removed by laser or loop electrosurgical excision (leep). The procedure is usually done in a doctors office or clinic or an outpatient surgery centre. Anal warts are caused by the human papilloma virus, which is usually transmitted through sexual contact but not necessarily through anal intercourse. There are many types of human papilloma virus some cause warts on the hands and feet and others cause genital and anal warts.