Perianal Skin Irritation and Burning After Bowel Movements

Perianal skin irritation and burning sensation?

Dear Dr.
Ke,
Thank you for your previous response.
Regarding case #157413, initially after the fistulotomy, the recovery was not very good, and there was excessive granulation tissue growth.
I underwent cryotherapy and applied a steroid ointment for a period of time, and now the fibrotic scar has stabilized.

I would like to consult you about an issue I am experiencing: after having a bowel movement, I feel a burning and stinging sensation on the skin near the anal folds (on the opposite side of the original fistula wound).
I later returned to the hospital for a colorectal examination, and the doctor indicated that there were no significant issues, suggesting that the burning sensation might be due to overuse of the ointment.
Could you please advise on what might be causing the burning sensation after bowel movements? Is it possible that the ointment has thinned the skin, making it more susceptible to irritation? Could fecal leakage also be a contributing factor? This burning sensation has persisted for about one to two months and only occurs after bowel movements; otherwise, I feel fine.
I have tried warm sitz baths, but they seem to have little effect, and the burning sensation appears to intensify afterward.
Thank you for your guidance!

Xiao Mi, 30~39 year old female. Ask Date: 2020/06/26

Dr. Ke Fangxu reply Surgery

The use of steroid ointments is not recommended for long-term application around the anal area due to the thinner skin in that region, which may lead to potential side effects with prolonged use.
It is advisable to stop using the steroid ointment.
Warm sitz baths can continue, but do not add povidone-iodine.
If symptoms persist without improvement, it is best to consult a physician for evaluation.

Reply Date: 2020/06/26

More Info

Understanding perianal skin irritation and burning sensations after bowel movements can be quite complex, especially in the context of prior surgical interventions such as fistula repairs. Based on your description, it seems that you are experiencing discomfort in the perianal region, particularly after bowel movements, which has persisted for one to two months.
There are several potential causes for the burning sensation you are experiencing:
1. Skin Sensitivity and Thinning: The use of topical corticosteroids, while effective for reducing inflammation, can lead to skin thinning (atrophy) when used excessively or for prolonged periods. This thinning can make the skin more susceptible to irritation from friction, moisture, and even the normal passage of stool. If the skin around the anal area is thinner, it may react more intensely to stimuli, leading to the burning sensation you describe.

2. Irritation from Stool: Even if there is no leakage, the act of passing stool can cause irritation, especially if the stool is hard or if there is straining involved. The friction and pressure can exacerbate any existing sensitivity in the area, leading to discomfort.

3. Moisture and Hygiene: The perianal area is prone to moisture, which can lead to irritation and discomfort. If there is any residual moisture after bowel movements, it can contribute to skin irritation. It is essential to maintain good hygiene and ensure the area is dry after cleaning.

4. Infection or Inflammation: Although your recent examination by a colorectal specialist did not reveal any significant issues, it is still possible for localized infections or inflammatory conditions to develop, especially in areas of previous surgery. Conditions such as dermatitis or even fungal infections can occur in moist environments.

5. Dietary Factors: Certain foods can irritate the gastrointestinal tract and lead to softer stools, which may increase irritation during bowel movements. Spicy foods, caffeine, and alcohol are common culprits.

Given your situation, here are some recommendations to help manage the symptoms:
- Topical Treatments: If you suspect that the corticosteroid cream may have contributed to the thinning of the skin, it might be worth discussing with your dermatologist or healthcare provider about adjusting your treatment plan. They may recommend a barrier cream or ointment that can protect the skin without causing further irritation.

- Gentle Cleansing: After bowel movements, consider using a gentle, non-irritating cleanser and patting the area dry instead of wiping harshly. You might also want to explore using moist wipes that are alcohol-free and fragrance-free.

- Sitz Baths: While you mentioned that sitz baths have not provided relief, they can still be beneficial for soothing the area. Ensure the water is warm, not hot, and try to soak for 10-15 minutes. You might also consider adding Epsom salts, which can help reduce inflammation.

- Dietary Adjustments: Pay attention to your diet and consider increasing fiber intake to promote softer stools, which can reduce strain during bowel movements. Staying well-hydrated is also crucial.

- Follow-Up Care: Since the burning sensation has persisted for a couple of months, it may be beneficial to follow up with your healthcare provider. They may want to reassess the area for any signs of infection or other underlying issues that could be contributing to your symptoms.

In conclusion, while the burning sensation after bowel movements can be distressing, understanding the potential causes and implementing appropriate management strategies can help alleviate discomfort. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

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