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Rectal itch

  Have hemorhoids which bleed a little with each bowell movement.  No constipation; however stool at beginning of bowell movement is very hard and thus painful and normal thereafter.  Have a rectal itch both internal and external extending approximately two inches all around the annus.  Itch has been almost constant for about one and a half years.  Itch is very intense at times.  Have been prescribed Proctofoam, hemorhoidal HC, and have also used Preparation H.  Former two meds provided no relief.  Preparation H has only relieved itching and burning for thirty minutes or so.  Have tried several prescribed creams for external itch and none brought relief.  Doctors unable to determine cause - any suggestions, help appreciated.
Dear Rose M,
Thank you for your question regarding rectal itch ( The medical term is pruritus ani).  This condition is very common in the adult population.  Approximately 5-10% of patients presenting to a colorectal surgeon have pruritus ani as the chief complaint.  
The public perception is that pruritus ani is associated with hemarrhoids, but this is incorrect.  Most people with rectal itch do not have a specific disease as the cause.  The symptom is the result of the perirectal skin breaking down because of excessive moisture and rubbing when wiping after a bowel movement or during bathing.  In addition to itching patients, will often have a mucous discharge from the rectum.  On examination the skin around the anus may appear moist, red, and cracked.  
The basic aims of treatment are 1) to keep the skin of the anal area clean and dry and  2) to avoid injury to the skin from excessive wiping, rubbing or scratching.  This will allow the skin to heal and the itching will resolve.  Several general suggestions follow:
a) When showering or bathing avoid the excess use of soap, especially rubbing the bar in the anal area or rubbing the washcloth at the site of itching. The soap residue can remain in this area for several hours and will irritate the perianal skin. Additionally, soap is alkaline and will alter the normal acidity of the skin
b) After bowel movements wash the anal area with water or use moist cotton or tissue. PAT the area dry. DO NOT RUB WITH TOILET PAPER.  If the symptom is very uncomfortable a hair dryer can be used to dry the area.
c) During the day have a thin piece of cooton  (drawn off the side of the roll of cotton; DO Not Use a cotton ball) placed directly against the anus.  This will facilitate keeping the area dry.  The cotton should be thin enough that you are not aware of its presence.  The cotton may be dusted with baby powder or cornstarch.  Change frequently for maximal dryness.  A snaitary napkin is NOT a substitute.
d) Take a Sitz bath morning and/or night. Remember no soap and pat dry!
e) Avoid Preparation H, other creams and lotions.  Application of these substances keeps the anal skin moist and promotes breakdown.  In some cases, steroids may be tried.
f) Wear gloves at night if you scratch in your sleep.
If you have pruritus ani without any disease cause, you must remember that recurrences are common.  The cotton pledget should be the first treatment started and the last abandoned.
There are several conditions that can cause rectal itch.  Children can be infected with pinworms.  Adults can have premalignant conditions.  If conservative treatment does not improve the symptoms, you should have a biopsy of the anal skin looking for Bowen's and Paget's diseases.  Finally, if you have leakage (incontinence) of feces (which can be due to several etiologies) you may get skin macerat ion of the anal skin.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution in order to obtain additional information regarding conservative treatment or to have a biopsy, please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Eggenburger.  He is  one of our colorectal surgeons who has extensive experience with this problem.
*keywords: pruritus ani, rectal itch

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