[19M] Experiencing anal itching, bleeding, and pain

Patient Description

A 19-year-old male reports persistent anal itching for over three weeks, with episodes lasting from 5-10 minutes to an hour or two, occurring both day and night. The patient experiences bleeding when wiping post-defecation and pain when scratching the affected area. There is noted swelling around the anus, and the patient mentions a decrease in bowel movement frequency, with associated pain during defecation. The patient has been using 0.5% hydrocortisone cream twice daily, which provides some relief, and takes daily immune gummies. No known drug allergies, no recent changes in medication, and no other systemic symptoms such as fever or significant weight loss have been reported.

Arora's Assessment

What might be happening

Based on the information you've provided, the following conditions could be causing your symptoms:

Hemorrhoids: These are swollen blood vessels in the rectum or anus that can be itchy, uncomfortable, and cause bleeding during bowel movements. Over-the-counter treatments like creams or suppositories can help, but if symptoms persist, you should see a doctor.
- Treatment typically involves lifestyle changes, such as increasing fiber and fluid intake, and over-the-counter remedies. More severe cases might require medical procedures.
Anal fissures: These are small tears in the thin, moist tissue that lines the anus. They can cause itching, pain, and bleeding during bowel movements.
- Treatment typically involves lifestyle changes, such as increasing fiber and fluid intake, and using over-the-counter remedies to help relax the anal muscle. More severe cases might require medical procedures.
Pinworms: These are small, thin, white worms that can live in the colon and rectum of humans. They're most common in children, but anyone can get them. The most common symptom is intense itching in the anal area, particularly at night.
- Treatment typically involves medication to kill the worms and thorough cleaning of your home to prevent re-infection.

Please remember that this is not a definitive diagnosis. You should see a healthcare provider for an accurate diagnosis and treatment.

What you can do

Continue using the hydrocortisone cream as directed, but don't use it for more than a week without consulting a doctor.
Try not to scratch the area, as this can make the symptoms worse.
Keep the anal area clean and dry. After a bowel movement, clean the area gently with water and pat dry.
Increase your fiber intake to help soften your stools and make them easier to pass.
Drink plenty of fluids to help prevent constipation.
Try over-the-counter remedies for hemorrhoids, such as witch hazel or a sitz bath.

What you should look out for

If your symptoms don't improve after a week of home treatment, or if they get worse, you should see a healthcare provider. Also, seek medical attention if you notice any of the following: