Brief Answer:
Additional information required

Detailed Answer:
Hi
Welcome to healthcare-Magic
Greetings of the day

Dear Ms

First and foremost let me reassure you, its unlikely to be lifethreatening issue. Things can be taken care of. Take heart!

Pruritis ani can be due to many causes. So lets not worry about that too much and move on to treatment basics.

Diet modification, bowel cleansing are unlikely to be helpful, instead they will worsen the issue by causing liquid stools which will cause maceration of skin of buttocks.

Possibility of helminthic (worm) infection also needs to be considered and empirical deworming will be helpful. Deworming drugs are simple single dose drugs but they are prescription meds, so you need to bring this to the notice of your Primary Care Physician.

It would be very helpful if you could provide me following additional information for me to be able to assist you further

1. Providing clinical photograph of anal region will be helpful for diagnosing the lesion near the anus

2. Do you have associated mucoid (Mucus) discharge from anus?

3. What kind and material of underclothing do you wear? What is your normal hygiene routine for this laundry? What kind of detergents do you use?

4. Is there much hair in the buttock region?

5. Are you sexually active?

This and any other information you can give me will help me give you more personalized useful information.

Awaiting your response

Take Care

Best Regards
Dr Shobha Deepak
MBBS,MD

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Brief Answer:
Pruritis is likely to be due to mucoid discharge

Detailed Answer:
Dear Ms

thanks for providing clinical photograph. From the picture provided there is lot of mucoid discharge. Also there is a small anal fissure. The mucoid discharge and anal fissure explain your symptoms.

I would suggest you the following

1. Drink plenty of water everyday:. It will help by mixing with the fiber of diet and give bulk to the stools so that they are well formed and soft.

2. High Fiber diet: Vegetable salad( 2 servings a day), Fruits especially citrus fruits.

3. Avoid Diet causing constipation: Especially those food stuffs containing refined flour like cakes, bread, biscuits, cookies

4. Hot Seitz bath: Add a handful of common table salt in a tub of lukewarm water and immerse the bottom by sitting in it. Every such session should last for 15 to 20 minutes. Two such session a day, one in the morning and one before retiring to bed at night. It would also be benificial to repeat it after every bowel movement. It will help in healing of fissure, decrease pain and relieve internal sphincter spasm.

5. Local application of local anesthetic ointment like Xylocaine will help in relief of pain. Apply it 15- 20 minutes prior to every bowel movements and also before retiring to bed.

6. Nifedepine Ointment: Local application of it will relieve the spasm of internal sphincter and help accelerate fissure healing.

7. Empirical intake of antibiotic like Metronidazole for 7 days will take care of excessive mucous discharge

Do get back to me if you need any further assistance, will be glad to assist you

Take Care

Regards
Dr Shobha

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