Table 2.

Instructions for patients

Do not scratch or rub the anal area

Wash the anal area with only water. Do not use soap or salt when you wash the anal area. Dry the area well after cleaning, by patting the skin with a soft towel or using a hair dryer with cool air

Make sure to clean the anal area after each bowel movement as instructed. Avoid the use of toilet paper that may be abrasive

When you shower or bathe, use unscented soap

Apply a thin cotton pledget directly in the anal crease in the morning and at bedtime, and change the pledget as needed if it becomes moist

Wear loose underwear

Soak the anal area in a warm sitz bath for 10 to 15 min two to three times a day. Do not add soaps, salt, oil, or skin softners to the water, and dry the anal area as above

Maintain a soft, large and nonirritating stool by having bulking agents such as psyllium or methylcellulose in 8-12 oz of water. Start at a low dose of the fiber supplement and slowly increase the amount of fiber until reaching at least 20-30 g/d

Eat a high fiber diet that includes 8-10 glasses of water a day

Avoid foods that include colas, spicy foods, citrus foods, coffee, beer, nuts, dairy products, tomatoes

You may apply 0.5% or 1% hydrocortisone ointment to the itch area, but only if directed by your doctor, and antihistamine tablets may be helpful for nighttime symptoms

Don’t be despondent when recurrence occurs because it is common. Reconsult your doctor so that appropriate management can be applied