The
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"We treat people, not just problems." |
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John L.
Pfenninger, M.D. |
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Lori Oswald,
P.A.-C. |
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(989) 631-4545 |
Visit our Website at http://www.MPCenter.net
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Anal Fissures and Pruritus Ani ("itchy butt") |
Many patients present to our office with symptoms of severe itching around the
anus. Others come thinking they have hemorrhoids because they have experienced
bright red rectal bleeding. On physical exam, physicians often find an area
that is very sore and irritated with very fine cracks in the skin. These cracks
are called fissures. Some fissures are more external on the skin and readily
visible. Other fissures are situated more deeply inside. Your physician will be
able to determine at the exam which type of fissure you’ve had and what the
appropriate treatment is. If yours are the ones that are more visible, then
this handout is appropriate for you.
Many people feel that their itching is due to being "dirty down
there". Many times, it is over-cleansing that causes the problem. After
having a bowel movement, either wash with a washcloth and warm water or use
Tucks Medicated Wipes. A less expensive method is to use baby wipes that do not
contain alcohol. Scrubbing is not necessary. Just gentle cleansing.
It is important to use hypoallergenic soaps and shampoos. Many people with this
condition have fair skin. They are very sensitive to perfumes and dyes. I like
to recommend Aveeno, Oilatum, or Lever 2000 soaps. Anything that states that
it’s hypoallergenic would probably suffice. For those who really have problems,
they will also need to get a hypoallergenic shampoo. We use Envi.
It is important to use only white toilet tissue. The colored dyes in toilet
tissue can exacerbate the problem. In addition, white cotton underwear is
essential. An extra rinse may be necessary when washing underwear if people
really have sensitive skin.
I like to help the immune system as much as possible to resolve the situation.
I always recommend a good multivitamin, a total of 1000 mg of vitamin C per
day, and 400 IU units of vitamin E. In addition, the herb echinacea (available
at food stores and health food stores) taken 2-3 times per day is also helpful.
You should really avoid any offending foods. Common items are coffee, anything
spicy, and acidic items. Try eliminating foods to see if it makes things
better. If it doesn’t you can go back to them later.
The final thing that we do to manage this problem is to often prescribe a drug
called Atarax. It is actually a strong antihistamine and its only side effect
is that it can cause drowsiness. Subsequently I recommend that people take
25-50 mg an hour before bedtime. Many times the scratching of the anal area
makes the problem worse. It often occurs at night. If we could just eliminate
the nighttime scratching, things often improve. One can actually take up to a
100 mg of Atarax at bedtime. Men with prostate problems should go very slowly
because this can sometimes make that worse.
At times, a hydrocortisone cream or suppositories may also be prescribed. One
has to be careful not to overuse these since they will thin out the skin and
actually make the problem worse. At times Xylocaine Ointment can also be
prescribed. This merely numbs up the area. It doesn’t treat the condition, but
again it tries to avoid the itch-scratch cycle which can often make things
persist and get worse.
For those with fissures that are deeper inside, suppositories may be tried and
other ointments. If they don’t resolve within three months, surgery may be indicated.
Your physician will tell you which if any of these approaches he wants you to
take. Generally a follow-up visit is required in one month.