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Pruritis Ani Management (04/02 RMD)
The Causes and Management of Anal Irritation
Anal irritation is principally a skin problem. Most people are aware of
how rapidly a severe 'nappy rash' will appear in a baby if it is left in
a wet or dirty nappy for hours or even minutes. Anal irritation is
frequently caused by a condition similar to a nappy rash. It is started
by the normal resistance of the skin being damaged by moisture or small
particles of faeces that can lurk in the crevices of furrowed skin
around the anus. The irritation makes you scratch, which in turn damaged
the skin, breaking the surface. This allows germs which usually abound
in the area to gain access beneath the surface and aggravate the
problem. Furthermore, many people apply creams or ointment they get from
their friends, the chemist or even the doctor. These can damage the skin
resistance or even produce an eczema-like rash similar to the type of
skin allergy that can occur to perfumes or detergents.
THE PRINCIPLES OF TREATMENT ARE TO KEEP THE ANAL SKIN
CLEAN & DRY, TO AVOID DAMAGE BY SCRATCHING OR RUBBING & TO AVOID
APPLYING IRRITANTS.
The Ten Rules
1. KEEP THE AREA CLEAN BY WASHING after every bowel action at night and
morning. The nightly bath is particularly important if you itch at
night. A bidet is ideal but sitting in a bath or a bowl of water is a
good substitute. A shower is also a useful way of cleaning. Make sure
that all the small particles of motion are removed from the skin
crevices around the anus. Baby wipes are great for washing the
anus after wiping your bottom.
2. AVOID RUBBING WITH A BAR OF SOAP or a rough flannel. Soap remaining
in the skin crevices can be very irritating. A few suds in the water and
the finger tips or cotton wool are all that are needed.
3. IF YOU ARE AWAY FROM HOME or good toilet facilities when you have to
pass a motion, use medicated wipes such as 'wet ones' or 'baby wipes'.
These provide better, gentle cleaning than hard paper.
4. KEEP THE AREA DRY. Dab the skin dry gently with a towel or very soft
paper. Do not rub. A hairdryer is the gentlest way of drying thoroughly.
5. AVOID EXCESSIVE MOISTURE. Never leave a wet dressing on the anal
skin. Wear cotton underwear, never nylon. Avoid any firm foundation
garment that presses the buttocks together. The free circulation of air
will prevent moisture accumulating. A loose skirt is better than tight
jeans. Avoid tights, use stockings or crutchless tights.
6. AFTER DRYING GENTLY keep a thin pledget of cotton wool dusted with
powder against the anus inside the pants. The pledget should be about
twice as large as a 50p piece and should be changed each time you wash.
7. AVOID PERFUMED TALCUM POWDER. This tends to collect into small, solid
lumps in the crevices and, also, the perfume may cause allergy. Zeasorb
or other special drying powders are better. Baby powder may also be
tolerated but it is not ideal. Use a Zeasorb to dust the cotton wool
pledget.
8. AVOID OINTMENTS & CREAMS unless specifically prescribed by a
specialist. Any greasy preparation tends to keep the skin soggy, which
is what we are trying to avoid. Many proprietary preparations are
hyperallergenic and should be avoided. Lotions may sometimes be
prescribed in the acute stage of the condition and are usually applied
after cleaning, before drying.
9. KEEP THE BOWELS REGULAR and smooth with plenty of fibre (roughage) in
the diet. Some dietary items cause irritation or loose motions in some
people, avoid anything that does this to you. Do not sit and strain for
many minutes when passing a motion, take more roughage if necessary.
10. AS THE CONDITION IMPROVES gradually reduce the strict routine
described here but remember the principles of keeping the area clean,
dry and avoid damage to skin by rubbing or medications. If the condition
recurs, as it may from time to time, start the routine again at one
until the irritation is controlled.
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 Whitnash
Medical Centre
110 Coppice Road
Whitnash
Warwickshire
CV31 2LT
Tel: 01926 316711
Fax: 01926 427260
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