I've had this condition since November 2005. It came on at the

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I've had this condition since November 2005. It came on at the end of a vigorous 2 mile run. I felt intense sharp pain just inside the anus. I dabbed it with tissue and found a small amount of bright red blood. The condition has persisted, though I've been able to prevent more bleeding by limiting my activity (i.e. not walking more than a few blocks). Â I have not been able to stop the pain from coming on whenever I'm actively walking. Less activity seems to help, at least temporarily. Also, a standard Pruritus Ani diet (avoiding caffeine and spicy foods, etc.) helps a little.

I've been to several doctors and one proctologist. Some of the diagnostic possibilities that they suggested:
1: Anal Rash - prescribed Clotrimazole/Betameth
2: Anal Herpes - prescribed and administered Valtrex (before test came back negative)
3: Hemorrhoids - prescribed hemorrhoidal ointment Preparation H
4:(the proctologist) Pruritus Ani - recommended gentle cleansing and bland diet

Some medical history:
- mild ulcer in 2002
- paternal grandmother died of colon cancer

In addition to the things I've tried above, I've also tried:
Â Prilosec (to lower stomach acidity)
Â Zeasorb-AF (miconazole nitrate 2% anti-fungal powder)
Â Pure cornstarch baby powder
Â Cortaid maximum strength
Â Tucks Hemorrhoidal ointment
Â Extra water, extra fiber
Â Less water, less fiber
Â Less sugar
Â Less corn and other potentially 'rough' foods

Â Any suggestions or guidance will be much appreciated.

Customer (name blocked for privacy)

Status: Closed Value: $30

I have a few questions for you before I provide an answer. Has anything (besides limiting your activity) helped with the pain and bleeding? Is there still bleeding? What were your follow-up plans with the proctologist/other physicians? Does anything else bring on the symptoms beside walking/running? You have no problems applying pressure to the area, being seated, etc.? Do you have any other health problems, or take any medications?

Let me know, and hopefully we can get you a good answer. Take care.

If I have helped, then please click the ACCEPT button and leave positive feedback - Thank you, and take care

Reply to Jon Fay's Post: Thanks Jon,
The pain tends to be worse some days, and better others. I haven't noticed a significant improvement from anything except inactivity, even then the relief is only during the inactivity. Sitting is usually not very uncomfortable. When the condition is particularly bad, sitting is also a bit uncomfortable. I do various freelance work ranging from art handling and painting to carpentry and web design work, so I don't ever get to really give it a rest. I had a couple weeks in hawaii in january which were relatively peaceful. still the same problem, though a bit better.
I tend to be rather sweaty around the anus when I'm active and stressed, but I tried the cotton swab and cornstarch recommendation, and it didn't seem to work.
there is no longer bleeding.
Follow up plans were to email the proctologist about further diagnosis, but I asked him during the visit what he would do in a second visit and he didn't seem that sure of what to look at (He also hasn't responded to the email I sent). I haven't had a colonoscopy yet, but i have had the doctors check for hemorrhoids and irregularities.
Other than this, I don't have any health issues. I'm 5'11 vegetarian 145lbs. very slightly dry skin.

Pruritus ani is a condition typified by intense itch as well as anal pain, and itching doesn't appear to be your primary complaint. As such, I am a little skeptical of this diagnosis, at least as the principal one involved. Yes, you could suffer from pruritus ani (not uncommon), and hence you would find some relief from diet and other lifestyle modifications recommended to treat the disease. But I'm of the opinion that there may be something else involved here, as well.

I think making another appointment with a proctologist is definitely in order. Perhaps return to the one you already saw, if you were comfortable with him/her; but the lack of response to your email, and apparent lack of ideas for follow-up is not, in my opinion, a real confidence-inducer. If you agree, you might try and set up an appointment with another proctologist.

Hopefully, a second opinion will help here. I don't think seeing another generalist (e.g. internal medicine physician, etc.) is indicated, since I don't think that they'll have much to add. Another exam will probably take place, and they may decide to perform a colonscopy at some point. An external exam might not be providing enough information at this point (you didn't mention if any anoscopy was performed), and a colonscopy might be of some help.

Pruritus ani is itchy and painful, and can lead to irritation and bleeding, but it doesn't sound like, to me, that you ever experienced much itching. Yes it could be a component, but I am of the opinion that there is likely something else going on, another diagnosis.

One more thought - it sounds as if you are doing everything right, with the dietary modifications, vegetarian diet (I, myself, am vegan), and trying all of the different available over the counter preparations.

I hope this helps. Please let me know if you have any further questions - I'm more than happy to help. Take care.

If I have helped, then please click the ACCEPT button and leave positive feedback - Thank you, and take care

Reply to Jon Fay's Post: I've been talking with friends and loved ones trying to understand this issue better, and a friend from the Israeli Army said that his brother and other solidiers would somewhat commonly come down with an 'ingrown hair of coccyx'. Have you ever heard of such a thing and do you know how it's diagnosed? I hesitate to just go right back to the proctologist, but of course I will eventually (I pay out of pocket)

This 'ingrown hair of coccyx' is another name for pilonidal disease. I think this is unlikely.

Pilonidal disease describes the formation of small tract or sinus, often in between the buttocks, that be caused (in part) by ingrown hairs. The hair leads to the formation of a sinus (tract), and this can become inflamed and infected. These often exist in between the anus and the coccyx.

I think this is unlikely because this would be visible on close visual examination; something, hopefully, that the proctologist (and the other physicians involved) did. Generally, with close visual exam a small tract is visible; this is more obvious if it is inflammed and infected (red, tender, full of pus, etc.).

Paying out of pocket is tough, and costly I'm sure. I still think it's indicated, and I'm hoping that maybe you just had bad luck with the first practictioner.

But again, let me know if you have any more questions. Take care.

If I have helped, then please click the ACCEPT button and leave positive feedback - Thank you, and take care

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I've had this condition since November 2005.

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