Don’t Scratch Your Bottom

Itching around the anal area is called Pruritus Ani. This condition is an unpleasant skin sensation that produces the desire to scratch.

Why this does happen?

There are a number of possible reasons. Some of them are moisture due to perspiration, a small amount of residual stool around the anus, hemorrhoids, fissures, fistulas, certain foods, smoking and drinking. Foods and beverages that are associated with Pruritus Ani include coffee, tea, carbonated beverages, milk products, cheese, chocolate, nuts, and spicy food. Rare anal malignancies can cause itching.

Lack of cleanliness is rarely the primary cause. Once the patient develops this condition, they have the tendency of washing the area vigorously with soap and a washcloth. This is usually counterproductive due to damage to the perianal skin and washing away protective natural oils.

Perianal dermatitis, anal warts and hypertrophic skin are other causes for this condition.
Parasites that cause anal itching are very rare in the United States.

What can be done to make the itching go away?

A careful examination by a specialist can identify a definite cause for the itching. At least half of these patients never identify the reason for their problem, but they are still treated for their symptoms. A biopsy is rarely needed in the work up of this condition. The goal should be to achieve clean, dry and intact skin.

Some general recommendations include:

  1. Avoid certain foods that cause this condition. Gradually reintroduce the offending foods; this helps identify which group is responsible and threshold for tolerance.
  2. Avoid moisture in the anal area.
  3. Avoid further trauma to the affected area. Anal hygiene is important. Use baby wipes or wet toilet paper to clean the area. Pat it dry. Never rub.
  4. Do not scrub the anal area with regular toilet paper.
  5. Minimize the use of soap in the anal area.
  6. Try not to scratch the itchy area. Scratching produces more damage to the skin, which in turn makes the itching worse.
  7. Use only medications prescribed by your physician.
  8. If symptoms persist after 6 weeks, make another appointment with your physician.

Surgical Treatments for Colon Cancer

Colon cancer affects over 100,000 men and women each year. The available treatment options that have proven to be effective for colon cancer are surgery, chemotherapy and radiation therapy. A combination of these treatments is common to achieve better results. But usually, surgery is the most effective option to treat colon cancer.

The surgical removal of a malignant tumor offers the best chance for a cure. This is especially true if the cancer has not spread to other areas of the body. Surgery is used to cure the disease when it is confined to one single area and also in other cases for diagnosis and relief of ongoing symptoms. Surgery is also used to determine the staging of the cancerous tumor. The surgical specimen is sent to a pathology lab where it is checked under a microscope to assess the depth of the tumor and the possible spread to surrounding lymph nodes.

If surgery is needed to treat colon cancer, there are 3 different modalities that are being used at this time. The oldest procedure for treating colon cancer is known as open surgery, in which the surgeon removes a part of the colon through a big cut in the abdomen. This kind of procedure is usually more painful and requires a longer hospital stay and recovery period before going back to work.

Over the last 20 years, a minimally invasive approach has developed called laparoscopic surgery. Larger facilities and advanced centers have this option available. In this procedure, the surgeon makes three to four small incisions in the abdomen. A long and skinny camera that is hooked to a television monitor enters the body and the surgeon is able to see the inside of the abdominal cavity on the monitor. Through the other incisions, the surgeon will remove the cancerous part of the colon. How much colon has to be removed depends on surgical principles and the size of the tumor. After the surgery, which usually takes 1 to 2 hours to perform, the patient has to stay in the hospital for 2 to 3 days. Patients that have laparoscopic procedures experience less postoperative pain, can return to their normal activities in 1-2 weeks, and can eat sooner. A better cosmetic result is another advantage.

Laparoscopic colon cancer surgery has been proven to be just as effective at removing colon cancer as the open technique. But not every patient is a candidate for laparoscopic surgery, although a majority is. With the common goal of a patient’s safety in mind, the surgeon will make the decision either before or during surgery regarding which approach is better for an individual patient based on different factors.

There is a third option which is still in its infancy called robotic surgery. This technique uses a machine with robotic arms that work inside the patient’s abdomen guided by a surgeon who is present in the operating room but sitting at an operating console. It has a 3D magnifying camera that allows the surgeon to have a great view of the operative field while he controls the robotic arms remotely. It is very similar to laparoscopic surgery in many aspects including recovery time, postoperative pain and probably surgical results. This procedure has been used in clinical practice but does take longer than laparoscopic surgery without any clear clinical benefits. Time will determine its role in colon cancer surgery.

The most important factor to have a successful outcome when having surgery for colon cancer is to choose the right surgeon to perform the procedure. It has been proven that surgeons who specialize in colon surgery and have a high volume of cases have better results than surgeons who are not as familiar with surgery for colon cancer. Patients should take their time and ask all the necessary questions to find a surgeon well trained and with enough experience to handle these cases in order to achieve optimal results.