Randy Jacobs, M.D. Patient Education

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Pruritus Ani


Skin Facts: Itching of the skin around the anus (opening towards the rectum) is a common  complaint. This area of sensitive skin is exposed to irritating digestive products in the stool. Irritation may lead to an itchy rash, especially when stools are frequent. Gentle care and patience is needed for ongoing relief.


What causes pruritus ani?

Anal itching is usually an isolated skin complaint in otherwise healthy people, but in some it is part of a disorder involving other areas of the skin. Often, the rash is worsened by vigorous use of toilet tissue or scrubbing with soap and water. Some make it worse by using baby wipes or other cleansing pads. Whether pruritus ani is an isolated problem or part of another skin disorder, irritation from stools and from harsh cleansing agents (diaper wipes) after bowel movements keep the rash going. People may find that coffee, spicy foods, or milk products make it worse. These foods can irritate the digestive tract and may increase the number of stools or amount of mucus (liquid) secreted from the rectum. Certain people are unable to digest milk and are left with undigested irritating stools that sit on the anal skin to irritate, oxidize, and ferment.



Treatment is intended to reduce irritation of the anal skin. Unfortunately, it's impossible to eliminate all irritation, since it's impossible to avoid contact of the stool with inflamed skin. Careful thorough, gentle cleansing after bowel movements is very important. You should moisten toilet paper with lukewarm water as dry toilet paper doesn't cleanse as well as wet paper. Dry paper can also irritate your skin as it gathers more friction and pulling. Never use harsh soap or shampoo on the anal area. Cleansing with plain water in either the shower or bathtub will do the job. If you desire a gentle cleansing method, ask our receptionist for Cetaphil. Dr. Jacobs will prescribe you with a very soothing preparation, possibly an antifungal medicated salve combined with Pramosone cream and zinc oxide cream. Please apply the salve liberally with your fingertips after each bowel movement, at bedtime, and at other times during the day as directed. Do not apply any other remedy, suppository, or medicine to your rash. Only the prescription medicine, water, moist toilet paper, Cetaphil, and clean underwear should ever touch inflamed anal skin. Be careful to not touch your anal area with bare hands that may be contaminated with irritating or allergic substances such as creams, soaps, perfumes, chemicals, and other substances you come in contact with in your daily life. When symptoms resolve, you may use zinc oxide cream for routine maintenance. You may also use Replenishing Creams One and Two for safe low allergy skin moisturization.


What to expect from therapy?

Pruritus ani is frequently stubborn and may require months of local medication and gentle skin care. Pruritus ani often comes back. Therefore, don't throw your medicines away when you are free from itching, but keep them on hand in case your trouble returns. Some persons need to continue using the medications once or twice daily, indefinitely, since the itching returns whenever medications are stopped. I will repeat an important point: Anyone who has had pruritus ani should always keep soap off the anal skin and use only wet toilet paper for gentle cleansing after bowel movements. Gentle care is needed in treatment. The more you scratch, the worse the problem will become. If the medicines no longer control your itch, please notify Dr. Jacobs. Additional therapy may be required. Finally, understand that your diet may also need special modifications to fine tune your condition.