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Instructions for Managing Perianal Itching [Pruritis Ani]

Definition:
Perianal itching (pruritus ani) is a common problem involving caused by irritation and rubbing of the perianal skin. The main symptoms or burning discomfort, moist drainage or weeping from the anal skin, spotty bleeding on toilet tissue and intense itching, particularly at night. The symptoms induce patients to try to rub or cleanse the area more thoroughly, which only contributes to the ongoing irritation.  Perspiration in the area caused by wearing polyester or non-absorbent clothing will enhance symptoms. The treatment of pruritis ani is to reduce the inflammation and break the cycle of rubbing and scratching.

 

Treatment:

  1. The basic aim of treatment is to keep the anal skin clean and dry, and to avoid continuing injury to the skin from excessive wiping or abrasion.
  2. Apply 1% hydrocortisone cream or ointment on the skin in a small amount twice a day.  If troubled by itching during sleep, it is helpful to wear cotton gloves to prevent yourself from scratching.
  3. When showering or bathing, avoid the use of perfumed soap. Especially avoid rubbing the anal area with the bar of soap or washcloth. Soap is highly alkaline and the residues collect in the folds of skin causing irritation and altering the normal acidity of the skin. Avoiding soap in this area completely is preferable.
  4. After bowel movements, instead of wiping vigorously with dry tissue ( sry tissue is made with wood fiber), use a flushable wipe or similar application. Do not rub.  Pat dry.  A non-medicated (corn-starch based) dusting powder can be used to keep the area dry. Do not use baby paper. It can cause infection.
  5. During the day, wear a thin piece of cotton drawn off a roll of 100% absorbent cotton. The cotton strip should be thin enough so that you are not conscious of its presence. Do not use rayon cotton balls or cosmetic puffs. Change the cotton strip frequently, especially if you perspire. Wear cotton underwear. 

Diet:

  1. Avoid foods that produce gas, indigestion or loose stools.
  2. Foods that may cause increased mucus production include: tomatoes, ketchup, citrus fruits and juices, coffee, tea, alcoholic beverages, colas, nuts, popcorn, milk, chocolate, and spices. Avoid these foods or decrease their intake.

 

Pruritus Ani does not abate promptly. Have patience. However, if symptoms persist longer than a month or two, please call for re-evaluation.

 

Information provided by UMHS Division of Colorectal Surgery
December, 2007