Question: I have been suffering from severe pruritus ani for nearly a year. To find relief from the itching, I’ve been to a family physician, a proctologist, four dermatologists, and an allergist. So far, no treatment has helped. Do you know of anything that might relieve my discomfort?
Answer: Since you’ve already seen seven doctors, they’ve probably ruled out the most common causes of anal itching: worms, hemorrhoids, fungal infections, skin fissures, sweating, irritants in food, and poor anal hygiene.
One possibility that’s sometimes overlooked is neuro-dematitis. This is not an actual nerve disorder but rather a lengthy cycle of itching and repeated scratching. It leads to gradual thickening of the skin around the anus, which then itches more than ever.
If neurodermatitis is indeed the cause of your condition, it may gradually abate if you force yourself not to scratch the thickened skin. When you’re at home, applying an ice-cold compress to the irritated area can ease the urge to scratch. Since many sufferers scratch when they’re asleep, you should keep your fingernails short and even wear soft mittens to bed. A hypnotist or psychotherapist might help you stop scratch-ing.
Question: I’ve been taking a tablespoon of mineral oil every night for many years to prevent anal fissures. Is this bad for me?
Answer: Yes. Mineral oil decreases absorption of fat-soluble vitamins (A, D, E, and K), and can cause a chronic type of pneumonia if inhaled. Try a stool softener (Colace, Surfak) or psyllium laxative (Metamucil, Mylanta Natural Fiber) to minimize trauma to the anal area during bowel movements. A warm bath for 10 to 15 minutes after bowel movements may bring some relief. Fissures that persist may require surgery.
BLOOD IN THE STOOL
Question: Microscopic traces of blood have been detected in my stool. Sigmoidoscopy revealed internal hemorrhoids near the entrance of the anus. Does this mean surgery, even though I’ve had no discomfort?
Answer: Not necessarily. Stool softeners (Colace, Surfak) or psyllium laxatives (Metamucil, Mylanta Natural Fiber) can reduce straining during bowel movements and may help stop the bleeding, just as they help prevent anal fissures. Antihemorrhoidal creams and suppositories are not particularly helpful for this problem. Like persistent fissures, persistent bleeding may require surgery. A colonoscopy should be done to rule out bleeding sources beyond the reach of a sigmoidoscope.
Question: Because of a strong family history of colon cancer; doctors have advised me to have an annual colonoscopy. Yve undergone the procedure a few times and found the pain nearly unbearable. My gastroenterologist says he doesn’t give painkillers for colonoscopy. Is there anything that would help me cope with this ordeal?
Answer: Yes—drugs, including those painkillers. Without them, the colonoscope causes discomfort and sometimes pain as it snakes through and stretches your colon. Before the procedure, most gastroenterologists give intravenous narcotics to kill pain and tranquilizers to relax you and your colon. If you can’t persuade your gastroenterologist to administer such medications, try another gastroenterologist.
DIET AND DIVERTICULOSIS
Question: Like many people my age (over 50), I have diverticu-losis. My doctor has told me not to eat seeds and nuts and to avoid constipation. But I know people with the same problem who have been told to eat, avoid, or do different things. Could you provide some insight into this problem?
Answer: Diverticulosis is a common condition in which the inner lining of the intestine protrudes into the intestinal wall, forming small pouches in the wall of the colon. It affects one in four people by the age of 50 and is near-universal by the age of 80. It’s believed that our modern low-fiber diet is at least partly to blame.
Diverticulosis usually doesn’t cause any symptoms, but some people with the condition do experience bloating, cramps, and changed bowel habits, such as constipation, diarrhea, or alternating attacks of both. Abdominal pain (especially low on the left side) accompanied by fever might signal the development of diverticulitis, an infection of the pouches. That can lead to abscess formation and to perforation of the bowel, which can cause peritonitis, a generalized infection of the abdominal lining.
To avoid those problems, switch gradually to a higher-fiber diet with more whole grains, fruits, and vegetables.
Question: I recently found out I have ulcerative colitis. What’s latest on the cause and treatment of this disease?
Answer: Physicians still don’t know what causes ulcerative colitis, an inflammatory disease of the colon that leads to diarrhea and rectal bleeding. (It can also affect the skin, eyes, joints, and liver.) However, various drugs can suppress the inflammation and control the symptoms. Those medications include mesalamine (Asacol) and sulfasalazine (Azulfidine), corticosteroid drugs such as prednisone (Deltasone), and in resistant cases, immunosuppressant drugs such as mercaptop-urine (Purinethol).
People who have had extensive ulcerative colitis for a long time are at increased risk of colon cancer. Those people should undergo annual colonoscopy (inspection of the entire colon through a flexible lighted tube) to check for cancer or precan-cerous changes.
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