Management of Pruritis Ani (Itchy Bottom)

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This is not a substitute for direct care by YOUR doctor. Confirm with your doctor before following any of the listed recommendations.

1. DISCONTINUE ALL TOPICAL MEDICATIONS except those recommended by your doctor 

2. Do NOT over clean/scrub, as this may worsen your condition. Clean the area after bowel movements with toilet tissue, wipes, or use a bidet. 

a. Sometimes toilet tissue can increase the irritation in the area. As an alternative, you can use wipes or a bidet. If you do this, make sure the area is completely dry by either patting it with a dry piece of tissue or using a hair dryer on the COOL setting.

b. Check to make sure the baby wipes you have selected do not contain alcohol or other alcohol derivative. These dry the skin and can make your problem worse. 

3. Do NOT scratch.  It will just itch more and things will get worse.

4. If you notice some seepage of stool or extra moisture, try a wisped half of a cotton ball. Tuck gently into the anus. It will pass with the next bowel movement or remove it the next time you bathe. If you have a lot of moisture usually due to the humidity/temperature try adding a little cornstarch to the cotton ball.

5. Try a VERY small amount of zinc oxide or Aquaphor as a barrier cream to protect from irritants. You can also try Calmoseptine cream in the same fashion (applied as a   VERY thin layer). All of these creams should be applied once daily unless instructed differently by your doctor.

6. Avoid coffee, tea, cola, nuts (especially almonds), chocolate, and other caffeine containing foods and beverages.

7. Supplement fiber using the fiber guide provided: 20 - 35 grams per day (link at the bottom of the page).

8. Drink plenty of water: 64-96 oz per day. Caffeinated beverages not included.

9. If you still have symptoms, please return to clinic for repeat evaluation. Sometimes if unresponsive to the above treatments, a biopsy is required. 

K Markell and R Billingham. Pruritus ani: etiology and management. Surg Clin North Am. 2010 Feb;90(1):125-35, Table of Contents. doi: 10.1016/j.suc.2009.09.007.

S Siddiqi 1, V Vijay, M Ward, R Mahendran, S Warren. Pruritus ani.  Ann R Coll Surg Engl. 2008 Sep;90(6):457-63. doi: 10.1308/003588408X317940. 

Y Nasseri and M C Osborne. Pruritus ani: diagnosis and treatment. Gastroenterol Clin North Am. 2013 Dec;42(4):801-13. doi: 10.1016/j.gtc.2013.09.002. Epub 2013 Nov 7.