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Suggest treatment for itchy anus despite using Cortisone cream

Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2380 Questions

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Posted on Mon, 6 Nov 2017 in Digestion and Bowels
Question: r the last 6 months i have had very very itchy anus. it mistly happens at night amd wakes me up in my sleep. i have taken a worming tabket twice used cortisone cream nappy. cream hemmoroid cream feel like ive tried everything. it feels like a wriggly feeling at night. with an intense urge to scratch. i have had a past of bum troubles constipation of late ( im hypothyroidism) hemmoroids etc but this itching is driving me insane!! how do i stop it? dr gave me two different cortisone creams but at night is tje worst. doesnt wake me every night but most on amd off .
doctor
Answered by Dr. Ramesh Kumar 5 hours later
Brief Answer:
please follow the detailed answer below.

Detailed Answer:
Hello,
Thanks choosing HealthcareMagic for your query.
I've gone through your details and I appreciate your concerns.

The diagnosis of the cause of anal itching requires examination of the anus.
Basically, Pruritus ani is the irritation of the skin at the exit of the rectum(the anus), causing such desire to scratch.

The intensity of anal itching increases from moisture, pressure, and rubbing caused by clothing and sitting.Itching can be mild or severe. The itching is usually worse at night. Typically over time, the itching worsens.

The acute trauma to the skin leads to anal burning. As the wounds heal, Histamine is released. Histamine causes itching of the skin. When a patient scratches aggressively multiple micro cuts and abrasions develop which cause the severe burning.

Caffeine is strongly associated with idiopathic anal itching. The more caffeine the more severe the itching.

Avoid citrus fruits.
Analpram 2.5% can be used. It has an anti-itch medication called Pramoxine which is mixed with a powerful steroid.

Calmoseptine ointment is a non-steroid ointment that can be used as much as necessary. It is comprised of Calamine lotion and Zinc oxide. The Zinc oxide coats the skin protecting it from irritants and the Calamine lotion soothes the itching.

Let me know if I can assist you further.
Thanks!


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramesh Kumar 15 minutes later
its been 6 months i feel i have tried every cream including zinc advantan and novasone . do o have to live with it or is it something sinister?
doctor
Answered by Dr. Ramesh Kumar 9 hours later
Brief Answer:
Methylene blue injections.

Detailed Answer:
Hi again,
If the intensity of problem is that much and medications are not helping then destructive procedure is to be used.
You may be benefited from injectable therapy. This particular therapy is saved for patients with persistent and intense pruritis ani like in your case
Methylene blue is a XXXXXXX which can be injected into the skin and may relieve symptoms by causing destruction of the nerve endings.
As nerve endings are damaged you won't feel these weird sensations any more.
You should consult a quaternary care medical centre for this therapy.

Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 8 minutes later
i dont want toxins in my body and sounds dramatic. dr in australia wont do that for me. what else can i do? why does it only happen at night? is 2 worm tablet enough? could it be something underlying?
doctor
Answered by Dr. Ramesh Kumar 13 minutes later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
One of the characterstic feature of pruritus ani is that it worsens at night so intense itching at night time is common with this problem.

If you suspect it to be related to worm infestation then before taking albendazole go for a stool microscopy test the number of days and potency of medication to be used depends on the nature of worm infesting you.
However in general you can take it for 3 days.
Albendazole 400mg 1 HS at night for 3 days.
What are you using for hemorrhoids?
Are they internal or external?
Grade of hemorrhoid?
Have you taken calcium dobusilate?

It could be related to poor management of hemorrhoids.
Was a colonoscopy ever done on you?
Blood profile?
Stool test?
Waiting.



Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 25 minutes later
i haf a colonoscopy done aboit 7 yrs ago.. bloods tests are normal just hypothyroidism which i am tteating and anemia which i am treating have thallesemia minor. my hemmoroid is internal pops out every now amd then no pain. dont take the calcium not sure whay that is. i drink prune juice daily so i can go otherwise no matter what i do im always co onstipated. what is the best management for internal hemmoroids and to stop it for good as ot beem a problem 9n and off for r nearly 10 yrs. im f 35.
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Follow up.

Detailed Answer:

As per your history your case appears to be grade 3 hemorrhoid (i.e.hemorrhoids prolapse and usually require manual reduction).

As per the protocol stage 1 to 3 are managed conservatively while surgery is done on stage 4 hemorrhoid.

Suggestion for conservative management are-

Start taking Syp. Lactulose 10-15ml once daily before going to bed. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Don't just use any stool softener.
Constipation should not be there at any cost

-Secondly, continue using PreprationH
Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate(its not calcium)-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.

Add Metamucil/Fybrogel to your regimen. It's a natural laxative containing husk. It absorbs water from the intestine and swells up making passage of stool easy and add bulk to stool.

-A probiotic should also be taken regularly with these medicines. Probiotic improves overall digestion and relieves constipation.

However, if not relieved even after 3 months of aggressive therapy proceed for Rubber bands ligation- inexpensive and are easy to deploy. It's a daycare procedure usually done under local anesthesia. The success rate varies from about 70-80%.

Strict lifestyle modification should be followed along with medications-

Take simple organic and vegetarian home cooked low-fat food for few days.
Avoid alcohol, smoking aerated beverages, junk food like pizza burger etc.

Take lots of probiotic rich food like yogurt.
Increase your fiber intake take oats, wheat, barley, vegetable and fruit like Pear, apple, and oranges.

No aerated beverages.
Take fiber containing easily digestible food.
Avoid red meat.
Drink a glass of lukewarm water before going to the washroom in morning.
Take Sitz bath.

Hope I provided you with the information you wanted.
In case you need further advice feel free to ask.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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