The
“We treat people, not just problems.”
John L. Pfenninger, M.D.
(989)
631-4545
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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
is 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 does not, you can go back to them
later.
The final thing that we do to manage this problem
is to 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 does not 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 do not 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.
Copyright, 2011. John L. Pfenninger, M.D.
jw11/10