What every gastroenterologist needs to know about common anorectal disorders

Table 1 Etiologies of pruritus ani

Anorectal disease	Anal fistula, fissure, skin tags, hemorrhoids, rectal prolapse, anal papillomas, rectal and anal carcinoma, fecal incontinence, hidradenitis
Systemic disease	Diabetes mellitus, chronic renal failure, iron deficiency, thyrotoxicosis, myxedema, Hodgkin’s lymphoma, jaundice, leukemia, aplastic anemia
Dermatologic conditions	Psoriasis, erythrasma, seborrheic dermatitis, atropic dematitis, intertrigo
Infections	Virus, bacteria, fungi, parasites
Gynecologic conditions	Vaginitis, endocervicitis
Neoplasms	Extramammary Paget’s disease, squamous cell carcinoma, cloacogenic carcinoma, Bowen’s disease
Hygiene	Poor cleansing or overaggressive cleansing with rubbing or excessive soap use
Diet	Coffee, chocolate, citrus, spicy foods, tea, beer, sodas containing caffeine, fat substitutes, milk and milk products
Local irritants	Obesity, excessive hair, tight-fitting clothing, anal creases, perfumed or dyed toilet paper, anal creams
Diarrheal states	Ulcerative colitis, crohn’s disease, irritable bowel syndrome
Radiation	Postirradiation changes
Psychogenic	Anxiety, neuroses, psychoses
Drugs: Idiopathic	Quinidine, colchicine, antibiotics, ointments that may contain alcohol

Table 2 Instructions for patients

Do not scratch or rub the anal area

Wash the anal area with only water. Do not use soap or salt when you wash the anal area. Dry the area well after cleaning, by patting the skin with a soft towel or using a hair dryer with cool air

Make sure to clean the anal area after each bowel movement as instructed. Avoid the use of toilet paper that may be abrasive

When you shower or bathe, use unscented soap

Apply a thin cotton pledget directly in the anal crease in the morning and at bedtime, and change the pledget as needed if it becomes moist

Wear loose underwear

Soak the anal area in a warm sitz bath for 10 to 15 min two to three times a day. Do not add soaps, salt, oil, or skin softners to the water, and dry the anal area as above

Maintain a soft, large and nonirritating stool by having bulking agents such as psyllium or methylcellulose in 8-12 oz of water. Start at a low dose of the fiber supplement and slowly increase the amount of fiber until reaching at least 20-30 g/d

Eat a high fiber diet that includes 8-10 glasses of water a day

Avoid foods that include colas, spicy foods, citrus foods, coffee, beer, nuts, dairy products, tomatoes

You may apply 0.5% or 1% hydrocortisone ointment to the itch area, but only if directed by your doctor, and antihistamine tablets may be helpful for nighttime symptoms

Don’t be despondent when recurrence occurs because it is common. Reconsult your doctor so that appropriate management can be applied