Q: I have been a reader of your column for many years. I am a female, 54, of normal weight, and lead a healthy lifestyle. I never suffered from constipation but am at my wit’s end because of an intolerable anal itch that has developed during the last couple of months. I ruled out a GYN problem and saw a rectal surgeon thinking it may be from a hemorrhoid. Except for the significant inflamed area, both the gynecologist and rectal surgeon didn’t see anything wrong. The rectal surgeon said there was a very small internal enlarged vein that could not cause the problem, so he diagnosed me with anal pruritis and prescribed Prax. Pruritis is just a Latin term for itching, as you know, so he really did not enlighten me.

I have used almost all available OTC ointments and creams and also prescription strength hydrocortisone. The itch is worse in the morning and at night. It subsides during the day when I sit. I hope that you will be able to advise me on some alternative remedy.

A: Some of the most common causes for anal itching may be from pinworms (a parasite seen primarily in young people), fungal infection, a hemorrhoid (external or internal), the dyes on toilet paper, or from irritating foods such as spices, peppers and hot sauces that are expelled through a bowel movement. The presence of continuous moisture to the area from liquid stools, diarrhea or incontinence may be to blame, since moisture increases the possibility of anal infection – particularly in patients diagnosed with diabetes and HIV. Factors that increase a person’s risk for developing an anal itch include having psoriasis, seborrhea, dry skin conditions, diet, fecal soiling, genital warts, diarrhea, profuse sweating, a fissure, moisture from wearing wet clothing such as a swim suit, in rare instances cancer, or from fistulas. A fistula is an abnormal connection between an organ or intestine and another structure. They are generally caused by injury or surgery but can also be the result of of an inflammation or infection.

The cause for an anal itch can often be determined by having a physician taking a history and performing an examination. Signs of such things as infection are relatively easy to identify and will likely cause the physician to perform a culture in order to determine what type of germ is involved. Should the problem be pinworms, they may not be seen during the day, so a physician may have the patient pit a piece of Scotch tape over the anus, allowing the minute pinworms to be caught on the tape. Because you have already determined that sitting diminishes the itch, you might find that moisture or friction might play a role in your ongoing problem. A protective barrier such as glycerin, aluminum hydroxide gel, white petrolatum, zinc oxide, or cod liver oil might provide relief. Astringents such as witch hazel, calamine and zinc oxide will promote dryness to the area which may help relieve itching, burning and pain. On the home front, the area should not be scrubbed with soap and water but might be cleaned gently with a baby wipe.

You have already gone the cortisone route; however, have you considered that the itch may be from pin worms? Were this to be true, anti-parasitic pills obtained via prescription from your physician might be in order. The Prax you are taking is an over-the-counter anesthetic. Whatever the cause, you need to be examined by a top-notch physician at a nearby teaching hospital who can get to the bottom of things (no pun intended) and get you back on track. Good luck.