Pruritis ani is defined as a chronic itching of the skin around the anus. There are many causes of the disorder, but the most common type can be managed without medication. The key to managing the problem is to minimize mechanical trauma to the area. Other recommendations include:
- As mentioned above, reduce mechanical trauma to the area, as this can aggravate the skin and cause more itching, prolonging the problem. Do not scratch or rub the anal area.
- After bowel movements, use very soft tissue paper and gently wipe only enough to clean the area (e.g., avoid wiping vigorously, or using a soap and water/washcloth to clean the area after BMs). Aloe vesta cleanser can be used after BMs.
- Do not use soap and water to clean after a BM. The soap and water is drying.
- Eliminate all ointments, creams, and lotions (such as Tucks, witch hazel, over the counter medications) other than those recommended or prescribed. Many of these contain alcohol, which dry the skin and cause further itching, or they contain perfumes, which can further irritate the skin.
- When showering, use an unscented/nonreactive soap (such as vanicream) and shampoo. Use just enough soap to clean the anal area and rinse thoroughly. Do not use a washcloth to clean the anal area. Once out of the shower, allow the area to air-dry thoroughly, or use a hair dryer. If a soft towel is used, pat the area, do not rub.
- Soak the area in a warm sitzbath for 10-15 minutes 2-3 times daily. Dry the anal area as above.
- While the anal area is still wet, generously apply Vanicream lotion to the entire anal area. Allow to air dry. This can take several minutes.
- Hydrocortisone ointment can be used for up to 1-2 weeks for symptom relief if directed by your doctor, but long term use is discouraged (it can cause skin thinning and suppress the local immune system). Hydrocortisone may be compounded with quaternary ammoniums, to which some people may have a reaction.
- Antihistamine agents, such as Benadryl or hydroxyzine, can be helpful for night-time symptoms.
- Begin fiber agents (see high fiber handout) to maintain a soft, large, non-irritating stool.
- Dietary changes are more controversial, but may provide additional relief. Avoid jalapeño peppers, tomatoes, coffee, chocolate, citrus, spicy foods, tea, beer, sodas with caffeine.
- Keep the anal area dry (wear cotton underwear, avoid tight clothing; for women use stockings instead of tights or pantyhose). Do not use talcum powder.
It will take at least 2 weeks of rigorous adherence to this for symptoms to improve. For people with a longer-standing condition, it may take longer. Don’t become frustrated if the condition re-occurs, because this is common (but tell your doctor). For severe skin breakdown, a barrier ointment such as aloe vera ointment, calmoseptine, or zinc oxide can be used after BMs.