Common anorectal conditions: Part I. Symptoms and complaints. (1/17)

Anorectal symptoms and complaints are common and may be caused by a wide spectrum of conditions. Although most conditions are benign and may be successfully treated by primary care practitioners, a high index of suspicion for colorectal cancer should be maintained, and all patients should be appropriately investigated. Inspection, palpation and anoscopic examination using an Ive's slotted anoscope provide adequate initial assessment. Pruritus ani usually represents a self-perpetuating itch-scratch cycle and is uncommonly due to infection. The history, as well as the physical examination, can distinguish anal pain due to hemorrhoids, fissure, abscess, cancer or proctalgia fugax. The most frequent causes of rectal bleeding are hemorrhoids, fissures and polyps. Diagnoses associated with difficulty in passing stool can range from constipation to fecal incontinence.  (+info)

Don't forget your toothbrush! (2/17)

Patients with rectally inserted foreign bodies can present to accident and emergency departments or general medical practitioners. Rarely dentally related objects are inserted because of their ready availability in the domestic environment. There are many reasons given for their presence in the rectum, most commonly accidental insertion, assault, and psychosexual motives. This case is the first reported incident of a patient using a toothbrush to relieve his pruritus ani and subsequently losing it up into the rectum.  (+info)

Capsaicin and menthol in the treatment of itch and pain: recently cloned receptors provide the key. (3/17)

Topical capsaicin is reported to be an effective treatment for idiopathic intractable pruritus ani. While both capsaicin and menthol application produce a transient perianal burning sensation, only capsaicin relieves itching. Classical observations on functional desensitisation of nociceptors by capsaicin may explain the beneficial effects but the recent discovery of a range of receptors which respond to capsaicin, menthol, and temperature, and their expression in subsets of sensory nerve fibres, provides an exciting prospect towards advancing our understanding and treatment of sensory dysfunction.  (+info)

Topical capsaicin--a novel and effective treatment for idiopathic intractable pruritus ani: a randomised, placebo controlled, crossover study. (4/17)

PURPOSE: Pruritus ani is a common and embarrassing proctological condition which can be very difficult to treat. We report the results of a double blind placebo controlled study of treatment with capsaicin. METHODS: Firstly, a pilot open study was carried out on five patients to establish which of two doses was the most acceptable by comparing effectiveness and side effects. Secondly, a double blind, placebo controlled, crossover study of topical capsaicin was performed. This study involved two four week treatment phases separated by a one week washout phase. Forty four patients were randomised to receive locally either active capsaicin (0.006%) or placebo (menthol 1%) ointment over a four week period (22 patients per group). After four weeks of treatment and a one week washout period, the placebo group began to receive capsaicin while the treated group received placebo (menthol 1%) for another four weeks. At the end of the controlled study, responders from both groups continued with capsaicin treatment in an open labelled manner. RESULTS: Thirty one of 44 patients experienced relief during capsaicin treatment periods and did not respond to menthol; all patients not responding to capsaicin also failed on menthol (p<0.0001). In 13 patients, treatment with capsaicin was unsuccessful: eight patients did not respond to capsaicin treatment, one responded equally to capsaicin and placebo, and four others dropped out because of side effects. During the follow up period (mean 10.9 (SD 5.8) months), 29 "responders" needed a mean application of capsaicin every day (1.6 (SD 1.2); range 0.5-7 days) to remain symptom free (or nearly symptom free). CONCLUSION: Capsaicin is a new, safe, and highly effective treatment for severe intractable idiopathic pruritus ani.  (+info)

Anorectal drug products for over-the-counter human use. Final rule. (5/17)

The Food and Drug Administration (FDA) is issuing a final rule establishing that any over-the-counter (OTC) drug product containing a combination of hydrocortisone and pramoxine hydrochloride (HCl) for anorectal use is not generally recognized as safe and effective and is misbranded. This combination product is not currently marketed OTC. This final rule discusses data on the combination of hydrocortisone and pramoxine HCl that were still under review when an earlier final rule on OTC anorectal drug products was issued. This rule is part of FDA's ongoing review of OTC drug products.  (+info)

Itching in the ear canal due to hypocerumenosis. An effective method of treatment. (6/17)

Itching of the ear canal, with oozing, edema and cracking of the skin due to absence or insufficiency of wax was treated in more than 200 cases by instructing the patient to massage the ear canal with a cotton tip applicator soaked with a hydrocortisone preparation and inserted a half to three-quarters of an inch beyond the meatus. Some 95 per cent of patients reported good to excellent results in three to four days after the beginning of treatment. In the remainder results were fair.  (+info)

Idiopathic perianal pruritus: washing compared with topical corticosteroids. (7/17)

BACKGROUND: Idiopathic perianal pruritus is a poorly managed condition. Topical corticosteroids are effective in idiopathic perianal pruritus, but they may cause some side effects. In this study, the effectiveness of topical steroids were compared with perianal cleansers in the treatment of idiopathic perianal pruritus. PATIENTS AND METHODS: Seventy two patients with the complaint of perianal pruritus were evaluated; 60 of the 72 patients were found to be idiopathic. Twenty eight patients were treated with topical steroids and 32 patients were treated only with a liquid cleanser. RESULTS: At the end of this two week period, cleansers were found to be as effective as topical corticosteroids. CONCLUSION: This study shows that perianal cleansers can be used as a safe first step treatment in idiopathic perianal pruritus.  (+info)

Pruritus ani. (8/17)

BACKGROUND: Pruritus ani is a common presenting problem in general practice, one that is particularly distressing to patients. However, there is little available research on which to base management OBJECTIVE: This article discusses the causes and management of this distressing symptom based on thecurrent available evidence. DISCUSSION: Perianal itch probably arises from localised inflammation. This may be the result of anorectal disease, skin disorders, excessive cleaning, application of local irritants or other causes. In children, perianal itch may be caused by intestinal hermetic Infection such as pinworm. Whatever the initial cause, the problem may at times become chronic, with scratching inflaming the area and more itching resulting. Avoiding trauma from excess washing, toilet paper and topical agents is important. Treatments likely to be effective are emollients such as sorbolene, a short course of topical hydrocortisone cream and capsaicin cream.  (+info)

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