Embarrassing rectal itch is tough to cure
DEAR DOCTOR: What can I do about persistent, intermittent rectal itch? I keep the area clean and dry and have tried numerous over-the-counter anti-itch medications and an anti-fungal prescription.
DEAR READER: Anal itching (pruritus ani) is a common condition affecting 1 percent to 5 percent of the population. It’s four times more common in men than in women and occurs predominantly between the ages of 40 and 70.
As for why the condition occurs, it’s generally due to small amounts of fluid stool that irritate the anal region. This may be because the stool itself is loose or because the anal sphincter is abnormally relaxed, allowing leakage. In both cases, fecal material irritates the area beyond the sphincter and causes itching, leading to excessive wiping or scratching of the region.
Other factors can lead to pruritus ani as well, including fungal or bacterial infections and chemicals from soaps, creams or wet wipes, either through direct irritation or through an allergy to these products. People with diabetes, those who are taking medications that suppress the immune system and those who have used multiple courses of antibiotics
are at increased risk of this type of infection. Hemorrhoids and psoriasis can be factors too.
The first step in treating pruritus ani is to eliminate practices that irritate the anal region. Start by washing the area — without soap — to remove any retained material. This can be done with a bidet, or through showering or bathing. Other steps: Use softer, more absorbent toilet paper to make wiping less irritating; make sure the anal area is dry before putting on underwear; and use a zinc oxide cream to help heal the anal area and create a barrier against further irritation.
As for food and drink, not only has coffee been associated with anal itching, other foods and beverages have been implicated. These include beer, cola, caffeinated tea, chocolate, citrus foods and drinks, tomatoes, chocolate, peanuts and grapes.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA 90095.