Pruritus ani is a difficult condition to treat. A careful history and physical examination should be performed to exclude secondary causes, such as diseases of the anorec-
tum, systemic diseases, diarrheal states, and dermatologic conditions, in which case appropriate therapy is instituted. The majority of cases, however, are idiopathic and there is no panacea treatment for this condition. First, it is important to reassure these patients that they do not have a cancer; avoidance of scratching is essential and is emphasized in order to break the scratch-itching-scratch cycle. Clothing is discussed and tight fitting pants or undergarments should be avoided, and all possible irritants to the perianal area, such as harsh toilet papers, soaps, creams, and ointments, should be discontinued. Foods and beverages such as tomatoes, spicy foods, nuts, coffee (regular or decaffeinated), milk products, tea, beer, wine, and chocolate can cause pruritus and the patient is instructed to eliminate each of these products for a 1 week duration to help determine if any are causative factors. It is extremely important that the perianal skin be kept clean and dry. Patients are instructed to clean the perianal area gently but thoroughly after each bowel movement with water or a nonalcoholic towelette and dry it with a hair dryer at a cool setting or by dabbing with a soft cotton cloth. Bulking agents are added to regulate bowel habits and minimize incomplete evacuation and soiling. Warm sitz baths for 20 minutes may also provide some relief. Short term hydrocortisone cream 0.5 to 1% can be used in resistant cases.
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