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I use the restroom and no matter how clean I am my anus

Customer Question
I use the restroom...

I use the restroom and no matter how clean I am my anus produces little dirt like gramules... I do have hemorrhoids and have been experiencing itching after I per with a couple of the same spots.. what is this ?

Doctor's Assistant: When was your last pap smear? Have you ever had an irregular pap?

No irregular pap, and it was 5 months ago

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I have Lyme disease and my dermatologist recently prescribed topical Ivermectin for rosacea/acne

Submitted: 3 months ago.Category: OB GYN
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Customer reply replied 3 months ago
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12/25/2017
OB GYN Doctor: Dr. Arun Phophalia, Doctor replied 3 months ago
Dr. Arun Phophalia
Category: OB GYN
Satisfied Customers: 37,794
Experience: MBBS, MS. Deal with women related all surgical problems including genito-urinary and breast surgery.
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OB GYN Doctor: Dr. Arun Phophalia, Doctor replied 3 months ago

Do you have external hemorrhoids or internal hemorrhoids?

Are you constipated?

Any pain or burning in anal region?

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Customer reply replied 3 months ago
I do have internal hemorrhoids and sometimes a small bit of itching both in front and back. Would the topical Ivermectin have an effect on ridding my body of any foreign parasites or foreign things? Also, would the Doxycycline help?
OB GYN Doctor: Dr. Arun Phophalia, Doctor replied 3 months ago

I am sorry, I cannot phone you but I am writing you the answer.

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Customer reply replied 3 months ago
Do you have the answer for my question? I'm very worried.
OB GYN Doctor: Dr. Arun Phophalia, Doctor replied 3 months ago

Ivermectin does not predispose for the parasite or foreign thing. But it can stimulate anal glands.

Culprit can be hemorrhoids which can explain the itching or dirt granules which is likely to be anal gland thickened secretion due to irritation.

This itching and discomfort in the anus region can be pruritus ani which is quite a common condition. It may be more troublesome at night or after passing a bowel action. Excessive cleaning of the perianal area may exacerbate the problem by removing natural protective oils. Itching in the perianal area can also be associated with the presence of

a) hemorrhoids or

b) anal fissures,

c) infections or

d) skin conditions, so examination by a general surgeon and dermatologist would be prudent.

Following can be helpful:

1) Referral to a dermatologist and a general surgeon is necessary for the proper management.

2) It is important to keep the perianal area clean but at the same time limit trauma and rough cleaning of the affected area. Thus be as gentle as possible.

3) Avoid using soap. Use QV cleanser or aqueous cream instead.

3) Minimize scratching as much as possible as it may make itching worse

4) Use a non-perfumed cornstarch powder or barrier ointment such as Bepanthen to protect the skin.

4) If moisture is a more resistant problem then consider using a sanitary pad.

5) If the above measures fail then a mild anti-inflammatory cortisone agent (such as Sigmacort 1% ointment or Egocort 1% cream available over the counter) may be required.

6) The dermatologist consultation should categorically rule out psoriasis, contact dermatitis, atopic dermatitis and hidradenitis suppurativa, as these need very specific treatment.

7) Dietary factors like certain foods items can be associated with anal pruritus; these are: coffee, tea, cola, chocolate, tomatoes, and citrus fruits. so they should be avoided.

8) A slight fecal soilage is very important cause for the anal itching. This happens due to a primary abnormality in the internal anal sphincter mechanism. Sleeping with a baby pad is the answer for it. Though some physician recommend biofeedback or Kegel exercises. The best ointment and helpful measure is a 1 percent hydrocortisone cream applied twice daily with keeping it dry. That should take care of it. Give at least 3-4 weeks for this treatment as changing the local application cream frequently would not be helpful.

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OB GYN Doctor: Dr. Arun Phophalia, Doctor replied 3 months ago
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