Colon and Rectal Center of Arizon
18275 N 59th Ave, Ste 146, Glendale,
AZ 85308
Adrienne Forstner-Barthell, M.D.
602-993-2622
PRURITIS ANI
Pruritis Ani, or "itchy butt", is
a frustrating and uncomfortable
disorder in which the affected person
develops severe itching around the
anus. Some patients don't describe
itching but will experience severe
burning or pain in the area. This
condition occurs as a result of
more than 100 different causes,
so it is often difficult or impossible
to find the source or cause in any
given patient. Your doctor will
examine you to try to get clues
as to the cause. Additional testing
may be recommended, including blood
work, biopsies of the area, colonoscopy,
and stool testing. Frequently we
don't find a source or cause --
most doctors feel in this case that
an environmental agent is causing
the problem, either a food sensitivity
or a chemical you use at home like
shampoo, soap or body lotions. The
following are tips for caring for
the skin of the anal area and may
help mitigate or eliminate the itching.
Your
goal is to keep the skin of
the anal area clean, dry.
Most
people will experience some
relief from itching within a
week. A cure may take four to
six weeks, or longer.
Recurrences
are common and to be expected;
try to follow these recommendations
as closely as possible
1.
Stop using any chemicals or agents
in the area except what you and
your doctor specifically discuss.
If you forgot to mention something,
call your doctor and let them know.
The tiniest bit of information may
help solve the mystery.
2. During bath or shower,
it is important that you keep other
cleansing products away from this
area. For example, shampoo will
naturally drain down into the anal
area when you rinse, and could be
the cause of irritation. After washing
with other skin care products (shampoo,
rinse, soap) wash the outside of
the anal area thoroughly with water.
Do not use soap in the anal area
(it is alkaline and will increase
discomfort). As the final step in
your morning shower or bath, cleanse
the anal area with hot water and
Balneol Lotion (Solvay Pharmaceutical,
Marietta, GA) applying it with fingertips
or wet cotton balls, then rinse
lightly afterwards. Balneol is available
hit and miss at pharmacies around
the area, and if available, is usually
located in the hemorrhoid section.
3. Dry carefully after cleansing.
Avoid abrasive trauma or vigorous
rubbing while drying – instead pat
the skin dry with a soft towel or
blow-dry the area with a hair dryer.
4. Following each bowel movement,
make sure the anal area is cleansed
of any residual stool. This is best
accomplished by washing with hot
water and Balneol Lotion. Alternatively,
a non-alcoholic towelette may be
used. Avoid the use of toilet paper
on irritated skin — never use colored
or scented toilet paper. Dry thoroughly.
5. If persistent fecal afterdrainage
occurs following your bowel movement,
rectal irrigation may be helpful.
Rectal irrigation is performed with
warm water, like taking an enema.
A Fleets Enema bottle is useful
for this purpose. The bottle should
be emptied of the Fleets enema and
filled 2/3 full with warm water.
After you have your morning bowel
movement, instill the enema, hold
it as long as you can and then expel.
The fleets bottle can be rinsed
after use and reused as necessary.
This will prevent fecal drainage
for several hours.
6. In the morning and at bedtime,
apply a thin cotton pledget or 4
x 4 gauze directly in the anal crease.
It should be small enough so that
you are not conscious of its presence.
You may dust the cotton with corn
starch if needed to keep dry. It
is important to change the cotton
pledget frequently during the day
if it becomes moist.
7. You will need to use a
barrier cream several times daily,
usually calmoseptine or desitin
or A & D ointment. .
8. Maintain a soft, large,
and nonirritating stool so that
it can pass through the anal canal
without causing mechanical or chemical
trauma. This may be accomplished
by the following:
Fiber
bulking agent such as Konsyl,
Metamucil, Citrucel, or Fibercon.
Begin with 1 teaspoon twice
a day with 6 – 8 glasses of
water each day, for two weeks.
After two weeks increase the
fiber to 1 tablespoon or scoop
twice a day with 6 – 8 glasses
of water each day. Drinking
plenty of water is very important.
.
Eat
a high-fiber diet that includes
8 – 10 glasses of water or juice
a day, plenty of fruits and
vegetables, and bran cereal
every day. Refer to the High
Fiber Diet handout in the Patient
Information section of this
web site.
9.
Avoid foods known to cause anal
irritation. These include dark colas,
spicy foods, citrus fruits and juices,
tomatoes, alcohol (yes, beer too),
coffee (regular or decaffeinated),
chocolate, nuts, popcorn, and milk.
Eliminate all of these from your
diet, then reintroduce them, one
at a time. If the itching returns,
permanently eliminate that item
from your diet.
10. Wearing cotton gloves
to bed can be of benefit to prevent
unconscious scratching while you
sleep.
11. After the blood work, colonoscopy,
fecal testing and biopsies as recommended
by your doctor, you may be started
on a steroid cream. It is important
you use this as directed. Misuse
of steroids in this area can permanently
damage the anal skin.
Major Causes of Pruritis
Ani
Idiopathic — "No
known cause"
Personal Hygiene
— Poor cleansing habits result in
chronic exposure to residual irritating
feces; conversely, overmeticulous
cleansing with excessive rubbing
and soap use.
Diet — Consumption
of large volumes of liquids: coffee
(caffeinated and decaffeinated,
coffee-containing products), chocolate,
citrus, tomatoes, spicy foods, popcorn
and nuts, tea, alcohol including
beer, milk and milk products, Vitamin
A and D deficiency
Anatomic Compromise
— Obesity, deep anal cleft, excessive
hair, tight-fitting clothes (tight
clothing or clothing that impairs
adequate ventilation), fistula,
fissure, skin tags, prolapsing papilla,
or mucosal prolapse
Systemic Disease
— Jaundice, diabetes mellitus, chronic
renal failure, iron deficiency,
thyrotoxicosis, myxedema, Hodgkin’s
lymphoma, polycythemia vera
Gynecologic Conditions
— Jaundice, diabetes mellitus, chronic
renal failure, iron deficiency,
thyrotoxicosis, myxedema, Hodgkin’s
lymphoma, polycythemia vera
Drugs — Quinidine,
colchicine, antibiotics (tetracycline),
IV hydrocortisone phosphate, ointments
or creams that contain “caine” drugs,
nonprescription medications for
personal hygiene such as perfumed
soaps and ointments that may containe
alcohol, witch hazel, or other astringents
This information is for guidance
only and should not constitute medical
advice. Adapted from Clinical Decision
Making in Colorectal Surgery. Wexner.
copyright 1995. pp51-53.
