Question: Dr.Lipnik , I have a problem with rectal itching. I’ve tried hemorrhoidal creams and they don’t help. What do you suggest?
Answer: Your problem involves several avenues for investigation by the treating physician. From the dermatologist’s perspective, one must investigate whether there is psoriasis involving the rectal area and the gluteal crease of the buttocks. Many times this may be the only area involved, but elbow or knee rash, scaly scalp, or pitted nails can help establish the diagnosis, and with the treatment of psoriasis, the itching disappears.
Sometimes a fungus infection of the thighs and buttocks will involve the rectal tissue. New internal antifungals, such as Sporanox, Lamisil, or Diflucan clear the eruption and itch. The newer antifungal creams can also be used. Sometimes a yeast infection, which occurs commonly after systemic antibiotics, causes the itching and redness, and yeast killing creams and medicines should be used to clear this infection.If these are not found, then other causes must be investigated. Some people show a gastro-intestinal hypersensitivity to coffee and spicy foods, these produce mucous and leakage. Eliminating these foods can sometimes produce dramatic clearing of the rectal itch.
Rectal discharge and fecal matter left on the skin are irritating. Cleansing after bowel movements with pre-moistened pads such as Tucks, or the use of Balneol, or a mild hand lotion on tissue, help with the cleansing process and avoid irritation.
Some persons with hemorrhoidal tags, excessive hair of the rectal area or very sensitive skin will find the use of a shower or bidet necessary for adequate cleansing. The rectal tissues are very sensitive and excessive scrubbing with soap (which is an irritant) should be avoided.
Inflamed rectal tissues are helped by use of a mild hydrocortisone cream, or lotion after bowel movements, and by morning and evening applications of the hydrocortisone. Sometimes internal steroids are necessary for severe itching and excoriated tissue. Your dermatologist or other treating physicians should prescribe many of the items mentioned.
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