Newly diagnosed - sphincter pain and irritated skin... How to deal?

[Meliss@]

Hi,

I was diagnosed with Crohn's last week and would like advice on how to handle pain in my sphincter and irritated, itchy and (in some areas) rashes around my anus? Are these symptoms something to discuss with my physician, or are they a normal result from having so many bowel movements every day? I use alcohol-free baby wipes to clean the area after each bm and then pat the region dry with toilet paper but the pain in the sphincter and the irritated skin is still a problem.

Thank you for taking the time to read my post.

 

[UnXmas]

I think that the irritated skin may well be just the result of frequent bowel movements. How many times a day do you go, and is it very watery diarrhoea? Does it sting a lot when you go? I would apply a barrier cream. Before I got an ileostomy, I used to use E45 as a barrier cream, though any thick cream that you'll be sure you won't react to should suffice. Put it on before every bowel movement and wipe it off with baby wipes afterwards. It's a bit of a hassle doing this every time if you're going very frequently, but it will protect the skin and stop it stinging. I would still talk to your doctor about it though.

What kind of pain is the sphincter pain? (E.g. aching, sharp, spasms etc.) Does it occur or worsen with a bowel movement or is it continuous?

 

[Meliss@]

I agree with you that the irritated skin is the result of wiping after months of frequent bowel movements. Until about two weeks ago I had very watery, forceful diarrhea at a frequency ranging from 10 to 20 times a day. At the suggestion of my physician, I began a low fiber, plain food diet and after the diagnosis, began to take Apriso. For the most part the awful diarrhea has subsided and frequency of bowel movements has decreased to the range of 4 to 6 times a day.

The pain is aching, and continuous and does increase during and for a while after bowel movements, but it is not sharp pain, just aching. I will definitely bring this up with my physician when I see him next if it is still going on. Right now I just have no idea what is a symptom of the symptoms of Crohn's or what a symptom caused directly by Crohn's. If that made sense.

Thank you for your advice about E45 cream. It looks like I will have to order it on Amazon as it doesn't seem to be available otherwise in the United States. Did you find that it helped with rashes and itchiness as well?

 

[Fernando1]

You have reached the right person that has the exact same problem for years and years. There could be two causes for this:

1) Frequent diarrheah has eroded this area, the itching comes from the inflammation of the tissues, often called proctitis. The main strategy is to slow down the diarrheah with Imodium or Lomotil. Keeping the area clean with baby wipes is essential. Do not use Tucks which have witch hazel irritating it some more. I also use Balmex (similar to Desitin) to constantly provide a cover lotion for the area. ***For itchiness order PRAX lotion from the pharmacy, it does not require a prescription but does require special order.

You can apply a steroid cream which comes in a variety of strengths:
Hydrocortisone 2.5 - very mild, will never hurt you

Fluocinonide - Very strong, you should only use for 2-3 days as tolerated, eventually it will make your skin raw. Could not sustain it, I was bleeding constantly from this so had to stop.

All in all these ointments did not significantly helped, it was the Balmex and leaving it alone that helped me the most.

2) Perianal Crohns - This is what I evolved to, it is inflammation coming from INSIDE the tissues, the whole area is now raised and begin to scar. There will be long rings around the anus. The treatment for this are the biologicals, like Remicade or Humira that cover the entire intestines.

I am on both treatments although 2 is more long term.

Above all don't wipe/scratch too much it makes it worse, apply Prax 4-5 times a day, it works very good.

Now the pain: you may have an ulcer in the rectum, common in Crohns. See a colorectal surgeon for that, the GI does not treat these. I have an ulcer for a long long time and is very frustrating. They may prescribe Canasa suppositories. Watch out that ulcers may get infected and get an abscess, that may be causing your pain. Do searches in this forum for abscess and you can get lots of stories on this topic.

 

[2thFairy]

In the US, over-the-counter Preparation H cream works good for painful skin. I used the maximum strength one that has pain relief stuff in it. Another that I like is Calmoseptine. You can get it on Amazon or ask any pharmacist to order it for you if they don't have it in their store. You don't need a prescription, but many places don't have it in stock. It is similar to Desitin or any other barrier cream, but is has a cooling effect added so it also helps take your mind off of pain and irritation.

As for the sphincter pain, you might need a suppository to help with that. Suppositories aren't fun, but they can help when you have aching and/or muscle spasm pain. You can get Preparation H suppositories over the counter, but those don't generally help for this type of problem; those are more directly for hemorrhoids. So, when you see your doctor next, you might ask him about suppositories for sphincter pain. In the meantime, warm baths or even sitz baths might help. I had a lot of spasming and would sit on a heating pad when it was at its worst.

 

[shamrock15]

I never found prep h to do much good for me. I found that there may have been a bit of fungal infection for me and variations on clotrimaderm (yeast infection cream) have been quite effective for me. There is also another product I have used previously called proctofoam that was very good at cutting down inflammation.