One of the possible causes of faecal seepage is poor anal sphincter tone.
Q. For about four months now, I have been suffering from uncomfortable itching and smarting of my anus. Now, each time after clearing my bowels, I have to wash my anus with a pH-balanced, soap-free, paraben-free and fragrance-free wash.
Otherwise, most of the time, my anus will start itching. This happens especially when tiny amounts of residual faeces seep out about half an hour after I have cleared my bowels.
I have seen a colorectal surgeon, who has ruled out piles. The surgeon and a dermatologist whom I saw separately prescribed antibiotic and steroid creams, such as Fucidin, Fucicort and Gentrisone. I have also been told to use barrier creams and moisturisers.
Steroid creams seem to irritate my skin further and so do the moisturisers that I was recommended. It seems that only Fucidin and barrier creams provide relief. The problem is, each time the skin heals and is problem-free for several days, and I stop using Fucidin, the whole cycle of smarting and itching starts again.
There is no change to my bowel habits. I still clear my bowels two to three times daily. I do not know what else I can do. This is affecting my daily life, as I am finding it difficult to go out in case I need to defaecate when I am outside and there are no washing facilities.
The problem you have described can be caused by many conditions. Therefore, an accurate and detailed diagnosis needs to be made.
You would have to check for conditions affecting the anus, colon and skin.
Itch is commonly caused by conditions such as haemorrhoids (piles), infections and fistulas (the abnormal connection of two body cavities such as the rectum and vagina, or the connection of a body cavity to the skin, such as the rectum to the skin).
It can also be caused by warts, fungal infections and skin conditions such as tinea (ringworm) and psoriasis.
Other possible causes of the problem include mucosal ectropion and poor anal sphincter tone. Mucosal ectropion means the lining of the anal canal has prolapsed and turned inside out.
This results in small amounts of seepage that may cause peri-anal itch (itch around the anus).
Poor anal sphincter tone can result from previous surgery where the sphincter muscle might have been damaged, thereby giving rise to incontinence.
Although haemorrhoids have been excluded, you would require a thorough physical examination, rectal examination and colonoscopy to exclude other causes of peri-anal itch.
Some other tests that may help to determine the cause of the problem include an endorectal ultrasound scan, in which a probe is inserted into the anus to see if there are any deep hidden collection of pus.
Other tests include wound swabs and biopsy (taking and testing of tissue samples for abnormalities), depending on the clinical findings.
If needed, the doctor may also conduct a magnetic resonance imaging (MRI) scan to look for difficult-to-see or hidden fistulas, and deep peri-anal collection of pus.
As fistulas can be deep- seated and may have multiple tracts or tunnels, they are best seen with an MRI scan.
This is a safe test which does not involve radiation.
Given the broad nature of this problem, it would be best for you to consult a colorectal specialist to rule out more serious or chronic conditions.
Dr Ng Chin
Consultant general surgeon at Raffles Surgery Centre at Raffles Hospital
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