The basic aim of treatment is to keep the anal area clean, dry, and to
avoid injury to the skin from excessive wiping or abrasion. Items in the diet that produce gas, indigestion or loose bowel should be avoided.
Foods associated with irritation of the bowels, producing mucus or aggravating drainage
include tomatoes (including ketchup), citrus fruits and juices, coffee and tea (including
"decaf" in excess of two cups a day), beer and alcoholic beverages, colas, nuts
and popcorn, milk, chocolate, spices (especially peppers). Some people
have anal itching only after certain foods (coffee, tea, cola, beer,
chocolate, and tomatoes) beginning 24 to 48 hours after eating them
and clearing up in a few days provided the more isn't eaten.
No matter what the
cause, certain rules apply. Wear cotton (dermal) gloves during the night to prevent yourself from scratching.
I can help you find these (Harriet Carter item B4914/5, 215-361-5151). Antihistamine pills
may be given for itch that disturbs sleep (both prescription and over the counter).
When showering or bathing avoid the use of perfumed soap. Especially avoid
rubbing the bar on the anal area or rubbing the itching area with a washcloth.
Soap is highly alkaline and the residues collecting in the folds of the skin cause
irritation and alter the normal acidity of the skin. Avoiding soap completely is
preferable. Use Cetaphil lotion for the shower.
After bowel movements, wash the anal area with water or use wet cotton or tissue.
Tucks Pads, hypoallergenic unscented baby wipes or absorbent cotton impregnated with Prax
lotion can be used for cleaning. Do not leave a wet dressing against the anal skin for any
protracted time. Pat the area dry with non-scented toilet paper and avoid rubbing with the
toilet tissue.
If your itching is worse following bowel movements or if there is an
"after-drainage," do a rectal irrigation using a 3 or 4 ounce bulb syringe and
warm water. A European style bidet is appropriate for severe and chronic cases.
During the day wear a thin cotton strip drawn off the side of a roll of absorbent
cotton (Red Cross Cotton/Johnson & Johnson). The cotton strip should be thin enough so
that you are not conscious of its presence. Do not use a cotton ball. Change the cotton
strip frequently. It is important to apply the cotton strip directly to the anus. A sanity
napkin is not a substitute. Wear cotton underwear.
Take a tub or Sitz bath morning and/or night in lukewarm water.
Apply the prescribed lotion, cream or ointment as directed by your physician
following a cleaning and drying routine.
This management program may be reduced or adjusted depending upon the control of
your symptoms. The cotton strip, should be the last measure abandoned and the
first measure to be resumed in the control of your problem.
Recurrences are common and to be expected. Call or plan to return to me if you
are unable to control your itching or if the situation worsens in spite of these measures.
A proctologist can sometimes help if this is due to some anal disease.
Grenz ray
treatments
can also be used. They give several months of help, but can only be repeated a
certain number of times. Oral antibiotics or antifungal agents may help others.