What are the over-the-counter (OTC) treatments for nocturnal pruritus ani (anal itching at night) caused by anal fissures?

From the Guidelines

To treat chronic anal itching at night from anal fissures over the counter, start with a sitz bath (warm water soak) for 10-15 minutes 2-3 times daily, especially after bowel movements, as recommended by the American Gastroenterological Association 1. The goal of treatment is to reduce inflammation, itching, and pain, and to promote healing of the fissure. Some key points to consider:

• Apply an over-the-counter hydrocortisone cream (0.5-1%) sparingly to the external anal area up to 3-4 times daily for no more than 1-2 weeks to reduce inflammation and itching.
• Consider using zinc oxide ointments like Desitin or petroleum jelly as a moisture barrier.
• For pain relief, try over-the-counter pain medications like acetaminophen or ibuprofen according to package directions.
• Stool softeners such as docusate sodium (Colace) can prevent constipation that might worsen fissures.
• Keep the area clean by gently washing with warm water (no soap) after bowel movements and patting dry.
• Avoid scratching, use unscented toilet paper, wear loose cotton underwear, and increase fiber and water intake to soften stools. However, according to the most recent study 1, calcium channel blockers (CCBs) such as diltiazem or nifedipine may be more effective than glyceryl trinitrate and have less risk of headache and hypotension, with healing rates ranging from 65 to 95%. If symptoms persist beyond 2-3 weeks, worsen, or if you experience bleeding, see a healthcare provider as prescription treatments may be necessary.

From the FDA Drug Label

Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... temporarily relieves external anal and genital itching For chronic anal itching at night from anal fissures, you can try applying hydrocortisone (TOP) to the affected area not more than 3 to 4 times daily 2. This may help temporarily relieve external anal itching 2.

• Clean the affected area with mild soap and warm water before applying the cream.
• Gently dry the area by patting or blotting with toilet tissue or a soft cloth before applying.
• If you are under 12 years of age, ask a doctor before using this product 2.

From the Research

Treatment Options for Chronic Anal Itching at Night from Anal Fissures

• Over-the-counter treatments for chronic anal itching at night from anal fissures are limited, but some options can be considered:
  • Topical nitrates, such as glyceryl trinitrate, can help relax the anal sphincter and increase blood flow to the area, promoting healing 3
  • Topical calcium channel blockers, such as diltiazem, can also help relax the anal sphincter and reduce pain and itching 4, 5
• It is essential to address the underlying cause of the anal fissure, such as constipation or diarrhea, to prevent further irritation and promote healing 6, 3
• Sitz baths and dietary changes, such as increasing fiber intake, can also help alleviate symptoms and promote healing 3
• In some cases, over-the-counter creams or ointments may not be effective, and further treatment, such as surgical options or other medical interventions, may be necessary 6, 3

Managing Pruritus Ani

• Pruritus ani, or anal itching, can be a symptom of anal fissures, and managing this symptom is crucial for overall treatment 7
• Keeping a journal to track symptoms, foods, and household chemicals used can help identify potential irritants and triggers 7
• Hygiene and diet modification, as well as stool-bulking agents, can help alleviate symptoms and promote healing 7
• In some cases, topical steroids, barrier creams, or other medical interventions may be necessary to manage pruritus ani 7