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Perianal irritation and anal fissure...help, please!

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Crohn's Disease
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Posted 7/30/2015 2:36 AM (GMT -5)
Hi, I am new to this forum! This is my first topic.

Anyway, a little background. I have had Crohn's for close to ten years. I am now in remission thanks to Remicade (just received my latest beautiful colonoscopy results several weeks ago!) but am still having one problem. I am having very persistent and painful irritation around my anal fissure--basically redness, itching, inflammation, pain, and occasional bleeding. It is mostly concentrated around my butt crack (is there a medical term for that area haha?) and my GI has been trying unsuccessfully to treat it for several years now. I have tried calmoseptine, triple cream, aquaphor, vaseline, and various other OTC creams recommended with little to no relief. I also take warm baths daily. I was prescribed an antibiotic cream and anti-yeast medication, both of which did nothing to fix the problem. I was then prescribed triamcinolone acetonide ointment, which provides some relief, but I can only use it for short periods of time because of the risk of damaging the sensitive skin in this area.

I would LOVE any suggestions or comments from others who have gone through the same thing, and any tips you might recommend! Thank you :)
Posted 7/30/2015 9:05 AM (GMT -5)
I've had similar problems especially when I was on Asacol. It's like my skin would tear instead of stretching, and it did improve after I went off Asacol, but I don't know if that was actually the cause. I take sulfasalazine now and I haven't had the problem come back so far.

The only thing that relieved mine, and this isn't a medication, was pure lanolin which is sold in the baby section for lactating mothers (if it's safe for breastfeeding babies, I figure it's safe for my bum). The only brand I know of is Lansinoh, which you can get online or at places like Target or Walmart, but there may be other brands.

Daily bathing is probably not going to help in the long run because it's more drying to the skin. I used to soak in the tub for pain relief and broke myself of the habit. Now I stick to showers only.
Posted 7/31/2015 12:39 PM (GMT -5)
I had this problem for years:

The inflammation leads to irritation which leads to itching and pain.

1) You need to use a gentle wipe like Cottonelle to clean off the debris. Do not use Tucks which contain witch hazel and irritates the area more and more.

2) Use Prax lotion, this is a miracle medicine for me: it contains Pramoxine a wonderful anesthetic. It is an over the counter medicine that can be ordered by you. A bottle is expensive, $40, but will last for 100 applications.

triamcinolone and other even stronger cortio-steroids will initially reduce some of the inflammation but after 4-5 days it strips the skin and make the problem worse, much worse. So now I don't use it at all.

The itching and pain is a daily struggle for me. I use Prax up to 5 times a day, no more since it has a rebound effect and cause pain.
Posted 7/31/2015 11:32 PM (GMT -5)
@JaSanne- That's interesting that you mentioned Asacol. I have just started taking Pentasa within the last few days. It really helped me during and after my first flare and initial diagnosis--during that time period when I was in remission, I had no anal irritation whatsoever. My only meds were Remicade and Pentasa. I asked my doctor to re-prescribe it in hopes it would help with this issue. Also, that's an interesting idea about the lanolin. That's one of the few OTC products/creams I haven't tried, so I might pick some up! Thanks for the tip!

@Fernando- Do you know of any flushable wipes that are preferably portable? Like, so I could stick a pack in my purse? Also, a problem with me for flushable wipes is that they tend to be somewhat expensive, and I'm on a college student budget :( But I always try to blot with damp toilet paper which is a lot better than dry. I wish I could try the prax lotion--it sounds promising! But $40 is a lot for a bottle of lotion which may or may not work for me :( And that's exactly how the corticosteroid cream works for me--it brings relief for a few days but then things get worse. I'm sorry you're experiencing similar pain and I hope things get better for you!
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